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

Abstract

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.

Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men’s Experiences on Prescription Testosterone

“…Most participants reported no negative side-effects or concerns after taking PT, and most participants would recommend PT to friends and family members. Further, findings mirror the general trends and prescribing patterns found in the U.S. PT literature [2,7,13,23,30,31,32,33,34].…”

“…Men under 40 more frequently reported “other” as the reason they were prescribed PT ( p = 0.01) instead of other diagnoses; this may indicate that prescribers (most often family doctors/general practitioners in this sample) are more hesitant to diagnose an individual under 40 who presents with similar symptoms and blood values as those with LOH. While a full review of the androgen deficiency literature is beyond the scope of this paper, it is notable that multiple publications note inconsistent prescriber pretreatment and follow-up evaluations (see [1,23,32]), which may lead to PT prescriptions for a wide range of testosterone levels. Further complicating interpretations of the low testosterone self-report responses are the variable effects PT (e.g., ranging from overall improvement to no apparent effects) may have between eugonadal and hypogonadal men [13,38,39,40,41,42,43,44,45,46].…”