Ascertainment of Testosterone Prescribing Practices in the VA
Abstract
BACKGROUND: Prescribing of exogenous testosterone is increasing. Because of the risks associated with testosterone, it is important to follow evidence-based procedures when initiating therapy. OBJECTIVE: We evaluated whether dispensing of testosterone was preceded by appropriate ascertainment of androgen deficiency, and consideration of potential contraindications, in accordance with practice guidelines. RESEARCH DESIGN: A cross-sectional study. SETTING: All outpatient clinics within Veterans Affairs (VA) during fiscal years 2009-2012 (FY09-FY12). SUBJECTS: A total of 111,631 men who had not previously received testosterone from VA, and received at least 1 testosterone dispensing during the study period. A 1-year "look-back" period was used to check for diagnostic tests that occurred before the first fill. MEASURES: Proportion who underwent appropriate diagnostic evaluation of androgen deficiency and ascertainment of contraindications for testosterone therapy during the year before receiving their first testosterone dispensing. RESULTS: New testosterone dispensing in VA increased from 20,437 in FY09 to 36,394 in FY12. Only 3.1% of men who received testosterone had 2 or more low (total or free) testosterone levels in the morning, LH and/or FSH level measured, and no contraindications to testosterone therapy. A total of 16.5% did not have their testosterone level checked at all. Among those prescribed therapy, 1.4% had prostate cancer, 7.6% had obstructive sleep apnea, and 3.5% had elevated hematocrit at baseline. CONCLUSIONS: Only a small proportion of men receiving testosterone in VA underwent appropriate testing, and some received this therapy despite important contraindications. Promoting a more uniform application of clinical guidelines may facilitate appropriate use of testosterone.
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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”
From Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study (2017) · cites this paper as [2]
Cites
Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999) · JAMA · doi:10.1001/jama.282.15.1458 · Cited by 6,677 · see citing works
Organizing Care for Patients with Chronic Illness
Wagner, E. H., Austin, B. T., & Korff, M. V. (1996) · The Milbank Quarterly · doi:10.2307/3350391 · Cited by 2,877 · see citing works
Longitudinal Effects of Aging on Serum Total and Free Testosterone Levels in Healthy Men
Harman, S. M., Metter, E. J., Tobin, J. D., Pearson, J., & Blackman, M. R. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.2.7219 · Cited by 2,760 · see citing works
Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., & Montori, V. M. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2354 · Cited by 1,954 · see citing works
Self-citationFeldman, H. A., Longcope, C., Derby, C. A., Johannes, C. B., Araujo, A. B., Coviello, A. D., Bremner, W. J., & McKinlay, J. B. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.2.8201 · Cited by 1,861 · see citing works
Adverse Events Associated with Testosterone Administration
Basaria, S., Coviello, A. D., Travison, T. G., Storer, T. W., Farwell, W. R., Jette, A. M., Eder, R., Tennstedt, S., Ulloor, J., Zhang, A., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1000485 · Cited by 1,494 · see citing works
Self-citationVigen, R. (2013) · JAMA · doi:10.1001/jama.2013.280386 · Cited by 1,003 · see citing works
Investigation, treatment and monitoring of late-onset hypogonadism in males
Wang, C., Nieschlag, E., Swerdloff, R., Behre, H. M., Hellstrom, W. J., Gooren, L. J., Kaufman, J. M., Legros, J.-J., Lunenfeld, B., Morales, A., et al. (2008) · European Journal of Endocrinology · doi:10.1530/eje-08-0601 · Cited by 867 · see citing works
Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men
Finkle, W. D., Greenland, S., Ridgeway, G. K., Adams, J. L., Frasco, M. A., Cook, M. B., Fraumeni, J. F., & Hoover, R. N. (2014) · PLoS ONE · doi:10.1371/journal.pone.0085805 · Cited by 735 · see citing works
Clinical decision support systems for the practice of evidence-based medicine
Sim, I., Gorman, P., Greenes, R. A., Haynes, R. B., Kaplan, B., Lehmann, H., & Tang, P. C. (2001) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2001.0080527 · Cited by 732 · see citing works
Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care
Jha, A. K., Perlin, J. B., Kizer, K. W., & Dudley, R. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa021899 · Cited by 643 · see citing works
Xu, L., Freeman, G., Cowling, B. J., & Schooling, C. M. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-108 · Cited by 562 · see citing works
Jones, T. H., Arver, S., Behre, H. M., Buvat, J., Meuleman, E., Moncada, I., Morales, A. M., Volterrani, M., Yellowlees, A., Howell, J. D., et al. (2011) · Diabetes Care · doi:10.2337/dc10-1233 · Cited by 548 · see citing works
Petak, S. M., Nankin, H. R., Spark, R. F., Swerdloff, R. S., Rodriguez‐Rigau, L. J., Anderson, R. J., Bergman, D. A., Garber, J. R., Hamilton, C. R., Hershon, K. S., et al. (2002) · Endocrine Practice · doi:10.4158/ep.8.6.439 · Cited by 372 · see citing works
Bhasin, S., Pencina, M., Jasuja, G. K., Travison, T. G., Coviello, A., Orwoll, E., Wang, P. Y., Nielson, C., Wu, F., Tajar, A., et al. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-3012 · Cited by 355 · see citing works
Self-citationTrends in androgen prescribing in the United States, 2001 to 2011
Baillargeon, J., Urban, R. J., Ottenbacher, K. J., Pierson, K. S., & Goodwin, J. S. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.6895 · Cited by 336 · see citing works
