Are we testing appropriately for low testosterone?: Characterization of tested men and compliance with current guidelines.
BACKGROUND
Direct-to-consumer ads for testosterone replacement therapies have significantly increased over the past several years. Subsequently, testing for low serum testosterone has correspondingly increased.


OBJECTIVE
We sought to determine the testing behaviors of practitioners as well as the characteristics of men who are undergoing testing for low testosterone.


METHODS
Men aged 18-85 years were queried from the institutional electronic data warehouse from 2009 to 2012. Men were considered "tested" if their serum total testosterone level had been measured for any purpose. Tested men (TM) were compared with those not tested (NT).


METHODS
The frequency and timing of testing for low testosterone as well as patient demographics and clinical characteristics were compared between TM and NT using multivariable logistic regression models.


RESULTS
Of the 321,674 total men, 10,133 (3.2%) underwent testing with a serum total testosterone (mean age of 55.2 ± 14.1 years). The frequency of testing increased from 2.5% to 3.6% during the study period (P < 0.001). Multivariable analysis demonstrated that TM were significantly (P < 0.001) more likely to be Caucasian and have increased body mass index. In addition, TM were significantly more likely to have comorbid conditions including decreased libido (adjusted odds ratio [aOR] 10.0, 95% confidence interval [CI] 8.5, 11.7), infertility (aOR 4.8, 95% CI 3.6, 6.6), erectile dysfunction (aOR 3.6, 95% CI 3.4, 3.8), osteoporosis (aOR 3.3, 95% CI 2.8, 3.8), depression (aOR 1.7, 95% CI 1.6, 1.8), prostate cancer (aOR 1.7, 95% CI 1.5, 1.8), hypertension (aOR 1.3. 95% CI 1.2, 1.4), chronic obstructive pulmonary disease (aOR 1.2, 95% CI 1.0, 1.4), and benign prostatic hyperplasia (aOR 1.2, 95% CI 1.1, 1.2). Among TM, only 889 (9%) men underwent testing between 7 am and 12 pm.


CONCLUSIONS
The rate of testosterone testing is increasing with most testing practices directed toward a subset of men with comorbidities that are associated with hypogonadism. Compliance of physicians obtaining early morning serum testosterone levels is low. Further education of practitioners is required to appropriately test patients for hypogonadism.
Department of Surgery, Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
Rena D
RD
Malik
Brittany
B
Lapin
Chihsiung E
CE
Wang
Justin C
JC
Lakeman
Brian T
BT
Helfand
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019983:Guideline Adherence; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000175:diagnosis*; D007989:Libido; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013739:Testosterone / Q000097:blood* / Q000172:deficiency; D014481:United States / Q000453:epidemiology; D044465:White People
D013739:Testosterone
Diurnal Variation; Hypogonadism; Low Testosterone; Serum Total Testosterone Testing