Improving the recognition, diagnosis, and management of male testosterone deficiency across the NHS: a Delphi consensus
Foster, Jeff Wright, Patrick Rao, Preethi Mohan Edwards, David Greenwood, Michelle Wayman, Richard Singh, Inderjit Fortes-Mayer, Gail Barber, Tom
Foster, Jeff
Wright, Patrick
Rao, Preethi Mohan
Edwards, David
Greenwood, Michelle
Wayman, Richard
Singh, Inderjit
Fortes-Mayer, Gail
Barber, Tom
Affiliation
Manual Men's Health Clinic; Croft Medical Centre; NHS Northeast and North Cumbria; Barnsley Hospital NHS Foundation Trust; Chipping Norton Health Centre; Imperial College Healthcare NHS Trust; The Leger Clinic; University Hospitals Birmingham NHS Foundation Trust; University Hospital Coventry and Warwickshire NHS Trust
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Publication date
2025-06-26
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Abstract
Introduction: Testosterone deficiency (TD) is a clinical and biochemical syndrome marked by the reduced production of testosterone. TD is associated with a decrease in quality of life, alongside increasing the risks of various comorbidities, including cardiovascular disease and type 2 diabetes. A lack of guidance concerning TD for healthcare professionals (HCPs) exists, leading to many men going undiagnosed and a broad variation in care.
Aim: Establish the views of UK HCPs working in male TD and develop recommendations that support improved diagnosis and management of TD across the NHS.
Methods: Using a modified Delphi method, a panel of experts developed 43 Likert-scale statements across 5 main domains. Statements were used to develop an online survey that was distributed via a "snowball sampling" approach through Microsoft Forms. The survey was distributed to HCPs working within male TD throughout the United Kingdom. The threshold for consensus was set at 75%.
Results: Fifty-five responses from UK HCPs were analyzed. Of the 43 statements, 30/43 reached very strong agreement (90%) and 13/43 attained strong agreement (<90 and 75%). Consequently, the authors developed 6 recommendations to improve the recognition, diagnosis, and management of male TD in the NHS.
Conclusion: The strength of agreement demonstrates that the respondents acknowledge that awareness of TD, along with its health and cost impacts, among UK HCPs is lacking. Respondents are clear on where the limitations in care currently exist. The proposed set of recommendations provides a framework to help improve the diagnosis and management of testosterone deficiency.
Citation
Foster J, Wright P, Rao PM, Edwards D, Greenwood M, Wayman R, Singh I, Fortes-Mayer G, Barber T. Improving the recognition, diagnosis, and management of male testosterone deficiency across the NHS: a Delphi consensus. J Sex Med. 2025 Aug 4;22(8):1390-1398. doi: 10.1093/jsxmed/qdaf130.
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Article