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
; 12(9): 1886-94, 2015 Sep.
Article
em En
| MEDLINE
| ID: mdl-26272690
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 OUTCOMEMEASURES:
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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Testosterona
/
Hormônio Luteinizante
/
Eunuquismo
/
Gonadotropinas
/
Androgênios
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Guideline
/
Observational_studies
Limite:
Adult
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Sex Med
Assunto da revista:
GINECOLOGIA
/
MEDICINA REPRODUTIVA
/
UROLOGIA
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Estados Unidos