Testosterone deficiency (TD) is an underdiagnosed condition that significantly impacts men’s quality of life, mental health, and professional relationships. Dr David Edwards, a specialist in men’s health and Chair of the Primary Care Testosterone Advisory Group, highlights a recent study published in the Journal of Men’s Health and the integral role of pharmacists in supporting men when there could be signs of TD.

Despite its effects on well-being, TD often remains untreated due to a lack of awareness and the stigma surrounding the condition.¹ A recent qualitative study, commissioned and paid for by Besins Healthcare UK, sheds light on the barriers men face in seeking help for TD. It found that men and healthcare providers can encounter obstacles at every stage of the care pathway, from symptom recognition to treatment initiation. The findings emphasise the need for improved awareness and standardisation in the diagnosis and management of TD. Pharmacists and dispensers can play a key role, following relevant education about testosterone and consultation skills, in initiating the care pathway.

The study, Barriers to Diagnosis and Accessing Effective Treatment and Support for Testosterone Deficiency,¹ involved interviews with 20 men aged 45-62, 30 GPs and 10 endocrinologists across the UK. The interviews revealed significant challenges in diagnosing and treating TD, largely due to a lack of knowledge about the condition and its symptoms

The men interviewed for the study described a slow onset of symptoms like fatigue, loss of energy, and muscle weakness, which they often attributed to aging or work stress. Few men connected these symptoms to TD, and even fewer were aware of the link between TD and sexual symptoms. Most only sought help when sexual problems began to strain their relationships.

The undiagnosed men managed their individual symptoms themselves through things like exercise, relaxation, tonics, energising supplements, vitamin supplements and purchasing oral PDE5 inhibitors from a pharmacy, usually online to avoid embarrassment.

The research found that a sense of stigma, embarrassment and “machismo” was a major factor preventing men from discussing their symptoms openly with GPs. Limited GP consultation time was a further barrier to meaningful conversations.

Many GPs were unaware of the full range of TD symptoms and may not think to check testosterone levels when presented with non-specific complaints such as low energy or mood swings. In cases where TD is suspected, GPs may hesitate to initiate treatment due to concerns about risks or uncertainty around testosterone assessment and monitoring. The study revealed that many GPs lacked confidence in managing TD and expressed a need for improvements in standardisation of care in line with evidence-based guidelines⁵ to support diagnosis and treatment in primary care.

Pharmacists, as key primary care healthcare providers, can support both GP colleagues and patients who may be presenting with symptoms suggestive of, or risk factors for, TD by initiating this conversation to enable men to receive the right support.

TD is more common in middle-aged and older men, particularly those with obesity² and other health conditions. An estimated 40% of men with type 2 diabetes (TD2M) will experience symptomatic TD.³

Men presenting with erectile dysfunction or loss of spontaneous erections, or those with reduced sexual desire may also benefit from screening for TD.⁴ Men taking long-term opiate or other pain medications including co-codamol, antipsychotic or anticonvulsant medication are also at risk.⁵

Pharmacists and dispensers have an opportunity as frontline healthcare providers to confidentially and sensitively provide proactive support and education to men who may be at greater risk of TD.

• Consider adding a note inside the prescription bag, discreetly inviting the patient for a consultation about testosterone health. This gentle approach acts as a flag to the dispenser and opens the door to a conversation without putting the patient on the spot.
• Lean into the patient’s support network: partners can be powerful ambassadors, and some men might feel more comfortable with their partner in the consultation room.

“As your pharmacist, I want to make sure we’re looking at every aspect of your health. Around 40% of men with T2DM can have problems with low testosterone, which may explain some of the symptoms you may be experiencing such as tiredness and erectile dysfunction. There may be things that can be done to help.”

“With a higher BMI, some men can have problems with low testosterone. There may be things that can be done to help. Sometimes addressing hormonal issues can improve overall well-being. Would you like to explore that?”

“Given the symptoms you’ve described, such as fatigue and changes in muscularity, it could be worth exploring your testosterone levels. This is sometimes the issue, especially in men managing T2DM or a higher BMI. Have you discussed this with your GP?”

Despite evidence-based guidelines, many men with symptomatic TD are still undiagnosed and untreated.1 TD is an under recognised men’s health issue that impacts quality of life and long-term well-being.5 In addition, TD can be a factor in increased morbidity and all-cause mortality.5

The study by David and Charles highlights the need for greater awareness, better education of healthcare professionals, and more consistent care pathways to improve outcomes for men with TD. Alongside lifestyle and other interventions, testosterone replacement therapy may improve many sexual, psychological and physical signs and symptoms given time.5 Some symptoms and signs may improve over a matter of months, but others may take years, so it is important that the patient is regularly assessed and monitored by a healthcare professional with experience of such issues.

Educating both men and healthcare providers is key to improving the diagnosis and management of TD. Pharmacists can play a critical role in this process by helping men identify symptoms and supporting them to access the appropriate care. As more men become aware of the condition, pharmacists can serve as essential partners together with clinicians in ensuring diagnosis and creating a bespoke management plan.

Besins Healthcare UK has developed the ‘Stronger Voices’ campaign which aims to empower healthcare providers, men and their partners to recognise the symptoms of TD and ensure men displaying symptoms suggestive of TD seek advice from their healthcare provider. Resources like the Androgen Deficiency in Aging Males (ADAM) questionnaire are available on their educational website, providing tools to help men initiate conversations with healthcare providers. The public facing disease education awareness website created and funded by Besins Healthcare UK can be accessed at www.strongervoices.co.uk.

Besins Healthcare UK is a specialist pharmaceutical company with a strong family heritage that specialises in producing the highest quality hormone therapies for the patients that need them. Besins hormone replacement therapies are trusted by patients and physicians worldwide for conditions including menopause, endometriosis, reproductive health, and TD.