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|Title:||Clinical practice patterns in the assessment and management of low testosterone in men: an international survey of endocrinologists.||Austin Authors:||Grossmann, Mathis ;Anawalt, Bradley D;Wu, Frederick C W||Affiliation:||Department of Medicine Austin Health, University of Melbourne, Heidelberg, Victoria, Australia||Issue Date:||24-Sep-2014||Publication information:||Clinical Endocrinology 2014; 82(2): 234-41||Abstract:||To document current practices in the approach to low testosterone in older men. Given that recommendations are based on low-level evidence, we hypothesized that there would be a wide variability in clinical practice patterns.Members of all major endocrine and andrological societies 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.Nine hundred and forty-three 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. Response rates among participating societies ranged from 4·1-20·0%. 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 (300 ng/dl). A total of 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.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.||Gov't Doc #:||25154540||URI:||http://ahro.austin.org.au/austinjspui/handle/1/12356||DOI:||10.1111/cen.12594||URL:||https://pubmed.ncbi.nlm.nih.gov/25154540||Type:||Journal Article|
|Appears in Collections:||Journal articles|
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