A BMJ commentary raises concerns about private TRT in the UK. Read the evidence on diagnosis, monitoring and NHS shared-care responsibilities.
On October 14, 2026, Medical Xpress reported on a commentary published in The BMJ by Stephen Atkin and Eric Kilpatrick about private and online testosterone prescribing in the UK. The authors warned that treatment could reach men with nonspecific symptoms or borderline results.
This article is for informational purposes only and is not medical advice. Personal decisions about testosterone treatment require a qualified clinician.
Atkin and Kilpatrick's central concern is that rapid access to testosterone replacement therapy, or TRT, could move treatment beyond men with a well-supported diagnosis. They argue that nonspecific symptoms or borderline results may become the basis for long-term treatment where the balance of benefit and risk is less certain.
That is not an argument against TRT as a whole. The authors describe testosterone replacement as valuable for carefully selected patients. Their concern is how treatment decisions are made and how care continues once prescribing has begun.
The commentary cites NHS figures showing that community testosterone dispensing increased 52% between 2020/21 and 2024/25. This is one of the signals the authors use to frame their concern about prescribing activity.
It also reports that the UK testosterone-replacement market was estimated at about $205 million in 2024, with a projection of $365 million by 2032. Those figures provide commercial context for the debate about access and oversight.
The authors describe private and online clinics using social media, influencers and outdoor advertising. They also discuss subscription services that include monitoring, remote consultations and home-delivered medication. Their argument is that the clinical responsibilities behind these services need as much attention as the ease of obtaining treatment.
The European Association of Urology (EAU) guideline provides a clinical reference for assessing that issue. It calls for symptoms or signs consistent with hypogonadism alongside consistently low morning testosterone. Low results should be confirmed on at least two separate occasions before treatment.
The key point is the combination of clinical features and repeat biochemical evidence. Symptoms alone or a single result do not establish the diagnosis described in the guideline. That is why repeat testosterone measurements need clinical context, rather than being read as isolated numbers.
According to the commentary, the private clinician who starts treatment remains responsible for care unless an NHS GP formally agrees to shared care. An expectation that the NHS will provide follow-up is different from an agreed arrangement.
Atkin and Kilpatrick warn that patients may nevertheless turn to their NHS GP for tests or help with side effects. In their assessment, this could shift work to the NHS without a formal care agreement. The question is not simply where treatment starts but who remains responsible afterward.
The proposed framework would involve private prescribers and dispensing pharmacies reporting:
These categories separate access to medication from the evidence and responsibilities supporting it. A record of why treatment began answers a different question from a record of who is reviewing care. Reporting both would make the treatment pathway easier to examine.
The authors' stated aim is greater transparency and evidence-based care while preserving access for patients who need TRT. This is a proposal for accountability, not a call to remove appropriate treatment.
Private testosterone prescriptions are not recorded nationally, so the scale of private provision is unknown. The commentary also says it is not established how consistently private providers follow diagnostic processes. It does not measure how often inappropriate prescribing or inadequate follow-up occurs.
The NHS dispensing increase is not a measure of private prescribing. Nor do market values count patients or prescriptions. The market figures are estimates, and the figure for 2032 is a projection rather than an observed outcome.
This is a commentary rather than a clinical trial reporting new physiological results. The authors identify potential longer-term heart and kidney problems as reasons for monitoring, but they do not quantify those risks. Their concern about an NHS workload burden is likewise an assessment rather than a measured effect.
Professional societies also use different diagnostic thresholds, as the commentary notes. The EAU guideline offers a useful reference but does not establish a single uniform threshold used across UK services. A mismatch between private and NHS criteria therefore needs clinical explanation rather than an assumption that either setting is automatically correct.
Taken together, these limits mean the warning should not be read as proof that private care is inherently inappropriate. The issue is whether assessment and follow-up are evidence-based and clearly documented.
For men researching TRT, the practical value of the commentary is a clearer set of questions for a qualified clinician. Those questions concern the basis for treatment and the plan for ongoing care. They are not a substitute for an individual medical assessment.
A service description can say that monitoring is included without settling every question about how care will be coordinated. The relevant discussion is about the actual arrangement: which clinician is accountable and how any transfer will be agreed. The following topics reflect the issues raised by the commentary and the EAU guidance.
The bottom line is not an immediate change to TRT treatment or a new diagnostic rule. The commentary supports applying established assessment standards and making responsibility for monitoring explicit. Decisions about starting, continuing or changing an individual man's treatment remain with a qualified treating clinician.
Private TRT involves more than access to medication; the evidence behind treatment and the responsibility for ongoing monitoring also matter. Testostra helps men make sense of TRT evidence, risks and monitoring through clear explanations that distinguish established guidance from emerging research without offering personal diagnoses or directing treatment.
Testostra follows testosterone research, clinical guidance and emerging evidence without turning general information into personal treatment advice.
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