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Cited by 44Hormonal and reproductive studiesAdrenal Hormones and DisordersOpioid Use Disorder Treatment

Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study

Open access
Jasuja, Guneet K., Bhasin, Shalender, Reisman, Joel I., Hanlon, Joseph T., Miller, Donald R., Morreale, Anthony P., Pogach, Leonard M., Cunningham, Francesca E. +3 more·2017·Journal of General Internal Medicine
DOI 10.1007/s11606-016-3940-7PMC PMC5331013
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Abstract

Background There has been concern about the growing off-label use of testosterone. Understanding the context within which testosterone is prescribed may contribute to interventions to improve prescribing.Objective To evaluate patient characteristics associated with receipt of testosterone.Design Cross-sectional.Setting A national cohort of male patients, who had received at least one outpatient prescription within the Veterans Affairs (VA) system during Fiscal Year 2008- Fiscal Year 2012.Participants The study sample consisted of 682,915 non-HIV male patients, of whom 132,764 had received testosterone and a random 10% sample, 550,151, had not.Main measures Conditions and medications associated with testosterone prescription.Key results Only 6.3% of men who received testosterone from the VA during the study period had a disorder of the testis, pituitary or hypothalamus associated with male hypogonadism. Among patients without a diagnosed disorder of hypogonadism, the use of opioids and obesity were the strongest predictors of testosterone prescription. Patients receiving >100 mg/equivalents of oral morphine daily (adjusted odds ratio = 5.75, p < 0.001) and those with body mass index (BMI) >40 kg/m 2 (adjusted odds ratio = 3.01, p < 0.001) were more likely to receive testosterone than non-opioid users and men with BMI <25 kg/m 2. Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001).Conclusions In the VA, 93.7% of men receiving testosterone did not have a diagnosed condition of the testes, pituitary, or hypothalamus. The strongest predictors of testosterone receipt (e.g., obesity, receipt of opioids), which though are associated with unapproved, off-label use, may be valid reasons for therapy. Interventions should aim to increase the proportion of testosterone recipients who have a valid indication.

AI snapshot

Written from the paper’s full text.

TL;DR

In a national VA cross-sectional study of 682,915 non-HIV male patients, only 6.3% of testosterone recipients had a diagnosed testicular, pituitary, or hypothalamic condition associated with classical hypogonadism. Among men without such a diagnosis, high-dose opioid use and severe obesity were the strongest predictors of testosterone receipt.

Key findings

  • Of 141,743 patients who received testosterone at least once during FY08–FY12, 8,890 (6.3%) had a diagnosed condition of the testis, pituitary, or hypothalamus; these conditions were absent in 93.7% of testosterone recipients and 99.0% of non-testosterone patients.
  • Among patients without a diagnosed classical hypogonadism indication, the strongest predictors of testosterone receipt were opioid use and obesity: patients receiving >100 mg/day morphine equivalents had adjusted odds ratio (AOR) = 5.75, and those with BMI >40 kg/m² had AOR = 3.01, both p < 0.001.
  • Other predictors of higher testosterone receipt included age 40–54, White race, sleep apnea (AOR = 1.79), depression (AOR = 1.38), diabetes (AOR = 1.28), antidepressants (AOR = 1.37), and systemic glucocorticoids (AOR = 1.15), all with AOR < 2 and p < 0.001.
  • Among testosterone recipients, 20.6% had no testosterone level checked, 5.3% had at least one level that was not low, 54.5% had only one documented low level, and 19.6% had two or more low levels as guidelines require; 79% had at least some documentation of testosterone levels before initiating therapy.

Methods

  • Cross-sectional analysis of VA outpatient pharmacy, diagnostic, and prescription data from FY2008–FY2012. The initial sample was 810,686 male patients; after exclusions for HIV, classical hypogonadism, gender identity disorder, and insufficient look-back data, the final analytical sample was 682,915 non-HIV male patients (132,764 testosterone recipients and 550,151 non-recipients).
  • Testosterone receipt was the primary outcome. Independent variables included socio-demographics, comorbid conditions, BMI, and medication classes (opioids, antidepressants, antipsychotics, systemic glucocorticoids), assessed during a 1-year look-back before the index fill.
  • Logistic regression generated bivariate and fully adjusted models; a 10% random sample of non-testosterone patients was weighted by 10 for proportions but not odds ratios. Statistical significance was set at p < 0.001.

Limitations

  • The paper states that the dataset cannot capture how patients or providers interpret health complaints or chronic conditions, and whether those meanings influence prescribing; ICD-9 codes may be inaccurate, though two codes separated by ≥7 days were required; determinants outside the VA may differ; provider- or site-level factors were not controlled; and the analysis focused on receiving testosterone at least once, not continuation or duration.
  • The text makes evident that this is an observational cross-sectional study, so associations cannot establish causality, and residual confounding by unmeasured patient or provider factors is possible.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s11606-016-3940-7

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among VA male patients without diagnosed classical hypogonadism, opioid use and obesity were the strongest predictors of testosterone receipt.

