The Testosterone Project (TTP), the independent nonprofit advancing evidence-based testosterone education, policy, and access, today released “The Hidden Cost of Missed Testosterone Deficiency,” a policy evidence brief on the clinical and economic burden of undiagnosed testosterone deficiency in American men.

The brief’s central finding: a low-cost testosterone test may be the missing first step for symptomatic, at-risk men. Testosterone deficiency among U.S. men ages 45 to 74 could be associated with $190 billion to $525 billion in inflation-adjusted direct health care expenditures over 20 years, with approximately $8.4 billion attributable in the first year alone.

Key findings include:

  • Economic burden: Men with newly diagnosed hypogonadism incurred approximately $2,821 more in annual direct medical spending than matched controls. Privately insured employees with hypogonadism carry roughly $4,869 more per year in combined direct and workforce costs.

  • Diabetes prevention: Against a backdrop of 115.2 million U.S. adults with prediabetes and $412.9 billion in annual diabetes cost, the T4DM trial found that testosterone plus lifestyle intervention reduced the two-year diabetes endpoint from 21% to 12% among selected high-risk men, a number needed to treat of approximately 11. Scaled to 1 million similar men, that implies roughly 90,000 fewer diabetes endpoints and approximately $1.1 billion in delayed direct-cost exposure.

  • Anemia correction: In the TRAVERSE anemia substudy, testosterone corrected anemia in 41% of anemic hypogonadal men versus 28% on placebo at six months.

  • Cardiovascular safety: The TRAVERSE trial (5,246 men) demonstrated noninferiority for major adverse cardiovascular events, addressing the safety concern that had limited treatment discussion for more than a decade.

The brief argues for targeted case-finding, not universal screening or treatment: routine evaluation for symptomatic men, repeat biochemical confirmation before diagnosis, and therapy reserved for confirmed deficiency tied to a specific clinical goal. With treatment discontinuation rates between 30% and 62%, the brief emphasizes that the policy problem extends beyond prescribing to access, affordability, monitoring, and persistence.

“Testosterone deficiency hides beneath conditions that already dominate men’s health care spending: diabetes, metabolic syndrome, obesity, unexplained anemia, fatigue, and depressed mood. The men with the strongest case for evaluation are often the ones who never get tested,” said Dr. Mohit Khera, professor of urology at Baylor College of Medicine and TTP spokesperson. “This is about finding the men who are being missed.”

The brief arrives as regulatory momentum accelerates. In June 2026, HHS announced that the FDA was requesting class-wide revisions to testosterone therapy prescribing information. Illinois recently removed testosterone from its Prescription Drug Monitoring Program. In July 2026, the Department of Defense announced that it will offer testosterone deficiency screening for service members.

TTP advocates for three policy reforms: descheduling testosterone from Schedule III, FDA-approved testosterone formulations for women, and formal recognition of testosterone deficiency as a medical condition.

The full report is available here.

About The Testosterone Project

The Testosterone Project is an independent nonprofit advancing evidence-based testosterone education, science-aligned policy, and equitable access for women and men. TTP is governed by an independent Board of Directors with clinical integrity guided by its Medical Advisory Board. The organization does not provide clinical services or endorse any treatment or product. Learn more at https://testosteroneproject.com/.

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