Context: Given that recommendations on the approach to low testosterone in older men are based on low-level evidence, we hypothesized that there would be a wide variability in clinical practice patterns.
Objective: To document current practices among members of U.S., European and Australasian endocrine and andrology societies.
Design, Setting and Participants:Members of The Endocrine Society, the American Association of Clinical Endocrinologists, the European Endocrine Society, the Endocrine Society of Australasia, the American Society of Andrology, and the European Academy of Andrology were invited to participate in a web-based survey of the diagnostic work-up and management of a hypothetical index case of a 61-year old overweight man presenting with symptoms suggestive of androgen deficiency, without evidence of hypothalamic-pituitary-gonadal (HPT) axis disease.
Results:943 respondents (91.2% adult endocrinologists) from Northern America (63.7%), Europe (12.7%), Oceania (8.2%), Latin America and Caribbean (7.6%), and the Middle East, Asia, or Africa (7.8 %) completed the survey. There was a wide variability in clinical practice patterns, especially regarding biochemical diagnosis of androgen deficiency, exclusion of HPT axis pathology, and monitoring for prostate cancer. In a man with suggestive symptoms, 42.4% of participants would offer testosterone treatment below a serum total testosterone of 10.4 nmol/L (300ng/dl). 46.0% of participants were, over the last five years, “less inclined” to prescribe testosterone to men with nonspecific symptoms and borderline testosterone levels, compared to “no change” (29.3%) or “more inclined” (24.7%), p <0.001.
Conclusions:This large-scale international survey shows a wide variability in the management of lowered testosterone in older men, with deviations from current clinical practice guidelines, and a temporal trend towards increasing reluctance to prescribe testosterone to men without classical hypogonadism. These findings highlight the need for better evidence to guide clinicians regarding testosterone therapy.