A large Epic Research review raises questions about repeat testing before testosterone prescriptions. Learn how the findings fit diagnostic guidance.
On October 27, 2026, Epic Research published an analysis of testosterone prescribing that puts repeat blood testing in focus. The review covered 300,277 men with new prescriptions. As reported by Men’s Journal through Yahoo Health the following day, 21.8% of men starting treatment in the first half of 2026 had two low results recorded on separate days during the preceding six months.
The finding concerns testing documented before a prescription. For readers considering testosterone, it raises a useful question: how does that record match the diagnostic process described in clinical guidance? That process brings symptoms or signs together with repeated low testosterone measurements.
Epic Research examined health records for men who received a new testosterone prescription between January 2017 and June 2026. This was an observational analysis of existing records rather than an experiment that assigned treatment. The population was defined by a prescribing event, not by an initial low blood test.
According to the Men’s Journal report, the records came from Cosmos, Epic’s health-record database. Researchers looked backward from the prescription to identify which testosterone measurements were on file.
Two different look-back periods matter. The measure for at least one testosterone test covered the preceding year. The measure for two low results on separate days covered the preceding six months.
Those measures address related but different questions. Having a test recorded shows that testing occurred. Having two low results recorded shows that low values were documented more than once.
Epic used two low results on separate days as a proxy for the repeat-testing component of diagnostic guidance. This gave researchers a record-based way to examine one feature of the assessment before treatment.
Epic Research reported these findings for men starting testosterone in the first half of 2026:
A test being present is not the same finding as repeated low results being present. The second measure is closer to the laboratory pattern described in diagnostic guidance.
According to the report, the share with at least one recorded test rose from 72.3% in 2017 to 82.6% in the first half of 2026. The share with two or more tests on separate days rose from 28.5% to 40.8% over those periods.
The trend for two low results was different. That share was 16.9% in 2017 and 22.8% in 2024. It was 21.8% in the first half of 2026.
These categories should remain separate. Two or more tests do not necessarily mean two low results. More testing overall also does not establish a steadily increasing share of men with repeated low results before a prescription.
Primary care physicians wrote 57.6% of prescriptions in the analysis. Urologists wrote 17.4% and endocrinologists wrote 11%, according to the report.
The findings therefore concern conversations across several care settings. Repeat-testing documentation is not a question confined to one specialty.
The 21.8% figure is not the share of prescriptions proved appropriate. Nor does the remainder represent prescriptions proved inappropriate. The analysis assessed a proxy for part of an evaluation rather than reviewing every element of each clinical decision.
Epic’s analysis could not establish whether blood samples were taken in the morning or whether the men had compatible symptoms. Both are part of the clinical criteria discussed in the report. Counting low readings on separate days therefore did not establish whether the complete diagnostic standard had been met.
The records also do not settle whether clinicians had relevant information outside the analyzed system. The findings do not show whether treatment benefited an individual patient or whether every prescription was medically justified.
There are limits to applying these results broadly. Men receiving testosterone through direct-to-consumer services may not be represented. The size of the underlying database does not make this group representative of everyone prescribed testosterone.
Finally, the analysis was not published in a peer-reviewed journal. The news report says two teams independently ran it and obtained similar results. Each team included a clinician and a research scientist.
That independent check is useful context, but it is not a substitute for peer review.
The clinical framework predates this record review. As described in the Men’s Journal report, the American Urological Association’s approach combines compatible symptoms or signs with two early-morning total testosterone results below 300 ng/dL.
The European Association of Urology likewise calls for compatible symptoms and low morning testosterone on at least two occasions. Its guidance includes a confirmatory measurement before testosterone therapy.
These recommendations answer a diagnostic question: what evidence should support identifying testosterone deficiency before treatment? Epic’s analysis asks a question about the prescribing process: how often were two low results documented before a new prescription? Reading the study alongside the guidance keeps those questions separate.
Both parts of the assessment matter. Symptoms or signs provide the clinical context. Repeated low measurements provide the laboratory evidence described in the guidance. Neither symptoms alone nor a single result supplies that combined picture.
The update therefore does not introduce a new diagnostic rule. It draws attention to how an existing expectation appears in prescribing records. Its practical value is in making the reasoning behind a prescription easier to discuss.
Related reading on assessment beyond a single hormone number offers broader context. The distinction between sexual symptoms and a diagnosis is also central to interpreting hormone-related concerns.
The news report also places prescribing within a changing safety discussion. It says the FDA removed a boxed cardiovascular-risk warning from testosterone products in February 2025 and added a warning about increased blood pressure.
The report summarizes TRAVERSE, a 2023 trial, as finding no increase in major cardiovascular events among men with low testosterone and increased cardiac risk. That was a different study with a different question from the prescribing-record analysis.
Safety evidence and diagnostic evidence have different roles. A finding about treatment risks in a studied population does not establish whether a particular person meets diagnostic criteria. Safety research is not a replacement for the assessment described in guidelines.
For someone considering testosterone, the most useful response is to ask about the basis for the decision. A conversation can focus on the connection between symptoms and repeated measurements rather than on whether a single number looks low.
The evidence supports questions such as:
These are prompts for a qualified clinician, not a way to diagnose yourself or decide on treatment. They keep the discussion focused on the same elements named in the guidance.
It is also reasonable to ask which results informed the decision and how they were interpreted together. This is a request for clinical context rather than a request for a prescription. Knowing that some testing occurred is a starting point for that discussion.
Someone who already has a prescription can bring questions about the original assessment to their clinician. This analysis alone is not a reason to change a personal treatment plan. Individual decisions belong in qualified care.
A concern about sexual wellbeing also deserves a clear description rather than an assumed explanation. Describing the change that prompted the appointment gives the clinician a starting point for discussing relevant symptoms or signs. The aim is to understand the reasoning behind the assessment rather than prove that one explanation must fit.
For readers whose main concern is changing desire, further context on the limited role of blood tests in a broader assessment may help frame questions for care. A conversation about a concern does not need to begin with a settled diagnosis.
Clearer questions deserve a place in every conversation about testosterone.
Men and the clinicians reviewing their testosterone results make personal care decisions; Sexential helps clarify the evidence without directing those decisions. The publication addresses hormones and sexual function for readers aged 35 to 65 by connecting biology with everyday concerns about confidence and intimacy.
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