Not Enough Men On Testosterone Get Guideline-Based Hypogonadism Work-Up

CHICAGO — Few men prescribed testosterone therapy received guideline-concordant diagnostic testing for androgen deficiency, and some received therapy despite contraindications, a retrospective chart review indicated.

In a random sample of 200 male patients cared for at a single institution, only 12% underwent testing according to the Endocrine Society’s recommendations. This included having two low morning testosterone levels followed by measuring LH and/or FSH, as well as having no contraindications to testosterone therapy. Low testosterone was defined as total testosterone below 300 ng/dL, free testosterone below 70 pg/mL, or low bioavailable testosterone between 5 a.m. and 10 a.m.

Casi el 40% de los hombres que recibieron testosterona tuvieron chequeos adecuados de niveles de testosterona en la mañana baja, LH y/o FSH, pero presentaron contraindicaciones al tratamiento.

Desviaciones en la práctica

“This highlights quite a discrepancy in testosterone prescribing practice,” said Sophia Sinha, MD, of the University of Michigan (UMich) in Ann Arbor at ENDO 2026, the annual meeting of the Endocrine Society.

Co-author Maria Papaleontiou, MD, also of UMich, added that the study findings “highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing. Long-term, these findings can lead to quality-improvement efforts and clinical decision support tools that promote consistent, guideline-concordant testosterone prescribing.”

Las prescripciones de testosterona se cuadruplicaron en las últimas 3 décadas en los EE. UU. a pesar de las tasas estables de diagnósticos de hipogonadismo masculino, notó Sinha. Los estudios han demostrado que la testosterona se prescribe a muchos sin pruebas claras de deficiencia de andrógenos.

Aumento en el uso de terapias

A recent cross-sectional study reported increases in testosterone therapy use across all age ranges from 2018 to 2022, incluyendo en aquellos de 24 años y menos (120%), 25 a 34 (86%), 35 a 44 (45%), 45 a 54 (35%), 55 a 64 (17%), y 65 y más (12%).

“There are risks involved with testosterone use, including hypertension, erythrocytosis, infertility, and also concerns for abuse, so we wanted to understand testosterone prescribing practices at our institution, the University of Michigan,” Sinha noted.

Métodos del estudio

The researchers performed a retrospective chart review of a random sample of adult male patients with a documented diagnosis of hypogonadism by ICD-9 or -10 codes. They assessed laboratory diagnostic evaluations prior to the first prescription and contraindications, which included an elevated prostate-specific antigen (PSA), a history of prostate cancer or breast cancer, erythrocytosis, and obstructive sleep apnea (OSA). Transgender individuals and patients with HIV were excluded.

The median patient age was 56, age of hypogonadism diagnosis was 53, and 83% were white. Two-thirds were sexually active and median BMI was 32.

La evaluación del hipogonadismo fue comúnmente desencadenada por fatiga (63%), disfunción eréctil (62%), disminución de libido (54%), y solicitud del paciente (25%). Las formulaciones tópicas de testosterona fueron las más comúnmente prescritas (68.5%).

Over half (55%) of patients had documented OSA, 4% had prostate cancer, and 1.5% had a PSA greater than 4 ng/mL prior to the index testosterone prescription — all contraindications to testosterone therapy.

La mayoría (76%) tenía dos o más comorbilidades, siendo las más comunes obesidad (63%), hipertensión (52%), depresión (40%), diabetes (28%) y artritis (28%). Los pacientes con dos o más comorbilidades fueron significativamente menos propensos a recibir una evaluación adecuada para la prescripción de testosterona en comparación con aquellos con menos comorbilidades.

Prácticas de prescripción

Testosterone was most commonly prescribed by primary care (45%), followed by urology (35.5%), and endocrinology (18%). Patients who received their prescription through endocrinology or urology were significantly more likely to have appropriate diagnostic evaluations than those prescribed testosterone by primary care.

Futuras investigaciones

Future studies should evaluate targeted interventions aimed at reducing inappropriate testosterone prescribing, Sinha suggested.

Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice. Always consult a healthcare professional for medical advice and treatment options.

Fuente: https://www.medpagetoday.com/meetingcoverage/endo/121749