Use of Hormone Testing for the Diagnosis and Evaluation of Male Hypogonadism and Monitoring of Testosterone Therapy: Application of Hormone Testing Guideline Recommendations in Clinical Practice.
BACKGROUND
Clinical practice guidelines recommend that testosterone (T) levels be measured on ≥2 occasions to confirm a diagnosis of hypogonadism, gonadotropins be measured to determine whether hypogonadism is primary or secondary, and T levels be measured to monitor the adequacy of T therapy. However, it is not known whether hormone testing as recommended by guidelines is routinely performed in real-world clinical practice.


OBJECTIVE
The aim of this study was to assess the use of hormone testing for the diagnosis and evaluation of hypogonadism and monitoring of T therapy in clinical practice.


METHODS
In this retrospective cohort study of the Truven Health Marketscan(®) Commercial and Medicare Supplemental Insurance Databases during 2010-2012, 63,534 men over 18 years old who received T therapy and had continuous medical benefit enrollment for 1 year prior to and 6 months after T therapy initiation were included in this analysis.


METHODS
Proportion of patients who received ≥2, 1, or no T-level determinations prior to or following T therapy initiation.


RESULTS
Seventy-one percent of hypogonadal men had T measured at least once and 40% had ≥ 2 tests, but only 12% of men had luteinizing hormone and/or follicle-stimulating hormone levels measured prior to T therapy initiation. Following T therapy initiation, 46% had ≥1 follow-up T measurements.


CONCLUSIONS
Appropriate use of T and gonadotropin levels in clinical practice as recommended by guidelines is suboptimal, increasing the possibility of overdiagnosis of male hypogonadism, underdiagnosis of secondary hypogonadism, and inappropriate T therapy use and management. Further investigation is needed into reasons for nonadherence to guidelines for appropriate hormone testing to inform future quality improvement efforts.
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
David
D
Muram
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
Xiang
X
Zhang
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
Zhanglin
Z
Cui
Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, 98108, USA.|Department of Medicine, University of Washington, Seattle, WA, 98195, USA.
Alvin M
AM
Matsumoto
D000328:Adult; D000728:Androgens / Q000627:therapeutic use*; D005058:Eunuchism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006062:Gonadotropins / Q000097:blood*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013739:Testosterone / Q000627:therapeutic use*
D000728:Androgens; D006062:Gonadotropins; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
Hormone Testing; Hypogonadism; Retrospective Study; Testosterone