title: Factors influencing patient decisions to initiate and discontinue subcutaneous testosterone pellets (Testopel) for treatment of hypogonadism.
abstract: BACKGROUND
  A variety of modalities for testosterone replacement therapy (TRT) are available, including topical gels, injections, and Testopel subcutaneous testosterone pellets (STP). STP are becoming more commonly utilized in the United States; however, patient preferences, expectations, and usage patterns regarding this therapy remain poorly characterized.
  
  
  OBJECTIVE
  To identify factors influencing patients' decisions to initiate or discontinue STP.
  
  
  METHODS
  A total of 175 men from an academic urology clinic who were currently using or who had previously used STP for hypogonadism received a 32-item electronic survey.
  
  
  METHODS
  Assessment of the impact of convenience, efficacy, side effects, cost, and symptom relief on initiation and discontinuation of STP.
  
  
  RESULTS
  One hundred and thirteen men (64.6% response rate) of mean age 51.4 years who previously underwent a mean of 2.8 STP implant procedures completed the survey. Fifty-nine (52.2%) and 40 (35.4%) men had switched to STP from topical gel and injection therapy, respectively, whereas 14 (12.4%) men initially started TRT with STP. Convenience (68.8%) was the most important factor in patients' decision to start STP, while cost of the previous form of TRT (14.7%) was least important. At the time of the survey, 32 men (28.3%) had discontinued STP therapy. Cost of therapy (50%) was the primary factor in discontinuing STP. There was no difference in serum testosterone levels between men who continued STP and those who discontinued therapy (642.8 vs. 629.0 ng/dL, P = 0.83). Overall, 68.1% of patients continued STP therapy at the time of survey completion.
  
  
  CONCLUSIONS
  Convenience is the most important factor in a patient's decision to initiate STP; however, physician recommendation also plays a substantial role. Cost was the primary reason for discontinuation. Upon survey completion, greater than two-thirds of respondents elected to continue STP therapy. STP are a viable treatment option for hypogonadal men seeking a convenient and efficacious alternative modality of TRT.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.forename: Abhinav
authors.initials: A
authors.lastname: Khanna
authors.forename: Robert M
authors.initials: RM
authors.lastname: Coward
authors.forename: Saneal
authors.initials: S
authors.lastname: Rajanahally
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kovac
authors.forename: Marshall A
authors.initials: MA
authors.lastname: Gonzales
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
mesh_terms: D003657:Decision Making; D016527:Drug Costs; D004343:Drug Implants; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000008:administration & dosage* / Q000097:blood / Q000172:deficiency / Q000191:economics
chemical_list: D004343:Drug Implants; D013739:Testosterone
keywords: Hypogonadism; Patient Satisfaction; Subcutaneous Testosterone Pellets; Testosterone; Testosterone Replacement