title: Diagnosing hypogonadism and treating decisions in different parts of the world: shifts in patterns between 2006 and 2015.
abstract: OBJECTIVE
  Variations in diagnosing and treating testosterone (T) deficiency between different regions of the world were analyzed in 2006, and repeated in 2010. At present, the changes since 2006 were analyzed.
  
  
  METHODS
  About 731 physicians were interviewed in Europe, South Africa, Central and South America regarding factors determining: (1) prescription of T or withholding T, (2) factors in the long-term use of T and the role of T formulations therein, (3) awareness of the wider spectrum of action of T (cardiometabolic disease) (4) reimbursement of T and its impact on (continued) use and (5) best strategies for information on T for physicians.
  
  
  RESULTS
  Total T was a key factor in identifying hypogonadism, but for >80% of physicians, clinical symptoms were weighed during diagnosis. Once diagnosed, >85% received T treatment, but the treatment compliance was problematic. Of these patients, 36% decided not to start or continue the treatment.
  
  
  CONCLUSIONS
  More hypogonadal men are treated than before, but ∼20% goes unidentified. Physicians have a greater awareness that T deficiency can be an element in cardiovascular and metabolic disease, but more education of physicians on diagnosis and treatment of hypogonadism are needed. Problems with reimbursement of T are barriers in the prescription of T and its use by patients.
authors.affiliation: a VU Medical Center, Department of Internal Medicine, Endocrine Section , Amsterdam , The Netherlands.
authors.forename: Louis
authors.initials: L
authors.lastname: Gooren
mesh_terms: D000328:Adult; D000367:Age Factors; D014943:Global Health; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis* / Q000188:drug therapy; D007348:Insurance, Health; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013739:Testosterone / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*
chemical_list: D013739:Testosterone
keywords: Definition of hypogonadism; prescription; regional difference; reimbursement of drug costs; testosterone