A Qualitative Exploration of Testosterone Replacement Therapy: Men’s Experiences and Healthcare Barriers

Introduction Testosterone deficiency (TD) remains underdiagnosed and undertreated, leading to diminished quality of life (QoL) for affected men. Previous quantitative studies showed that many men delayed treatment but ultimately reported high effectiveness of testosterone replacement therapy (TRT). The underlying reasons for these delays and the broader impact of TRT remain underexplored. Objectives The aim of this qualitative study was to explore systemic and individual determinants in shaping care-seeking behaviours, factors influencing access to TRT, and its biopsychosocial impacts. Methods Semi-structured interviews were conducted with 21 UK men who were current or past TRT users, purposefully sampled to ensure diversity in age, TRT duration and symptom duration to reflect significant variables identified from prior quantitative study. Semi-structured interviews explored motivations for starting TRT, pre-treatment symptoms and the biopsychosocial impact of TRT. Each 60-minute online interview was audio recorded, transcribed verbatim and thematically analysed using NVivo software. The socioecological framework was used to contextualise the findings. Results Systemic barriers including delays in diagnosis and the National Health Service’s protocol-based care were perceived as major challenges. Participants expressed frustration with attribution of symptoms to ageing or stress, leading many to seek private care. A lack of awareness and stigma surrounding TD were significant barriers to treatment-seeking behaviour. However, men overwhelmingly valued TRT, noting improvements in self-confidence, professional success and social engagement. Participants also reported significant improvements in energy, fitness, mood and overall QoL, with few men reporting side effects. Conclusion Our study reveals systemic barriers that delay timely diagnosis and treatment of TD, and highlighted substantial biopsychosocial benefits of TRT. There is a critical need for increased awareness of TD among healthcare providers and the public, alongside a shift toward more personalised, symptom-based approaches in the healthcare system. Future research should explore the broader societal and economic impacts of TRT, including its potential to improve workforce productivity and reduce long-term health risks associated with TD.