Experts call for national diabetes guidelines to include routine testing for testosterone deficiency in men

Experts call for national diabetes guidelines to include routine testing for testosterone deficiency in men

New UK consensus paper urges action to improve testosterone deficiency (TD) diagnosis and standardisation across the NHS

• Experts call for routine testosterone testing in men with type 2 diabetes and “red-flag” symptoms
• Establishing National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines could improve the recognition and management of TD
• Improving TD care pathways supports NHS shift from treatment to prevention

28 July 2025 – A group of men’s health experts have published a new UK consensus study on testosterone deficiency (TD), initiated and funded by Besins Healthcare UK, calling for the implementation of 4 key recommendations including the routine testing in clinically at-risk men and clearer national National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) diabetes guidance to support diagnosis and management.

The paper, Improving the recognition, diagnosis, and management of male testosterone deficiency across the NHS¹, which was published in The Journal of Sexual Medicine, reflects strong agreement among more than 50 clinicians that TD is under-recognised, under-tested, and under-treated – particularly in men with type 2 diabetes mellitus (T2DM). The authors say that integrating routine testosterone testing into national diabetes guidelines could improve outcomes and reduce long-term health costs and highlight a potential opportunity to prioritise treatment in this patient group.

Testosterone plays a vital role in men’s physical and mental health, including supporting cognitive ability, cardiac and muscle function, and the maintenance of regular sexual function. The estimated incidence of symptomatic TD in men aged 40-70 years varies between 2.1 and 5.7 per cent², however men with T2DM are at higher risk, with a potential estimated 40 per cent of men with T2DM experiencing symptomatic TD³. Despite this, awareness remains low among healthcare professionals, and current care pathways do not consistently support timely diagnosis and management, the study found.

The report makes four key recommendations to improve the understanding of testosterone deficiency within the NHS:¹

• National (e.g., NICE, SIGN) diabetes guidelines and professional resources should include routine TD testing, as per the BSSM 2023 guidance,⁴ for men with T2DM and established red flag symptoms or diagnoses.
• Unless contraindicated, once TD is diagnosed, testosterone replacement therapy should be considered in most patients and offered on a shared decision-making basis.
• A government-appointed Ambassador for Men’s Health should be introduced to drive advocacy for men with TD and reduce the impact of the condition.
• Early testing and intervention should be conducted in those with and without T2DM to reduce the health and cost impact of complications associated with TD.

Lead author and GP specialist in men’s health, Dr Jeff Foster, commented: “Since menopause and the importance of HRT have become more mainstream, we have started to see growing interest in the importance of male hormone health, and how the impact of low testosterone levels in men can adversely affect a range of health outcomes. In fact, we now know that men with testosterone deficiency (TD) not only experience a poorer quality of life but are also more likely to live shorter lives. Given the impact of TD on overall male health, it is vital that UK healthcare professionals are well-trained in understanding the symptoms, treatments, and implications of this condition. Drawing on our findings around HCP understanding of TD, this paper puts forward recommendations in four key areas to improve the recognition, diagnosis, and management of this increasingly acknowledged, expanding condition - supporting the ambition for the NHS to reach patients earlier and achieve better health outcomes.”

Dr Preethi Rao, consultant physician in endocrinology and diabetes, who co-authored the study, said: “Men with type 2 diabetes and metabolic syndrome are at much higher risk of testosterone deficiency, yet national care pathways do not reflect this. Actively screening for hypogonadism annually in this cohort should be a QOF target to detect and address the burden appropriately. Low testosterone has been linked to poorer glycaemic control, adverse metabolic outcomes and increased mortality in men with type 2 diabetes – a condition which disproportionately affects men from Black African, African Caribbean and South Asian backgrounds. We need to move from reactive to proactive care – testing earlier, diagnosing sooner, and intervening before complications develop.”

The authors note that these recommendations should be tested within a real-world environment for further refinement and to assess their general practicability in managing TD.      

ENDS

Notes to editors:

Disclosure 

• The study was initiated and funded by Besins Healthcare UK Limited. All authors received honoraria from Besins Healthcare while undertaking this study. Besins Healthcare commissioned Triducive Partners Limited to facilitate the project, analyse the responses to the consensus statements in line with the Delphi methodology, and write the draft manuscript, which they reviewed.

About Besins Healthcare UK

Besins Healthcare 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. Our hormone replacement therapies are trusted by patients and physicians worldwide for conditions including menopause, endometriosis, reproductive health and testosterone deficiency.

By working with passion and commitment, we develop and deliver hormone therapies to people with hormone imbalance in the UK and Ireland. Our aim is to empower those with life-impacting hormonal conditions, enabling them to lead fulfilling lives both now and in the future. Our patient-centric ethos is: “By your side, for life”. www.besinshealthcare.co.uk

For media enquiries, please contact:

Lex Rosenthal, Account Director, TALA

lex.rosenthal@teamtala.com

+44 (0) 7912611432

Heather Hopkin, Associate Director, TALA

heather.hopkin@teamtala.com

+44 (0) 7545536147

Roseann Ward, Head of Communications and External Affairs, Besins Healthcare UK

rward@besins-healthcare.com

+44 (0) 7990045449

References

¹ Foster J, et al. Improving the recognition, diagnosis, and management of male testosterone deficiency across the NHS: a Delphi consensus. The Journal of Sexual Medicine. 2025. Available from: https://doi.org/10.1093/jsxmed/qdaf130.

2 Salonia A, Boeri L, Capogrosso P, Corona G, Dinkelman-Smith M et al. EAU Guidelines on Sexual and Reproductive Health. European Association of Urology 2025. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2025.pdf.

3 Kapoor D. Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007. Doi: 10.2337/dc06-1426.

4 Hackett G, et al. The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice. The World Journal of Men’s Health. 2023. Available from: https://doi.org/10.5534/wjmh.221027.

MAT-BHUK-NP-0555     July 2025