Use of Hormone Testing for the Diagnosis and Evaluation of Male Hypogonadism and Monitoring of Testosterone Therapy: Application of Hormone Testing Guideline Recommendations in Clinical Practice

Publisher： John Wiley & Sons Inc

E-ISSN： 1743-6109|12|9|1886-1894

ISSN： 1743-6095

Source： THE JOURNAL OF SEXUAL MEDICINE, Vol.12, Iss.9, 2015-09, pp. : 1886-1894

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Abstract

AbstractIntroductionClinical practice guidelines recommend that testosterone (T) levels be measured on ≥2 occasions to confirm a diagnosis of hypogonadism, gonadotropins be measured to determine whether hypogonadism is primary or secondary, and T levels be measured to monitor the adequacy of T therapy. However, it is not known whether hormone testing as recommended by guidelines is routinely performed in real‐world clinical practice.AimThe aim of this study was to assess the use of hormone testing for the diagnosis and evaluation of hypogonadism and monitoring of T therapy in clinical practice.MethodsIn this retrospective cohort study of the Truven Health Marketscan®Commercial and Medicare Supplemental Insurance Databases during 2010–2012, 63,534 men over 18 years old who received T therapy and had continuous medical benefit enrollment for 1 year prior to and 6 months after T therapy initiation were included in this analysis.Main Outcome MeasuresProportion of patients who received ≥2, 1, or no T‐level determinations prior to or following T therapy initiation.ResultsSeventy‐one percent of hypogonadal men had T measured at least once and 40% had ≥ 2 tests, but only 12% of men had luteinizing hormone and/or follicle‐stimulating hormone levels measured prior to T therapy initiation. Following T therapy initiation, 46% had ≥1 follow‐up T measurements.ConclusionsAppropriate use of T and gonadotropin levels in clinical practice as recommended by guidelines is suboptimal, increasing the possibility of overdiagnosis of male hypogonadism, underdiagnosis of secondary hypogonadism, and inappropriate T therapy use and management. Further investigation is needed into reasons for nonadherence to guidelines for appropriate hormone testing to inform future quality improvement efforts. Muram D, Zhang X, Cui Z, and Matsumoto AM. Use of Hormone Testing for the Diagnosis and Evaluation of Male Hypogonadism and Monitoring of Testosterone Therapy: Application of Hormone Testing Guideline Recommendations in Clinical Practice. J Sex Med 2015;12:1886–1894.