Patient satisfaction with testosterone replacement therapies: the reasons behind the choices.

[Nelson Vergel]

Another great study from Dr Kovac and Dr Lipshultz.


Patient satisfaction with testosterone replacement therapies: the reasons behind the choices.

Kovac JR, et al.

J Sex Med. 2014 Feb;11(2):553-62. doi: 10.1111/jsm.12369. Epub 2013 Nov 6.

Abstract

INTRODUCTION: Testosterone replacement therapy (TRT) for male hypogonadism is rapidly gaining popularity and acceptance. Options include gels, injections, and implantable subcutaneous pellets.

AIMS: The aim of this study was to determine rates of patient satisfaction and reasons for patient preferences in hypogonadal men on TRT.

METHODS: An anonymous, prospective survey was distributed to men presenting for TRT at an academic urology clinic. The survey was organized into multiple domains including patient satisfaction and treatment motivation.

MAIN OUTCOME MEASURES: Patient satisfaction responses obtained via anonymous survey.

RESULTS: Average patient age was 49 ± 0.7 years (n = 382).

Injectable testosterone was chosen by 53%, gel-based regimens by 31%, and pellets by 17%.

Overall, 70% of patients were satisfied with their TRT and 14% reported dissatisfaction.

Satisfaction rates were similar between gels (68%), injections (73%), and implantable pellets (70%).

Doctor recommendation was the sole significant reason for patients preferring gel-based TRT (66% vs. 37% injection users vs. 31% pellet users).

Injectable TRT was favored because of lower cost (35% vs. 21% gel users vs. 19% pellet users).

Pellets were favored for ease of use (64% vs. 44% injection users vs. 43% gel users) and convenience (58% vs. 26% injection users vs. 19% gel users). Pellets had increased rates of satisfaction within the first 12 months.

Improvements in concentration and mood occurred at higher percentages in satisfied patients.

CONCLUSIONS: Patients are satisfied with TRT. Lower costs are important to patients on injections. Convenience and ease of use are central in choosing pellet therapy. Men on TRT should be questioned about mood and concentration because these factors exhibited the greatest improvements in satisfied patients.

 

[HarryCat]

From where I stand 14% dissatisfaction is huge, especially since I'm in that 14%. But I understand where you coming from. In the medical world 70% success rate is about as close to a cure as it gets.

 

[tiwas]

I was wondering about the memory and other executive functions - has there been reported a point of no return? A point where there's a decrease again?

 

[Nelson Vergel]

I think we hit a plateau when it comes to further improvements. Look at the last graph on this link.

How long does testosterone take to show effects?

 

[HarryCat]

OK, now I'm totally confused. From the study to mention in this thread:

"Overall, 70% of patients were satisfied with their TRT and 14% reported dissatisfaction."
But from this link, FDA committees withhold approval of oral testosterone therapy, that you posted over in this thread: F.D.A. Panel Backs Limits on Testosterone Drug
"Generally, the testosterone therapy adherence rate is low, Cunningham underscored, with only 24% of currently-treated patients satisfied with treatment options."

That's about as opposite a conclusion as you can get.

 

[Nelson Vergel]

HarryCat

The main reason for the discrepancy is that Dr Lipshultz knows how to monitor and manage his patients. That is why his patients have higher satisfaction rates of T products.