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Clinical practice patterns in the assessment and management of low testosterone in men: an international survey of endocrinologists
Author(s) -
Grossmann Mathis,
Anawalt Bradley D.,
Wu Frederick C.W.
Publication year - 2015
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12594
Subject(s) - testosterone (patch) , medicine , androgen deficiency , overweight , androgen , endocrinology , clinical practice , endocrine system , demography , gynecology , body mass index , family medicine , hormone , sociology
Summary Objective To document current practices in the approach to low testosterone in older men. Given that recommendations are based on low‐level evidence, we hypothesized that there would be a wide variability in clinical practice patterns. Design Members of all major endocrine and andrological societies were invited to participate in a Web‐based survey of the diagnostic work‐up and management of a hypothetical index case of a 61‐year old overweight man presenting with symptoms suggestive of androgen deficiency, without evidence of hypothalamic‐pituitary‐gonadal ( HPT ) axis disease. Results Nine hundred and forty‐three respondents (91·2% adult endocrinologists) from Northern America (63·7%), Europe (12·7%), Oceania (8·2%), Latin America and Caribbean (7·6%), and the Middle East, Asia, or Africa (7·8%) completed the survey. Response rates among participating societies ranged from 4·1–20·0%. There was a wide variability in clinical practice patterns, especially regarding biochemical diagnosis of androgen deficiency, exclusion of HPT axis pathology, and monitoring for prostate cancer. In a man with suggestive symptoms, 42·4% of participants would offer testosterone treatment below a serum total testosterone of 10·4 nmol/l (300 ng/dl). A total of 46·0% of participants were, over the last five years, ‘less inclined’ to prescribe testosterone to men with nonspecific symptoms and borderline testosterone levels, compared to ‘no change’ (29·3%) or ‘more inclined’ (24·7%), P < 0·001. Conclusions This large‐scale international survey shows a wide variability in the management of lowered testosterone in older men, with deviations from current clinical practice guidelines, and a temporal trend towards increasing reluctance to prescribe testosterone to men without classical hypogonadism. These findings highlight the need for better evidence to guide clinicians regarding testosterone therapy.