title: Factors that may be influencing the rise in prescription testosterone replacement therapy in adult men: a qualitative study.
abstract: OBJECTIVE
  To explore and describe the factors that may be influencing the rise of prescribing and use of testosterone replacement therapy (TRT) in adult men.
  
  
  METHODS
  A rapid qualitative research design using semi-structured interviews with providers and patients.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  Nine men who have used TRT (referred to as "patients"), and six primary care clinicians and seven specialists (collectively referred to as "providers") who prescribed or administered TRT.
  
  
  METHODS
  Patients' and providers' perspectives were investigated through semi-structured interviews. A purposive sampling approach was used to recruit all participants. We conducted qualitative analysis using the framework approach for applied health research.
  
  
  RESULTS
  Participants perceived the following factors to have influenced TRT prescriptions and use in adult men: provider factors (diagnostic ambiguity of age-related hypogonadism and beliefs about appropriateness of TRT) and patient factors (access to information on TRT and drug seeking behavior). They perceived that these factors have perpetuated a rise in prescription in the absence of clear clinical guidelines and unclear research evidence on the safety and efficacy of TRT.
  
  
  CONCLUSIONS
  The findings of this study highlight that much work still needs to be done to improve diagnostic accuracy and encourage appropriate TRT prescription in adult men. In addition, both patients and providers need more information about the risks and long-term effects of TRT in men.
authors.affiliation: a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada .
authors.forename: Alekhya
authors.initials: A
authors.lastname: Mascarenhas
authors.affiliation: a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada .
authors.forename: Sobia
authors.initials: S
authors.lastname: Khan
authors.affiliation: a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada .
authors.forename: Radha
authors.initials: R
authors.lastname: Sayal
authors.affiliation: a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada .
authors.forename: Sandra
authors.initials: S
authors.lastname: Knowles
authors.affiliation: a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada .|b The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada , and.|c Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada .
authors.forename: Julia E
authors.initials: JE
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005058:Eunuchism / Q000188:drug therapy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D036301:Qualitative Research; D013739:Testosterone / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013739:Testosterone
keywords: Testosterone replacement therapy; androgen therapy; hypogonadism; qualitative research