What the PBS actually requires, what workup to order first, and when it's a specialist referral rather than a GP prescription.
Quick PBS eligibility check
What are the patient's morning testosterone results?
Required workup before any prescribing decision
Two morning fasting samples at least several weeks apart — testosterone is highest in the morning and can fall 20–40% by afternoon; a single afternoon result is not diagnostic
Total testosterone + SHBG (to calculate free testosterone — total alone can be misleading, especially with obesity or metabolic syndrome affecting SHBG)
LH and FSH — distinguishes primary (testicular) from secondary (pituitary/hypothalamic) hypogonadism and determines whether the patient meets the 6–15 nmol/L + raised LH exception
Prolactin if secondary hypogonadism is suspected (raised prolactin can suppress the HPG axis)
Baseline haematocrit, PSA (if age-appropriate), LFTs, lipids — needed for pre-treatment comparison regardless of pathway chosen
Explicitly excluded from PBS authority: low testosterone due primarily to age, obesity, cardiovascular disease, or medication effects. This is the single most common scenario in general practice — a patient with fatigue/low libido and a borderline-low level but no other diagnosed cause. Be upfront that this will not meet PBS criteria before ordering extensive workup, to set expectations early.
When it's a specialist referral, not a GP script
PBS authority prescriptions require a named specialist on the application — endocrinologist, urologist, or a Fellow of the Australasian Chapter of Sexual Health Medicine. A GP cannot independently authorise ongoing PBS-subsidised testosterone without this.
Refer to endocrinology if results support a possible diagnosis and the patient wants to pursue treatment
If the cause is unclear (isolated low testosterone with normal LH/FSH, or symptoms out of proportion to results) — endocrinology assessment before starting anything
If results clearly don't meet PBS criteria, the patient may still seek a private (non-PBS) prescription from a doctor willing to prescribe on clinical judgement — this is a separate, legal pathway but is the prescribing doctor's independent decision, and typically involves different diagnostic thresholds than PBS
Ongoing monitoring once treatment starts
Haematocrit: monitor periodically. General concern threshold ~0.52, action (dose review/pause) typically considered ~0.54+ — confirm current local/specialist protocol.
PSA: baseline then periodic monitoring, particularly age 40+.
Testosterone levels: re-check to confirm therapeutic range is reached, then periodically.
Fertility counselling: TRT suppresses spermatogenesis — discuss before starting in men who may want future fertility. Consider referral for fertility preservation discussion if relevant.
Cardiovascular risk factors: part of the ongoing review, given the evidence base is still debated.
Handling the conversation when criteria aren't met
A common, low-friction scenario: patient has seen online content about "low T," requests testing or treatment, and results come back in the low-normal range without a diagnosed cause.
Order the workup rather than dismissing the request outright — validates the concern and rules out alternative explanations (sleep apnoea, depression, thyroid dysfunction, medication effects, alcohol)
Explain the PBS threshold plainly and early, to avoid the patient feeling "sprung" later
If they want to pursue private treatment despite not meeting PBS criteria, that's a legitimate discussion to have — document the counselling given regarding evidence, risks, and monitoring, regardless of pathway
General information only — not clinical advice. This page summarises publicly available PBS criteria and general monitoring principles. It does not replace specialist guidance, current product information, or your own clinical judgement for an individual patient. Verify current PBS authority requirements and specialist referral criteria before prescribing.