The scale of the market illustrates how quickly this sector has grown. In 2024, the UK testosterone replacement market was valued at around 205 million dollars, with projections suggesting it could reach 365 million dollars by 2032. Official NHS figures show that community dispensing of testosterone increased by 52 percent between 2020/21 and 2024/25. Alongside this, there was a ten-fold rise in testosterone gel prescriptions for women aged 50 and older in England between 2015 and 2022, reflecting growing off-label use of the hormone for menopausal symptoms.

One of the central problems, the authors explain, is that private prescriptions are not recorded in any national system, so the true scale of private testosterone provision is unknown. Nevertheless, several indicators point to rapid growth. There has been a proliferation of private and online clinics offering testosterone services, many built around subscription pricing models ranging from 100 to 375 pounds a month. These subscriptions typically cover ongoing monitoring, remote consultations, and home-delivered medication. Heavy marketing through social media platforms, influencers, and outdoor advertising has amplified demand, targeting men who may simply be experiencing the natural effects of ageing.

The potential market is substantial. Declining testosterone levels and reduced libido are natural aspects of ageing, and up to a fifth of men over 50 may report symptoms consistent with deficiency. Yet fewer than 1 percent of these men receive treatment through the NHS, where prescribing is reserved for those with confirmed clinical need. This gap between symptom prevalence and NHS treatment rates represents the commercial opportunity that private providers are increasingly moving to fill, often with diagnostic and monitoring standards that differ from those applied in conventional medical practice.

Diagnosing genuine testosterone deficiency is not a simple matter. It requires time, careful clinical assessment, and repeated testing to confirm consistently low levels alongside characteristic symptoms. The authors note that it is not established how consistently private providers follow this rigorous process. They warn that rapid-access subscription models built around marketing to non-specific symptoms are unsuitable to handle the complexity of the diagnostic process, and that such models risk unnecessary lifelong treatment and a resulting NHS monitoring burden. Fatigue, low mood, and reduced libido, the symptoms most commonly marketed in advertising campaigns, can have many causes and do not by themselves justify hormone replacement.

Another layer of complexity arises from the absence of a single unified standard for treatment. For testosterone therapy in men, clinicians rely on professional society guidance that uses differing thresholds for diagnosis and treatment initiation. This inconsistency means that NHS clinicians may encounter patients who have already started taking testosterone prescribed against a more permissive private threshold, creating difficult decisions about whether to continue, adjust, or withdraw treatment that was initiated outside NHS pathways. The lack of harmonised criteria complicates continuity of care and makes it harder to evaluate whether individual patients are receiving appropriate therapy.

The long-term risks of testosterone therapy add further weight to these concerns. Treatment can be associated with heart and kidney problems that require ongoing monitoring, and the authors argue that this follow-up work will likely fall to the NHS regardless of where treatment began. There are also growing concerns about private off-label testosterone prescribing for women, mainly for low libido associated with menopause. While testosterone can be a valuable treatment for carefully selected patients of both sexes, the expansion of commercial prescribing raises questions about whether selection criteria and safety monitoring are being applied consistently across the private sector.

Responsibility for care is another flashpoint. As stated in official guidance, the responsibility of care rests exclusively with any private sector clinician who initiates treatment, unless an NHS GP formally agrees to a shared care arrangement. In practice, however, patients who started treatment privately may return to their GP informally for blood tests or help with managing side effects. This informal transfer creates a situation in which the NHS absorbs the workload without any formal agreement, shouldering the clinical and administrative consequences of prescribing decisions made elsewhere. GPs are left managing the downstream effects of treatment they did not initiate, often without complete records of dosing, monitoring history, or the original diagnostic rationale.

The authors stress that testosterone replacement remains a valuable treatment for carefully selected patients, and their criticism is not of the therapy itself but of the commercial structures growing around it. They call for national data to close the evidence gap on private prescribing of testosterone, arguing that without systematic information, neither regulators nor the NHS can accurately assess the scale of the issue or its impact on patient safety and health service resources. Reliable data would allow policymakers to distinguish between appropriate private provision and practices that generate avoidable harm.

To address the gap, Atkin and Kilpatrick propose a concrete solution. A reporting framework for private prescribers and dispensing pharmacies could capture indications, patient numbers, monitoring, and transfers of care, they write. Such a framework would lead to transparent prescribing and demonstrable adherence to evidence-based care, protecting patients while preserving access to effective treatment. As the private testosterone market continues its projected growth toward 365 million dollars by 2032, the authors argue that establishing robust oversight now, before the sector expands further, is essential to prevent a widening divide between commercial incentives and clinical standards, and to ensure the NHS is not left carrying the consequences of a trade it neither authorised nor recorded.

Subject of Research: Commercial and private testosterone prescribing in the UK and its implications for the NHS

Article Title: Rise in private testosterone prescribing risks overtreatment and more strain on the NHS

Article References: Rise in private testosterone prescribing risks overtreatment and more strain on the NHS. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: testosterone, testosterone replacement therapy, private prescribing, NHS, The BMJ, hypogonadism, menopause, off-label prescribing, health policy, patient safety, hormone therapy, UK healthcare