Testosterone prescribing practices in cisgender and transgender populations in regional Australia — ASN Events
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Testosterone prescribing practices in cisgender and transgender populations in regional Australia (#355)

Akash Konantambigi 1 , Tameem Quader 1 , Aatif Syed 1 , Majid Al-Abbood 2 , Aongus O'Brolchain 2 , Usman Malabu 3 , Gaurav Puri 4 , Vasant Shenoy 3 , Harshal Deshmukh 1 2
  1. James Cook University, Mackay, QLD, Australia
  2. Faculty of Health Sciences and Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia
  3. James Cook University, Townsville, QLD, Australia
  4. Logan Hospital, Logan Endocrine and Diabetes Service, Logan, QLD, Australia

Aims: Testosterone replacement therapy (TRT) prescribing has increased internationally, however there exists limited data examining prescribing patterns in regional cohorts. This study aims to explore testosterone prescribing practices across diverse populations including cisgender men and women and transgender men in regional contexts, and highlight areas of discordance from established guidelines.

Methods: We conducted a retrospective observational study in a large, regional hospital in North Queensland, evaluating outpatient testosterone prescriptions between January 2014 and December 2024. Demographic and clinical data were extracted from electronic medical records. Patients were stratified by sex/gender category and clinical indication. In cisgender men, baseline characteristics were compared according to the presence or absence of established pituitary or testicular dysfunction.

Results: A total of 103 individuals received TRT, including 69 cisgender men, 29 transgender men, and 5 cisgender women. Among cisgender men, 29 had established pituitary or testicular dysfunction and 40 did not. Injectable formulations were most commonly prescribed overall (56.3%), followed by transdermal gels (33.0%). 18.5% of testosterone prescriptions were non-Pharmaceutical Benefit Scheme (PBS) prescriptions and monitoring gaps were most evident in transgender men, with limited baseline and follow-up biochemical data. Men with established dysfunction were younger (55.0 vs 61.5 years, p = 0.027), while hypertension was more common in men without established dysfunction (65.0% vs 24.1%, p = 0.002). Higher BMI was associated with lower baseline testosterone in men with established dysfunction (Spearman’s ρ = −0.545, p = 0.007; n = 23).

Conclusion: In this regional Australian cohort, TRT prescribing was largely specialist-led, however gaps remained in confirmatory biochemical testing and longitudinal monitoring. Standardised, guideline-integrated pathways are needed to support safe and equitable testosterone prescribing in regional settings.