A psychiatrist is a medical doctor (MD or DO) who specializes in the diagnosis and treatment of mental health conditions. As physicians, psychiatrists are trained to understand the complex interplay between the brain, body, and overall health. Testosterone is a steroid hormone that influences reproductive health, bone density, muscle mass, and mood regulation. The question of whether a psychiatrist can prescribe testosterone addresses the intersection of psychiatric care with the endocrine system.
Psychiatrists Legal Prescribing Authority
Psychiatrists are fully licensed medical doctors and possess the legal authority to prescribe any medication approved by the U.S. Food and Drug Administration (FDA). This legal capacity includes controlled substances and hormones, such as testosterone. The ability to write a prescription is granted through their medical degree and state licensing board, which does not restrict their prescribing privileges to psychotropic drugs alone. A psychiatrist’s medical license is the same as a surgeon’s or a primary care physician’s license in terms of formulary access.
While the legal ability exists, the clinical standard of practice often dictates whether a psychiatrist will choose to prescribe a non-psychiatric medication. Most physicians tend to practice within their specialty to maintain expertise. Therefore, for a patient presenting solely with symptoms of low testosterone (hypogonadism) without a psychiatric component, a psychiatrist would typically refer the patient to a primary care provider or an endocrinologist.
Testosterone and Mental Health Conditions
A psychiatrist may consider prescribing testosterone when a patient’s mental health symptoms appear to be directly influenced or exacerbated by a hormonal imbalance. Low testosterone levels have been associated with symptoms that mimic or complicate psychiatric diagnoses, including fatigue, anxiety, and a depressed mood. Research indicates that testosterone therapy can heighten positive mood parameters, such as energy and a sense of wellness, while lessening negative feelings like irritability and anger in hypogonadal men.
The psychiatrist’s involvement often begins with ordering specific blood tests, such as total and free testosterone, to determine if a deficiency is present. If a patient presents with treatment-resistant depression or generalized anxiety, the hormonal workup helps rule out an underlying endocrine cause. If a diagnosis of hypogonadism is confirmed, the psychiatrist may initiate testosterone replacement therapy to stabilize the patient’s mood and cognitive function, addressing difficulties with memory and concentration.
Hormone Therapy in Gender-Affirming Care
The second major clinical context where psychiatrists may prescribe testosterone is within gender-affirming care (GAC) for transgender or non-binary individuals. In this specialized area, the mental health professional plays an important role in the overall transition process. The psychiatrist performs a comprehensive mental health assessment to affirm the diagnosis of gender dysphoria and evaluate the patient’s readiness for hormonal treatment.
Many specialized clinics operate under an “informed consent” model, where the mental health provider’s assessment is one step in a multidisciplinary process. The physician prescribing testosterone, who may be the psychiatrist, ensures the patient understands the full risks and benefits of therapy. In settings where physicians with specific training in transgender health are scarce, the psychiatrist may step into the role of prescribing physician to facilitate timely access to care.
Required Monitoring and Collaborative Treatment
Any physician who prescribes testosterone therapy assumes responsibility for the required medical monitoring, which is often outside the typical scope of daily psychiatric practice. Managing this treatment necessitates regular laboratory work to prevent potential complications.
Ongoing monitoring includes:
- Measuring total testosterone levels to ensure they remain within the therapeutic target range.
- Checking hematocrit, a measure of red blood cell concentration, as testosterone can increase red blood cell production.
- Monitoring lipid panels and liver function tests.
- Checking prostate-specific antigen (PSA) in older patients.
Because of these comprehensive physical health requirements, most psychiatrists who prescribe testosterone work closely with a primary care physician or an endocrinologist. This collaborative treatment model ensures that both the mental health effects and the physical side effects of hormone therapy are managed safely and effectively.