Clinical practice patterns in the assessment and management of low testosterone in men: an international survey of endocrinologists. (24th September 2014)

• Record Type: Journal Article
• Authors: Grossmann, Mathis; Anawalt, Bradley D.; Wu, Frederick C.W.
• Is Part Of: Clinical endocrinology. Volume 82:Number 2(2015:Feb.)
• Page Start: 234
• Page End: 241
• Publication Date: 2014-09-24
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12594
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12594-abs-0001"> <title>Summary</title> <sec id="cen12594-sec-0001" sec-type="section"> <title>Objective</title> <p>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.</p> </sec> <sec id="cen12594-sec-0002" sec-type="section"> <title>Design</title> <p>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.</p> </sec> <sec id="cen12594-sec-0003" sec-type="section"> <title>Results</title> <p>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%), <italic>P</italic> < 0·001.</p> </sec> <sec id="cen12594-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>