Veterans’ Access to and Use of Medicare and Veterans Affairs Health Care
Hynes, D. M., Koelling, K., Stroupe, K. T., Arnold, N., Mallin, K., Sohn, M., Weaver, F. M., Manheim, L. M., & Kok, L. (2007) · Medical Care · doi:10.1097/01.mlr.0000244657.90074.b7 · Cited by 311 · see citing works
Wang, C., Nieschlag, E., Swerdloff, R. S., Behre, H. M., Hellstrom, W. J. G., Gooren, L. J., Kaufman, J., Legros, J.-J., Lunenfeld, B., Morales, Á., et al. (2008) · International Journal of Impotence Research · doi:10.1038/ijir.2008.41 · Cited by 287 · see citing works
Prevalence and Costs of Chronic Conditions in the VA Health Care System
Yu, W., Ravelo, A., Wagner, T. H., Phibbs, C. S., Bhandari, A., Chen, S., & Barnett, P. G. (2003) · Medical Care Research and Review · doi:10.1177/1077558703257000 · Cited by 282 · see citing works
Effects of Testosterone and Progressive Resistance Training in Eugonadal Men with AIDS Wasting
Grinspoon, S. K., Corcoran, C., Parlman, K., Costello, M., Rosenthal, D., Anderson, E., Stanley, T. L., Schoenfeld, D., Burrows, B. A., Hayden, D., et al. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-133-5-200009050-00010 · Cited by 207 · see citing works
Testosterone Lab Testing and Initiation in the United Kingdom and the United States, 2000 to 2011
Layton, J. B., Li, D., Meier, C. R., Sharpless, J. L., Stürmer, T., Jick, S. S., & Brookhart, M. A. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3570 · Cited by 195 · see citing works
Risks and benefits of testosterone therapy in older men
Spitzer, M., Huang, G., Basaria, S., Travison, T. G., & Bhasin, S. (2013) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.73 · Cited by 154 · see citing works
Self-citationThe use of claims data in healthcare research.
Ferver, K., Burton, B., & Jesilow, P. (2009) · The Open Public Health Journal · doi:10.2174/1874944500902010011 · Cited by 103 · see citing works
Screening and Monitoring in Men Prescribed Testosterone Therapy in the U.S., 2001–2010
Baillargeon, J., Urban, R. J., Kuo, Y.-F., Holmes, H. M., Raji, M. A., Morgentaler, A., Howrey, B. T., Lin, Y.-L., & Ottenbacher, K. J. (2015) · Public Health Reports® · doi:10.1177/003335491513000207 · Cited by 61 · see citing works
Androgen therapy in AIDS wasting
Dobs, A. S. (1998) · Baillière s Clinical Endocrinology and Metabolism · doi:10.1016/s0950-351x(98)80096-7 · Cited by 37 · see citing works
Gentry, J., Price, D., & Peiris, A. N. (2013) · Southern Medical Journal · doi:10.1097/smj.0b013e3182a5ee77 · Cited by 8 · see citing works
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Cited by
Sorted by citations
Paediatric and adult-onset male hypogonadism
Salonia, A., Rastrelli, G., Hackett, G., Seminara, S. B., Huhtaniemi, I. T., Rey, R. A., Hellstrom, W. J. G., Palmert, M. R., Corona, G., Dohle, G. R., et al. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0087-y · Cited by 286 · see citing works
Testosterone treatment and risk of venous thromboembolism: population based case-control study
Martinez, C., Suissa, S., Rietbrock, S., Katholing, A., Freedman, B., Cohen, A. T., & Handelsman, D. J. (2016) · BMJ · doi:10.1136/bmj.i5968 · Cited by 181 · see citing works
Storer, T. W., Basaria, S., Traustadottir, T., Harman, S. M., Pencina, K., Li, Z., Travison, T. G., Miciek, R., Tsitouras, P., Hally, K., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2771 · Cited by 174 · see citing works
Self-citationPonce, O. J., Spencer-Bonilla, G., Alvarez-Villalobos, N., Serrano, V., Singh-Ospina, N., Rodriguez-Gutierrez, R., Salcido-Montenegro, A., Benkhadra, R., Prokop, L. J., Bhasin, S., et al. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-00404 · Cited by 148 · see citing works
Self-citation2016 Update on Medical Overuse: A Systematic Review
Morgan, D. J., Dhruva, S. S., Wright, S. M., & Korenstein, D. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.5381 · Cited by 104 · see citing works
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., et al. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3940-7 · Cited by 44 · see citing works
Self-citationIrrational Exuberance in Testosterone Prescribing: When Will the Bubble Burst?
Handelsman, D. J. (2015) · Medical Care · doi:10.1097/mlr.0000000000000416 · Cited by 22 · see citing works
- Authors
- Jasuja, G. K., Bhasin, S., Reisman, J. I., Berlowitz, D. R., & Rose, A. J.
- Affiliations
- Boston University (US)
- Brigham and Women's Hospital (US)
- Center for Health Optimization and Implementation Research (US)
- Corresponding author
- Jasuja, Guneet K.
- Reisman, Joel I.
- Berlowitz, Dan R.
- Rose, Adam J.
- Venue
- Medical Care
- Published
- 2015-09
- Volume
- 53
- Issue
- 9
- Pages
- 746-752
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2395185113
- Cited by
- 51
- References
- 26
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 15 · 2016: 9 · 2015: 2
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK2 HX001553)
- 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 › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- testosterone replacement therapy, androgen deficiency, prescribing patterns, veterans, clinical guideline adherence, prostate cancer, obstructive sleep apnea, hematocrit, appropriateness of prescribing
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Humans, Male, Middle Aged, Practice Patterns, Physicians', Testosterone, United States, United States Department of Veterans Affairs, Guideline Adherence
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