Male Hypogonadism Treatment Guidelines Adherence
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Boston, MA – The landscape of testosterone prescribing for men is complex, marked by both instances of overuse and a meaningful number of undiagnosed cases of testosterone deficiency.Experts highlight the need for careful diagnosis and patient education to ensure appropriate treatment and improve men’s quality of life.
Fluctuating Trends and Systemic Improvements
Testosterone prescribing patterns have seen notable shifts over the years. Dr. Shalender bhasin, of Metabolism at brigham and Women’s Hospital in Boston, noted that prescribing rates dropped in 2013 following an FDA advisory concerning cardiovascular risks. However, these rates began to rise again around 2017, influenced by the TRAVERSE trial results, which demonstrated the cardiovascular safety of testosterone therapy.
“Testosterone sales are growing,and simultaneously occurring,many men wiht testosterone deficiency remain undiagnosed,so it’s both overuse and underuse,” Bhasin told Medscape Medical news. He also pointed out that these findings align with a study his group conducted a decade ago in the Veterans Management (VA). “I think it’s gotten much better,” Bhasin stated, referring to the VA system. “In the VA,it was very low,and it has gotten substantially better because at the VA now there’s one policy. Also, the assays have gotten better.”
The Importance of Accurate Diagnosis
Experts emphasize that a thorough diagnostic process is crucial before initiating testosterone therapy. Dr. Ismat Shafiq, a session moderator from the University of Rochester, rochester, New York, explained that patients may present with low total testosterone levels due to factors like overweight, obesity, or sleep apnea, while their free testosterone levels remain normal.”If that’s the case,we can properly educate our patients and work on managing their weight and sleep problems,” Dr. Shafiq advised. “That can reverse the hypogonadism and make them feel better, rather than giving them testosterone.”
Furthermore, if both total and free testosterone levels are low, the underlying cause might be reversible. Conditions such as prolactinomas or pituitary macroadenomas can lead to hypogonadism. “If we check the prolactin level and we treat them,the hypogonadism will resolve. Primary hypothyroidism, too, if treated, can resolve the hypogonadism,” Shafiq said. “Diagnosing the patient appropriately can identify causes that can be treatable and that can improve their quality of life and improve their testosterone level too, rather than jumping into giving them testosterone.”
Educating Patients on Testosterone Therapy
Patient education plays a vital role in managing expectations and ensuring adherence to appropriate treatment plans. Dr. Shafiq highlighted that many patients mistakenly believe that higher testosterone levels are always better.”We need to educate them,” she urged. ”In my experience, most of the patients listen and understand because nobody wants to take extra medicine all the time, unless it’s really needed for them to improve their quality of life.”
This approach underscores the importance of a patient-centered strategy, focusing on addressing the root causes of low testosterone and ensuring that therapy is only prescribed when truly indicated, thereby optimizing patient outcomes and well-being.
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Disclosures: Dr. Pederson and Dr. Shafiq reported having no disclosures. Dr.Bhasin reported receiving research grant support from AbbVie and Metro International Biotech for investigator-initiated research, with the grants managed by Brigham and Women’s Hospital. He has served as a consultant to Besins and Versanis and has an equity interest in XYone Therapeutics.
Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.*