(086) ANALYSIS OF PRACTICE PATTERNS IN THE MANAGEMENT OF TESTOSTERONE DEFICIENCY AMONG UROLOGISTS AND ENDOCRINOLOGISTS AT A TERTIARY HEALTH CENTER
Authors: Appleton A , Klomhaus A , Mills J , Eleswarapu S 
Published: December 2024

Introduction

Guideline-concordant care is crucial for ensuring optimal outcomes in patients with testosterone deficiency (TD), yet approaches can vary significantly between specialties. While up to a third of men who are placed on testosterone therapy (TTh) do not meet the diagnostic criteria for TD, there is a large percentage of men in need of testosterone therapy who do not receive it due to clinician concerns. However, current evidence does not definitively support or refute these concerns which typically include increased prostate cancer and cardiovascular risks.

Objective

Analyze the differences in the frequency and type of testosterone lab orders and testosterone therapy (TTh) prescriptions by urologists and endocrinologists, as well as examine the relationship between patient characteristics and the probability of TTh with an emphasis on specialty-specific variations.

Methods

Deidentified patient data were extracted from our institutional medical record. Male patients with ICD-10 E29.1 (TD) and E23.1 (secondary hypogonadism) were included. Individuals age &lt; 18, those under the care of both endocrinology and urology, those lacking prescription data, and those with gross pituitary pathology or genetic cause for TD were excluded. Variables examined included age, BMI, and history of prostate cancer, hypertension, hyperlipemia, type 2 diabetes, or major adverse cardiovascular event. Missing BMI were imputed. Univariate and multivariate analyses were performed to identify differences in prescribing among urologists versus endocrinologists based on patient characteristics. Logistic regression was used to identify factors which predicted TTh prescribing. Statistical significance was defined by p &lt; 0.05. Statistics were done using JMP 172022.

Results

Among the 9266 patients diagnosed with TD, 4846 were treated by endocrinologists and 4420 by urologists. Most patients in both endocrinology (89.0%) and urology (92.3%) had at least one serum testosterone result within the year of TD diagnosis. Both urologists and endocrinologists ordered an equal amount of total testosterone labs. However, endocrinologists ordered free testosterone, percent free testosterone, and bioavailable testosterone and percentage bioavailable testosterone more often than urologists (p &lt; .01). Urologists prescribed TTh to 51.5% of these patients, compared to 57.1% for endocrinologists. Differences were seen in TTh prescribing across urologists versus endocrinologists among patients with history of elevated BMI (p &lt; .01), hyperlipidemia (p &lt; .01), prostate cancer (p = 0.00), and serum testosterone lab testing (p &lt; .01). Multivariate analysis showed that older patients (ORE = 1.45, ORU = 2.05) or patients with at least one serum testosterone result (ORE = 1.36, ORU = 1.65) were more likely to receive TTh, while those overweight (OREndo = 0.75, ORU = 0.60) or with a history of prostate cancer (ORE = 0.38, ORU = 0.67) were less likely to, regardless of specialty. Additionally, TD patients with diabetes (OR = 0.81) and hyperlipidemia (OR = 0.78) seen by endocrinologists were less likely to undergo TTh.

Conclusions

Our study underscores significant differences in the diagnosis and management of TD between urologists and endocrinologists. Recognizing the impact of clinician specialty on these practice patterns is crucial for promoting guideline-concordant care. While TTh is the standard treatment, clinicians may hesitate to prescribe it due to certain comorbidities. Future studies should investigate how differences in training, societal guidelines, and provider comfort levels with TTh influence practice patterns and their implications for patient outcomes.

Disclosure

No.