Testosterone deficiency syndrome and cardiovascular health: An assessment of beliefs, knowledge and practice of general practitioners and cardiologists in Victoria, BC

Abstract

Introduction: Testosterone deficiency syndrome (TDS) has been shown to be an independent cardiovascular risk factor and a predisposing factor for metabolic syndrome. As general practitioners and cardiologists primarily care for these patients, we sought to assess their knowledge, beliefs and practice patterns with respect to TDS and cardiac health. Methods: We distributed a questionnaire to all 20 cardiologists and a cohort of 128 family practitioners in Victoria, British Columbia. Of the 13 questions, 10 assessed knowledge and beliefs on TDS and 3 assessed current practice patterns. Results: Most respondents believed that TDS is a medical condition (66.7%) and could negatively affect body composition (62%), but a similar majority was unsure whether it was a cardiac risk factor (66.7%). While most believed that testosterone replacement therapy (TRT) could improve exercise tolerance (62%), most were unsure if it was beneficial in cardiac patients. Cardiologists were significantly less likely to believe that TRT was beneficial in preventing recurrent myocardial infarction and improving myocardial perfusion (p = 0.0133, 0.00186, respectively). The vast majority (88%) did not screen cardiac patients for TDS. If a patient was identified as having TDS, only10% of those surveyed would refer these patients to a urologist. Conclusion: Despite its prevalence in cardiac patients, TDS is not well-understood by general practitioners and cardiologists; they lack knowledge on its deleterious cardiovascular effects. In their role as men's health advocates, urologists should educate our colleagues regarding the correlation between TDS and cardiovascular mortality and risk factors. Limitations of this study include small sample size and restricted geographic scope.

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

“…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.…”

Testosterone deficiency syndrome and cardiovascular health: Looking carefully at the evidence

“…1 Although the questionnaire used is not shown and there is no evidence that it was validated, the responders appear to be adequately informed and properly cautious on the management of a condition which is at the centre of considerable and, frequently poorly informed controversy. The controversy is bolstered by the "expert" views from all of walks of life: from endocrinologists and epidemiologists to urological surgeons and gerontologists, from the lay press to the regulatory agencies and from the pharmaceutical to the film industries.…”