Nelson Vergel
Founder, ExcelMale.com
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.
Muram D, et al. J Sex Med. 2015.
Authors
Muram D1, Zhang X1, Cui Z1, Matsumoto AM2,3.
Author information
1Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
2Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, 98108, USA.
3Department of Medicine, University of Washington, Seattle, WA, 98195, USA.
Citation
J Sex Med. 2015 Aug 14. doi: 10.1111/jsm.12968. [Epub ahead of print]
Abstract
INTRODUCTION: Clinical 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.
AIM: The 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.
METHODS: In 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 MEASURES: Proportion of patients who received ≥2, 1, or no T-level determinations prior to or following T therapy initiation.
RESULTS: Seventy-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.
CONCLUSIONS: Appropriate 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, et al. J Sex Med. 2015.
Authors
Muram D1, Zhang X1, Cui Z1, Matsumoto AM2,3.
Author information
1Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
2Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, 98108, USA.
3Department of Medicine, University of Washington, Seattle, WA, 98195, USA.
Citation
J Sex Med. 2015 Aug 14. doi: 10.1111/jsm.12968. [Epub ahead of print]
Abstract
INTRODUCTION: Clinical 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.
AIM: The 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.
METHODS: In 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 MEASURES: Proportion of patients who received ≥2, 1, or no T-level determinations prior to or following T therapy initiation.
RESULTS: Seventy-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.
CONCLUSIONS: Appropriate 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.
