title: Clinical practice patterns in the assessment and management of low testosterone in men: an international survey of endocrinologists.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  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.
authors.affiliation: Department of Medicine Austin Health, University of Melbourne, Heidelberg, Vic, Australia.
authors.forename: Mathis
authors.initials: M
authors.lastname: Grossmann
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Anawalt
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D004704:Endocrinology / Q000379:methods / Q000592:standards; D005843:Geography; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D013739:Testosterone / Q000097:blood / Q000172:deficiency*; D000078329:Workforce
chemical_list: D013739:Testosterone