Gaps in Patient Knowledge About Risks and Benefits of Testosterone Replacement Therapy

Gilbert, Kirven; Cimmino, Cara; Beebe, Lucius C.; Mehta, Akanksha

doi:10.1016/j.urology.2016.12.066

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…In recent years, there has been considerable global concern for the over prescription of testosterone due to both a lack of universal hypogonadism management guidelines and a failure to adhere to established ones. This concern arises from a knowledge of the risks inherent to TRT ( Bassil, Alkaade, & Morley, 2009 ; Gilbert, Cimmino, Beebe, & Mehta, 2017 ; Rhoden & Morgentaler, 2004 ). In Korea, increase in prescriptions by both PCPs and urologists have led to heightened efforts to understand the effects of exogenous testosterone on Asian men with the intention of developing race-specific guidelines ( Ko & Kim, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Variation in Practice Pattern of Male Hypogonadism: A Comparative Analysis of Primary Care, Urology, Endocrinology, and HIV Specialists

et al. 2017

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The objective of the current study was to measure the adherence of guideline-based evaluation and treatment of hypogonadism by medical specialty. A retrospective review was performed analyzing patients from a single academic institution within the past 10 years. The cohort of 193 men was grouped according to medical specialty of the diagnosing physician (50 urology, 49 primary care, 44 endocrinology, and 50 HIV medicine). Adherence to guidelines was assessed using the Endocrine Society’s criteria. Primary care patients were older compared to the rest of the cohort (p < .001) but BMI and cardiovascular risk factors were similar (p = .900). Patients treated by urologists and endocrinologists had the highest percentage of low testosterone findings at initial encounter at 72% (p < .001). Sixty-two percent of urology patients had low LH or FSH compared to 63.6% for endocrinology and 16% for primary care (p < .001). As for brain MRI findings, no urology patients had positive findings (0/9) while eight pituitary adenomas (40%) were found by endocrinologists. Forty-five percent of men treated by urologists received TRT without repeat confirmation, compared to 58% of endocrinologists, 77% of primary care, and 88% of HIV medicine (p < .001). All urology patients had PSA checked before TRT compared to 77.5% of primary care and 61.2% of endocrinology patients (p = .063). Adherence to the guidelines helps prevent undue over-diagnosis and over-treatment of hypogonadism. This study suggests that adherence to guideline-based screening is varied among specialties.

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Section: Discussionmentioning

confidence: 99%

Variation in Practice Pattern of Male Hypogonadism: A Comparative Analysis of Primary Care, Urology, Endocrinology, and HIV Specialists

et al. 2017

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“…In the present analysis, we demonstrated that even when failure to account for immortal‐time bias did not qualitatively change the study conclusions (as in, from benefit to harm), it may qualitatively change the study findings in such a way to significantly influence practice. As there is considerable debate regarding the risk–benefit balance of TRT , changes in risk estimates of ≥10% may be of importance in patient counselling and decision making.…”

Section: Discussionmentioning

confidence: 99%

Estimating the effect of immortal‐time bias in urological research: a case example of testosterone‐replacement therapy

et al. 2017

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“…Many physicians, who treat aging with an androgen, can be justly chided for letting economic return override good medical ethics (Blazer & Liverman, 2004; Gilbert, Cimmino, Beebe, & Mehta, 2017; Kampf et al, 2013; Marshall, 2009). They fail their patients when they make little or no effort to sensitize them to the fact that androgens are social hormones with psychosocial effects (Eisenegger, Haushofer, & Fehr, 2011; Zilioli & Bird, 2017).…”

Section: So What Defines Masculinities Studies?mentioning

confidence: 99%

On the meaning of masculinities and its implication to advancing men’s health.

Tsang

Hamilton

Wassersug

2019

Psychology of Men & Masculinities

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Men's health research is dominated by biomedical research, and those working within biomedicine are often unaware of discourses on the topic of men's health within the field of masculinities studies. We argue that incorporating social sciences in biomedical research would greatly benefit men's health, but these fields have differing worldviews that isolate them from one another. There are many factors that contribute to this separation of the disciplines, including the use of language. Here, we focus specifically on the term masculinities, which emerged in the sociological literature in 1992. Classic scientific disciplines are based upon identifiable and diagnosable entities, and agreed upon criteria for distinguishing one entity from another. We argue, however, that there are no established criteria for distinguishing one masculinity from another and that, in turn, parks masculinities studies outside the sciences as viewed from the perspective of biomedicine. We argue that research in masculinities does not incorporate the realities of the body, such as hormones, in ways that would be relevant for health research. Lastly, we argue that substantive advances in men's health will require a multidisciplinary approach, which first and foremost requires commonly agreed upon language. We use the example of andropause, to demonstrate the need for the disciples of biomedicine and masculinities studies to understand each other's language, methodologies, and goals as a step toward advancing men's health. Public Significance StatementCross culturally, the mean longevity for men is statistically less than for women. We seek a perspective on men's health that integrates biomedicine with sociology. If we are going to improve male health and survival overall, we need to work toward common understandings in these respective fields about the factors that regulate male health-related behaviors.

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Gaps in Patient Knowledge About Risks and Benefits of Testosterone Replacement Therapy

Cited by 12 publications

References 18 publications

Variation in Practice Pattern of Male Hypogonadism: A Comparative Analysis of Primary Care, Urology, Endocrinology, and HIV Specialists

Variation in Practice Pattern of Male Hypogonadism: A Comparative Analysis of Primary Care, Urology, Endocrinology, and HIV Specialists

Estimating the effect of immortal‐time bias in urological research: a case example of testosterone‐replacement therapy

On the meaning of masculinities and its implication to advancing men’s health.

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