Only 1 in 5 Men Starting Testosterone Had the Two Low Blood Tests Guidelines Call For, Study of 300,000 Finds

Most men who start testosterone get a blood test first. Only about 1 in 5 get the two low results that urology guidelines call for.

Epic Research looked at the health records of 300,277 men who were given a new testosterone prescription between January 2017 and June 2026, and published the numbers on Oct. 27.

In the first half of this year, 82.6% of the men starting testosterone had their levels checked at some point in the year before. Just 21.8% had two low readings in the six months before the prescription.

What Counts as Low T

The American Urological Association says low testosterone means a total level that stays under 300 ng/dL on at least two early-morning blood tests, along with symptoms like low libido, fatigue or erectile dysfunction.

The Epic researchers used two low results on separate days as their stand-in for that rule. In 2017, 16.9% of men starting testosterone met it. It went up to 22.8% in 2024 and was at 21.8% in the first half of 2026.

Testing overall has gone up. In 2017, 72.3% of men had at least one test before starting, and 28.5% had two or more on separate days. In the first half of 2026, those numbers were 82.6% and 40.8%.

Most Prescriptions Come From Primary Care

Primary care doctors wrote 57.6% of the prescriptions. Urologists wrote 17.4% and endocrinologists 11%.

Endocrinologists’ patients were the most likely to have a low reading on file before starting, at 69.6%. It was 63.5% for primary care and 60% for urology.

Age made a small difference, too. Among men in their 30s, 66.2% had at least one low reading first. For men 75 and older, it was 58.8%.

Prescriptions Are Up Again

Testosterone prescribing dropped after 2015, when the FDA added a warning about a possible higher risk of heart attack and stroke. It started going back up around 2022.

In a July analysis, Epic Research found the share of men with a testosterone prescription fell from 0.83% in 2013 to 0.64% in 2021, then climbed to 0.93% in 2025.

In 2023, a large trial called TRAVERSE found testosterone didn’t raise the risk of major heart problems in men with low testosterone and higher cardiac risk. In February 2025, the FDA took the boxed cardiovascular warning off testosterone products and added a warning about higher blood pressure.

One Test Isn’t a Diagnosis

Under the urology guideline, one low reading isn’t enough. You need two early-morning results under 300 ng/dL, plus symptoms. If you’re thinking about testosterone and you’ve only had one test, that’s worth bringing up with your doctor.

What the Numbers Don’t Show

This is a data analysis from Epic Research, not a study in a peer-reviewed journal. Two teams, each with a clinician and a research scientist, ran it separately and got similar results.

The researchers could only see lab results in the records. They couldn’t tell if a test was done in the morning or whether the patient had symptoms. Men who got testosterone from direct-to-consumer services probably aren’t in the data, they said.

The records come from Cosmos, Epic’s database of more than 310 million patient records from health systems in all 50 states, plus Canada, Lebanon and Saudi Arabia.

This story was originally published by Men’s Journal on Oct 28, 2026, where it first appeared in the News section. Add Men’s Journal as a Preferred Source by clicking here.