title: Adherence to treatment in men with hypogonadotrophic hypogonadism.
abstract: OBJECTIVE
  Men with congenital hypogonadotrophic hypogonadism (CHH) typically require lifelong hormonal therapy, and discontinuing treatment can have negative health consequences. Little is known about adherence to treatment or the psychosocial impact of CHH.
  
  
  METHODS
  A sequential, multiple methods approach was used. A quantitative online survey assessed adherence to treatment, depressive symptoms and illness perceptions. Subsequently, qualitative focus groups explored patient-reported factors for adherence.
  
  
  METHODS
  Adult men with CHH on at least 1 year of treatment were recruited internationally.
  
  
  METHODS
  Adherence (Morisky medication adherence scale), depressive symptoms (Zung self-rating depression scale) and patient perception of CHH (revised illness perception questionnaire) were assessed in an online survey, and comparisons were made to reference groups. Patient focus group discussions were conducted and thematic analysis was employed to identify patient-reported factors for adherence.
  
  
  RESULTS
  In total, 101 men on long-term treatment were included (mean age 37 ± 11 years). Forty three percent (43/101) exhibited low medication adherence and a significantly elevated prevalence of mild, moderate or severe depressive symptoms (27%, 17%, 20%, respectively, all P < 0·001 vs reference population). Patients reported negative illness perceptions and significant psychosocial consequences. Focus group discussions (n = 3, 26 total patients) identified patient-, health professional- and healthcare system-related barriers as targets for improving adherence.
  
  
  CONCLUSIONS
  Congenital hypogonadotrophic hypogonadism men are challenged to adhere to long-term treatment. Poor adherence may contribute to adverse effects on bone, sexual and psychological health. The psychosocial morbidity of CHH is significant and appears to be underappreciated by healthcare providers.
authors.affiliation: Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland.|Endocrinology, Diabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Dwyer
authors.affiliation: Department of Psychology, University of California Merced, Merced, CA, USA.
authors.forename: Jitske
authors.initials: J
authors.lastname: Tiemensma
authors.affiliation: Department of Endocrinology, Institute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Quinton
authors.affiliation: Endocrinology, Diabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.|Department of Physiology, Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Nelly
authors.initials: N
authors.lastname: Pitteloud
authors.affiliation: Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland.|Faculty of Nursing Science, Laval University, Québec City, QC, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Morin
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology*; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000151:congenital / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011584:Psychology; D011795:Surveys and Questionnaires