BMJ Analysis Warns Fast-Growing Private Testosterone Prescribing Could Land on the NHS

The gel trend predates the analysis. The Pharmaceutical Journal reported in 2023 that women aged 50 and over receiving NHS testosterone gel rose from 429 in November 2015 to 4,675 in November 2022, and that no testosterone product is licensed for women in the UK.

Who ends up carrying the follow-up?

Official guidance puts responsibility on the private clinician who starts treatment unless an NHS GP formally agrees to share care. In practice, the authors say, patients often return to their GP informally for blood tests or to manage side effects, so the NHS takes on the work without any agreement. They flag longer-term heart and kidney problems that need ongoing monitoring, and note that professional societies use different thresholds for treating men, so GPs may meet patients who began therapy under a more permissive private cut-off.

Up to a fifth of men over 50 may report symptoms of deficiency, the authors write, yet fewer than 1 percent receive NHS treatment, which helps explain why demand has gone private.

What do the authors want changed?

They want national data on private prescribing and a reporting framework for private prescribers and dispensing pharmacies that captures the reason for treatment, patient numbers, monitoring and transfers of care.

This article is reporting, not medical advice. Falling testosterone and libido are part of normal ageing, and anyone worried about symptoms, or thinking about starting or stopping testosterone, should talk to a clinician who knows their history, including any heart, blood or fertility concerns. The analysis is a viewpoint built on prescribing data, not a trial, and the evidence needed to settle the question is national data on who is treated and what happens to them.