    “Among patients without a diagnosed disorder of hypogonadism, the use of opioids and obesity were the strongest predictors of testosterone prescription.”
    • Also stated in: § DISCUSSION · hedged
      “Among those without a diagnosed condition, the men most likely to receive testosterone were middle-aged men with obesity who had comorbid conditions such as obstructive sleep apnea, depression, or diabetes or who were using medications such as opioids, anti-depressants, or glucocorticoids.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among VA male patients without diagnosed classical hypogonadism, diabetes was associated with an adjusted odds ratio of 1.28 for testosterone receipt.

    “Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001).”
    • Also stated in: § Comorbid Conditions and Medications Associated with Testosterone Use · plain
      “Testosterone receipt was more likely in patients with sleep apnea (AOR = 1.79), hyperlipidemia (AOR = 1.43), depression (AOR = 1.38), bipolar disorder (AOR = 1.34), diabetes (AOR = 1.28), hypertension (AOR = 1.25), anxiety disorder (AOR = 1.18), and post-traumatic stress disorder (AOR = 1.10).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among VA male patients without diagnosed classical hypogonadism, those receiving >100 mg/day morphine equivalents had an adjusted odds ratio of 5.75 for testosterone receipt compared with those receiving no opioids.

    “Patients receiving >100 mg/equivalents of oral morphine daily (adjusted odds ratio = 5.75, p < 0.001) and those with body mass index (BMI) >40 kg/m 2 (adjusted odds ratio = 3.01, p < 0.001) were more likely to receive testosterone than non-opioid users and men with BMI <25 kg/m 2 .”
    • Also stated in: § Comorbid Conditions and Medications Associated with Testosterone Use · plain
      “Men receiving a dose greater than 100 mg/ day morphine equivalents had nearly six times the odds of receiving testosterone compared to patients receiving no opioids in the fully adjusted model (AOR = 5.75).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among VA male patients without diagnosed classical hypogonadism, men aged 40-54 years were more likely to receive testosterone than other age groups.

    “Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001).”
    • Also stated in: § Patient Socio-Demographics Associated with Testosterone Prescription · plain
      “In the fully adjusted model, men age 40-54 years were most likely to receive testosterone, while those under 40 years [adjusted odds ratio (AOR) = 0.67; for this and all other findings discussed here, p < 0.001] and those over 80 years (AOR = 0.37) were considerably less likely.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among VA male patients without diagnosed classical hypogonadism, White non-Hispanic race was associated with a higher likelihood of testosterone receipt compared with Hispanic and Black non-Hispanic race.

    “Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001).”
    • Also stated in: § Patient Socio-Demographics Associated with Testosterone Prescription · plain
      “Hispanic and Black non-Hispanics were less likely to receive testosterone compared to White non-Hispanics (AOR = 0.61 and 0.72, respectively).”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 12
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 3

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, anxiety disorder was associated with an adjusted odds ratio of 1.18 for testosterone receipt.

    “Testosterone receipt was more likely in patients with sleep apnea (AOR = 1.79), hyperlipidemia (AOR = 1.43), depression (AOR = 1.38), bipolar disorder (AOR = 1.34), diabetes (AOR = 1.28), hypertension (AOR = 1.25), anxiety disorder (AOR = 1.18), and post-traumatic stress disorder (AOR = 1.10).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, post-traumatic stress disorder was associated with an adjusted odds ratio of 1.10 for testosterone receipt.

    “Testosterone receipt was more likely in patients with sleep apnea (AOR = 1.79), hyperlipidemia (AOR = 1.43), depression (AOR = 1.38), bipolar disorder (AOR = 1.34), diabetes (AOR = 1.28), hypertension (AOR = 1.25), anxiety disorder (AOR = 1.18), and post-traumatic stress disorder (AOR = 1.10).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, hyperlipidemia was associated with an adjusted odds ratio of 1.43 for testosterone receipt.

    “Testosterone receipt was more likely in patients with sleep apnea (AOR = 1.79), hyperlipidemia (AOR = 1.43), depression (AOR = 1.38), bipolar disorder (AOR = 1.34), diabetes (AOR = 1.28), hypertension (AOR = 1.25), anxiety disorder (AOR = 1.18), and post-traumatic stress disorder (AOR = 1.10).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, sleep apnea was associated with an adjusted odds ratio of 1.79 for testosterone receipt.

