Figure - available from: International Journal of Impotence Research
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Annual trends of testosterone claim counts across different medication forms The line with open box symbols shows total testosterone claims across all types from 2013 to 2017. Line with circle symbols shows claims for transdermal/topical testosterone. The triangle line shows the claim count for injectable testosterone. The line with the solid box is Per Os (Oral) preparation claims and the line with the vertical dash symbol is pellet preparation claims.
Source publication
Testosterone Therapy (TTh) trends have changed as a result of clinical research and market forces over the past several years. Understanding the trends or preferences regarding testosterone prescriptions remains unknown. Our objective was to assess both regional and national trends in TTh prescriptions amongst medical specialties within the United...
Citations
... However, further research concluded that there was insufficient data to show a significant increase cardiovascular risk with use of TTh [6]. Following this determination, prescriptions for TTh have increased through 2017 [7]. ...
... We demonstrate a significant increase in testosterone prescriptions coinciding with the release of new TD management guidelines by the AUA and ES in 2018. This trend of rising testosterone prescriptions in CMS between 2016 to 2019 is consistent with years prior [7]. Our analysis highlights the statistically significant increase in the average annual claims per provider in 2018, the year of AUA and ES guideline publication, compared to the year prior, suggesting that the new guidelines are associated with higher prescriptions rates. ...
... Unfortunately, the large proportion of prescriptions where the specific formulation or modality of testosterone was unspecified in the CMS dataset prohibits analysis of modality prescribed without significant bias. While trends in testosterone modality usage are beyond the scope of this investigation, past studies have shown that there is significant variation between specialties [7]. Finally, our study focused on the guidelines' association with prescription rates, we were not able to elucidate if providers actual adhered to the recommendations. ...
The American Urological Association and Endocrine Society published guidelines for the management of testosterone deficiency in 2018. Testosterone prescription patterns have varied widely recently, owing to increased public interest and emerging data on the safety of testosterone therapy. The effect of guideline publication on testosterone prescribing is unknown. Thus, we aimed to assess testosterone prescription trends using Medicare prescriber data. Specialties with over 100 testosterone prescribers from 2016–2019 were analyzed. Nine specialties were included (in order of descending prescription frequency): family practice, internal medicine, urology, endocrinology, nurse practitioners, physician assistants, general practice, infectious disease, and emergency medicine. The number of prescribers grew by a mean of 8.8% annually. There was a significant increase in average claims per provider from 2016 to 2019 (26.4 to 28.7, p < 0.0001), with the steepest increase occurring between 2017 and 2018 when the guidelines were released (27.2 to 28.1, p = 0.015). The largest increase in claims per provider was among urologists. Advanced practice providers comprised 7.5% of Medicare testosterone claims in 2016 and 11.6% in 2019. While no causation can be established, these results suggest that professional society guidelines are associated with increasing numbers of testosterone claims per provider, especially among urologists. The changing demographics of prescribers justifies targeted education and further research.
... Evidence of this increased interest in men's healthcare and therapeutics continues to be illustrated within the literature. For example, increasing the use of testosterone replacement therapy has been demonstrated time and time again [11][12][13]. W hile these trends may likely be multifactorial, they are most certainly spurred on by growing patient motivation and access to free information. Ensuring that online patient-facing content is accurate and understandable is essential for all patients, regardless of access or resources. ...
Introduction: The use of online health information by patients has gained considerable attention during the last decade. The National Institute of Health (NIH) and American Medical Association (AMA) advocate the dissemination of accessible and readable resources. We aimed to evaluate the readability of online patient resources from the Sexual Medicine Society of North America (SMSNA) website.
Methods: Content published under the web-section “SMSNA: For Patients - conditions and topics'' portal (n=16) were reviewed. Identical topics published online via Urology Care Foundation (ie AUA; n=8) and the European Association of Urology (ie EAU; n=8) were also reviewed. Readability and estimated educational level required for understanding was assessed using validated readability and English language assessment tools including the Flesh Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau and Automated Readability index.
Results: SMSNA online patient education materials (PEM), on average, are written at a college sophomore reading level (14th grade). This is 6.5 and 8 grade levels higher than the average U.S. adult and recommended reading levels for PEM, respectively. Comparable AUA and EAU resources were an average of 10th (p<0.05) and 12th (p=0.854) grade reading levels, respectively.
Conclusion: Men’s sexual health PEM’s published online are written at an advanced reading level, most notably the SMSNA compared to equivalent professional sources. This could pose a barrier to patient understanding and impact patients’ engagement and health decision-making. One proposed mitigatory strategy is for PEM to provide improved readability, and appropriate user-friendly language to facilitate easier and inclusive understanding, outreach and educational support.
Background
Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction.
Aim
In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD.
Methods
We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen.
Outcomes
Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone.
Results
Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years.
Clinical Implications
The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment.
Strengths and Limitations
Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD.
Conclusion
Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment.
Objective:
To characterize direct-to-consumer men's health clinics by reviewing their online content. Increasing numbers of patients are seeking treatment for erectile dysfunction and hypogonadism from direct-to-consumer "men's health" clinics. Treatments are often used off-label, with lack of transparency of provider credentials and qualifications.
Methods:
We identified direct-to-consumer Men's Health Clinics in the United States by internet search by state using the terms, "Men's Health Clinic," and "Low T Center." All stand-alone clinics were reviewed.
Results:
223 clinics were reviewed, with 147 (65.9%) offered ED treatments and 196 (87.9%) offering testosterone replacement and 120 (53.8%) offering both ED treatment and testosterone replacement. Of those clinics offering ED treatments, 93 (63.3%) advertised SWT and 84 (57.1%) PRP therapy. There were 56 (38%) who offered SWT and PRP. ICI was significantly more likely to be offered if there was a urologist on staff (p<0.001). Clinic providers represented 20 different medical and alternative medicine specialties. Internal medicine was most common (17.4%), followed by family medicine (11.1%). A non-physician (nurse practitioner or physician assistant) was listed as the primary provider in 10 clinics (4.5%) and 45 clinics (20.1%) did not list their providers. Urologists were listed as the primary provider in 10.3% of clinics. A naturopathic provider was listed as a staff member in 22 (11.6%) of clinics.
Conclusion:
There is significant heterogeneity and misinformation available to the public regarding men's health. Familiarity with and insight into practice patterns of "men's health" clinics will help provide informed patient care and counseling.
