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The rapid expansion of private testosterone prescribing risks extending treatment beyond men with clearly defined need to people with nonspecific symptoms and borderline test results, for whom the balance of benefit and long-term risk is less certain, warn experts in The BMJ.

Stephen Atkin and Eric Kilpatrick argue that the complexity of care is seldom covered in commercial testing, so managing the longer-term risks of testosterone therapy will likely fall to the NHS.

In 2024, the U.K. testosterone replacement market was valued at around $205 million and is projected to reach $365 million by 2032. NHS figures show community dispensing increased by 52% from 2020/21 to 2024/25 alongside a tenfold rise in testosterone gel prescriptions for women aged 50 and older in England between 2015 and 2022.

Private prescriptions are not recorded nationally, so the scale of private testosterone provision is unknown, explain the authors. However, several indicators suggest rapid growth: a proliferation of private and online clinics, subscription pricing of £100–£375 a month (to cover ongoing monitoring, remote consultations and home-delivered medication), and heavy marketing via social media, influencers and outdoor advertising.

The market is potentially large, they add. Declining testosterone and libido are natural aspects of aging, and up to a fifth of men over 50 may report deficiency symptoms, although under 1% receive treatment from the NHS.

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