    “Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001).”
    • Also stated in: § Comorbid Conditions and Medications Associated with Testosterone Use · plain
      “Testosterone receipt was more likely in patients with sleep apnea (AOR = 1.79), hyperlipidemia (AOR = 1.43), depression (AOR = 1.38), bipolar disorder (AOR = 1.34), diabetes (AOR = 1.28), hypertension (AOR = 1.25), anxiety disorder (AOR = 1.18), and post-traumatic stress disorder (AOR = 1.10).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, stroke was associated with a lower likelihood of testosterone receipt (AOR = 0.67).

    “Some conditions, such as prostate cancer (AOR = 0.28), stroke (AOR = 0.67), dementia (AOR = 0.76), and heart failure (AOR = 0.83), were associated with lower likelihood of receiving testosterone.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, prostate cancer was associated with a lower likelihood of testosterone receipt (AOR = 0.28).

    “Some conditions, such as prostate cancer (AOR = 0.28), stroke (AOR = 0.67), dementia (AOR = 0.76), and heart failure (AOR = 0.83), were associated with lower likelihood of receiving testosterone.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, any opioid use was associated with an adjusted odds ratio of 1.70 for testosterone receipt compared with no opioid use.

    “Opioid use was the most highly associated with testosterone (AOR = 1.70 compared *Odds ratio differs from the reference group, that is, patients without the specified factor, at the level of P < 0.001.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, hypertension was associated with an adjusted odds ratio of 1.25 for testosterone receipt.

    “Testosterone receipt was more likely in patients with sleep apnea (AOR = 1.79), hyperlipidemia (AOR = 1.43), depression (AOR = 1.38), bipolar disorder (AOR = 1.34), diabetes (AOR = 1.28), hypertension (AOR = 1.25), anxiety disorder (AOR = 1.18), and post-traumatic stress disorder (AOR = 1.10).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, those who had a copayment for medications were less likely to receive testosterone compared with those with no copay (AOR = 0.81).

    “Patients who had a copayment for medications were less likely to receive testosterone compared to those with no copay (AOR = 0.81).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, dementia was associated with a lower likelihood of testosterone receipt (AOR = 0.76).

    “Some conditions, such as prostate cancer (AOR = 0.28), stroke (AOR = 0.67), dementia (AOR = 0.76), and heart failure (AOR = 0.83), were associated with lower likelihood of receiving testosterone.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, those residing in zip codes with more than 30% of residents living in poverty were less likely to receive testosterone (AOR = 0.76 compared to less than 10% poverty).

    “Men residing in zip codes with more than 30% of residents living in poverty were less likely to receive testosterone (AOR = 0.76 compared to less than 10% poverty).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among VA male patients without diagnosed classical hypogonadism, heart failure was associated with a lower likelihood of testosterone receipt (AOR = 0.83).

    “Some conditions, such as prostate cancer (AOR = 0.28), stroke (AOR = 0.67), dementia (AOR = 0.76), and heart failure (AOR = 0.83), were associated with lower likelihood of receiving testosterone.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Testosterone therapy may be justifiable in men receiving opioids who may suffer from opioid-induced suppression of testosterone levels and associated sexual dysfunction, osteoporosis, and/or muscle atrophy.

    “Testosterone therapy may be justifiable in patients with some of these conditions, such as men receiving opioids, who may suffer from opioid-induced suppression of testosterone levels 32 and sexual dysfunction, 33 osteoporosis, and/or muscle atrophy.34”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [32] Smith HS, Elliott JA. Opioid-induced androgen deficiency (OPIAD). Pain Physician. 2012;15(3 Suppl):Es145–56.

      Not checked in the free run.

    • cites [33] Isidori AM, Giannetta E, Gianfrilli D, et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf). 2005;63(4):381–94. source

      Not checked in the free run.

    • cites [34] Daniell HW. Opioid osteoporosis. Arch Intern Med. 2004;164(3):338. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The study used a large and highly detailed data set from the nation's largest integrated system of care and adjusted for a comprehensive set of patient-level predictors of testosterone receipt.

    “We used a large and highly detailed data set from the nation's largest integrated system of care and adjusted for a comprehensive set of patient-level predictors of testosterone receipt.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The Endocrine Society guidelines recommend that the diagnosis of androgen deficiency should be made by ascertainment of signs and symptoms together with low morning testosterone levels on two or more occasions.

    “The Endocrine Society guidelines recommend that the diagnosis of androgen deficiency should be made by ascertainment of signs and symptoms together with low morning testosterone levels on two or more occasions.1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536–59. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Clinical guidelines emphasize the need to measure free testosterone levels, rather than total testosterone, in obese or diabetic patients.

    “Clinical guidelines emphasize the need to measure free testosterone levels, rather than total testosterone, in obese or diabetic patients.1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536–59. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The study required two ICD-9 codes separated by 7 or more days to confirm the presence of conditions.

    “We addressed this concern in part by requiring two ICD-9 codes to confirm the conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Obesity and diabetes are associated with low SHBG, which may lower total testosterone levels.

