Knowledge, confidence, and prescription gaps in testosterone replacement therapy among urologists

Hypogonadism is defined as an androgen deficiency characterized by low serum total testosterone (TT) concentrations. Reduced TT levels are associated with decreased libido, erectile dysfunction, loss of muscle mass, increased fat accumulation, fatigue, and other symptoms that significantly impair quality of life. According to the European Association of Urology, the incidence of hypogonadism ranges between 11.7 and 12.3 cases per 1000 individuals per year. Among men aged 40 to 79 years, the incidence of symptomatic hypogonadism varies between 2.1% and 5.7%.1 Testosterone replacement therapy (TRT) has been widely studied and recommended as the standard treatment for hypogonadism to restore physiological TT levels and alleviate associated symptoms. However, its use must be individualized and preceded by a comprehensive evaluation of potential risks and benefits. Following international societies’ endorsement and regulatory approval, TRT utilization has increased globally, reflecting a broader clinical acceptance of its role in men’s health management.2,3 Despite its growing relevance in clinical practice, knowledge and confidence regarding TRT among Mexican urologists remain insufficiently explored. While prior literature has largely focused on patient awareness, misconceptions, and perceived barriers to care, and clinical guidelines such as those from the American Urological Association emphasize evidence-based evaluation and management of testosterone deficiency, there is limited real-world data assessing how closely practicing urologists align with these recommendations in daily practice. Mexico, as one of the most influential countries in Latin America, with the world’s 15th largest economy and an expanding role in global healthcare, represents a particularly relevant setting in which to examine these professional-level gaps. Evaluating physician knowledge and decision-making in this context may also provide insight into broader regional and international trends, as similar challenges are likely present across comparable healthcare systems.4