Article: Less than 4 % of Men at the Veterans Healthcare System Get Proper Testosterone Management

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Nelson Vergel

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Only less than 4 % of Men at the Veterans Healthcare System Get Proper Testosterone Management

AIDS Care. 2018 Mar 19:1-8. doi: 10.1080/09540121.2018.1447080. [Epub ahead of print]

Use of testosterone in men infected with human immunodeficiency virus in the veterans healthcare system.

Jasuja GK1,2, Bhasin S3, Rose AJ1,4, Reisman JI1, Skolnik A1,2, Berlowitz DR1,2, Gifford AL1,5,2,4.

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Abstract

Testosterone supplementation has been widely used in those infected with human immunodeficiency virus (HIV) for hypogonadism, and wasting. But with effective antiretroviral therapy and increasing recognition of atherosclerotic disease and adults infected with HIV, the risks of inappropriate testosterone use in HIV-infected patients are far better recognized than previously. Testosterone use has expanded among U.S. males, but few studies have examined prescribing in those infected with HIV. In a national cohort of males with at least one outpatient prescription in the Veterans Health Administration (VHA), we examined 9475 HIV-infected males, including 2484 who had received testosterone and a randomly selected 6991 who had not. For comparison, we identified 1,387,241 uninfected males (189,369 had received testosterone and a randomly selected 1,197,872 had not). We determined rates of new and prevalent testosterone use, and also examined the adequacy of the diagnostic evaluation that had preceded testosterone initiation among our HIV-infected and uninfected testosterone groups. Our main results were as follows. HIV-infected men had higher rates of initiation (0.8% vs. 0.4% in FY09; p < 0.001) and prevalence of testosterone use (2.2% vs. 0.8% in FY08; p < 0.001) compared to the uninfected men across the entire period. Trends of prescribing for both groups followed a similar pattern, rising from FY08, reaching a peak in FY13, and then dipping in FY 14. Only 1.1% of HIV-infected patients had a fully guideline-concordant workup before starting testosterone therapy, compared to 3.5% of uninfected patients (p < 0.001). In conclusion, testosterone use among HIV-infected patients in the VHA system rose to a peak in FY13 and has decreased somewhat since. Only a small minority of HIV-infected patients who receive testosterone therapy from VHA have undergone an appropriate workup before starting therapy, suggesting an opportunity for improvement.
 
Defy Medical TRT clinic doctor
I am thinking about doing my doctoral project on this subject, I'd appreciate any data I can find on this. I know how the VA does TRT is stone-age with every 2 week protocols.
 
I didn't even try to get labs with VA much less treatment for low T. My primary, a nurse practitioner, has become less and less engaged over the years. I asked for tadalafil for mild BPH. She thought it was off-label use and didn't even want to look it up.
 
Beyond Testosterone Book by Nelson Vergel
Medical insurance in the USA is a contract with an insurance company under which you pay a certain amount to the insurance company every month
There's a huge conflict of interest in our healthcare system, the more people that need repeated appointments, drugs and treatments, the more money the doctors and providers make.
 
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