    “Both obesity and diabetes are associated with low SHBG, which may lower total testosterone levels.18,36”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Wang C, Jackson G, Jones TH, et al. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care. 2011;34(7):1669–75. source

      Not checked in the free run.

    • cites [36] Fui MNT, Dupuis P, Grossmann M. Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian J Androl. 2014;16(2):223–31. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The increasing off-label use of testosterone motivated the FDA's recent move to more explicitly restrict the label to diseases of the testis, pituitary, and hypothalamus.

    “The increasing off-label use of testosterone motivated the FDA's recent move to more explicitly restrict the label to diseases of the testis, pituitary, and hypothalamus.37”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Tavernise S. FDA Panel Backs Limits on Testosterone Drugs. New York: The New York Times Company. Available at: http://nyti.ms/1uU2VZ1 . Accessed: December 9, 2014.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Potential contributors to overprescribing of testosterone include commercial advertising and lax definition of hypogonadism by some society guidelines that fails to distinguish true pathological hypogonadism from the mere presence of low testosterone levels.

    “Potential contributors to this overprescribing of testosterone include commercial advertising and lax definition of Bhypogonadism^by some society guidelines that fails to distinguish between true pathological hypogonadism (for which testosterone therapy is approved) and the mere presence of low testosterone levels.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Handelsman DJ. Irrational exuberance in testosterone prescribing: when will the bubble burst? Med Care. 2015;53(9):743–5. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    We have previously reported that 16.5% of male Veterans Administration Health Care System patients received testosterone therapy without first undergoing the recommended workup.

    “We have previously reported that 16.5% of male Veterans Administration Health Care System (VA) patients received this therapy without first undergoing the recommended workup. 2”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Jasuja GK, Bhasin S, Reisman JI, Berlowitz DR, Rose AJ. Ascertainment of testosterone prescribing practices in the VA. Med Care. 2015;53(9):746–52. source

      Not checked in the free run.

21 of 21

  • The paper relies on this without support.

    ICD-9 diagnosis codes accurately identify the conditions of interest (classical hypogonadism and comorbidities).

    “We determined the presence of such conditions using inpatient and outpatient ICD-9 diagnosis codes (Online Appendix 1).”
    “although ICD-9 codes are commonly used to identify conditions, these codes may not always be applied accurately by practicing clinicians.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Obesity has emerged as one of the strongest predictors of receiving testosterone treatment in middle-aged US American men.

    “obesity has emerged as one of the strongest predictors of receiving testosterone treatment in middle-aged US American men. 2”

    From Hypogonadism and male obesity: Focus on unresolved questions (2018) · cites this paper as [2]

The citation lists haven’t been fetched yet

References 33 · Cited by 44

Research works printed but not linked: 1

  1. Krieger N, Waterman PD, Chen JT, et al. Geocoding and Monitoring US Socioeconomic Inequalities in Health: An Introduction to Using Area-Based Socioeconomic Measures—The Public Health Disparities Geocoding Project Monograph [online]. Boston, MA: Harvard School of Public Health; 2004.

Authors
Jasuja, G. K., Bhasin, S., Reisman, J. I., Hanlon, J. T., Miller, D. R., Morreale, A. P., Pogach, L. M., Cunningham, F. E., Park, A., Berlowitz, D. R., & Rose, A. J.
Affiliations
  • Boston University (US)
  • Brigham and Women's Hospital (US)
  • Edith Nourse Rogers Memorial Veterans Hospital (US)
  • University of Pittsburgh (US)
  • United States Department of Veterans Affairs (US)
  • VA New Jersey Health Care System (US)
  • VA Boston Healthcare System (US)
Corresponding author
Jasuja, Guneet K.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2016-12-19
Volume
32
Issue
3
Pages
304-311
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-016-3940-7
PMC
PMC5331013
OpenAlex
W4321508407
Semantic Scholar
a429740a17c0c9a9b9a9b4d203b9f9e80b3678f7
Cited by
44
References
33
Citations by year
2025: 4 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 3 · 2020: 2 · 2019: 6 · 2018: 2 · 2017: 7 · 2016: 1
FWCI
5.36
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Health Services Research and Development (CDA 13-265)
  • National Institute on Aging (P30AG024827)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
off-label drug use, male hypogonadism, veterans, opioid use, obesity, comorbidities, prescribing appropriateness, Veterans Affairs health care
MeSH terms
Adult, Aged, Aged, 80 and over, Analgesics, Opioid, Androgens, Cross-Sectional Studies, Humans, Hypogonadism, Male, Middle Aged, Obesity, Practice Patterns, Physicians', Testosterone, United States, United States Department of Veterans Affairs, Veterans, Comorbidity, Body Mass Index, Odds Ratio, Case-Control Studies, Young Adult, Off-Label Use

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