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Endocrinologists, urologists more likely to prescribe testosterone vs. PCPs
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In the Department of Veterans Affairs health care system, prescriptions for testosterone are more likely to be written by younger providers, those with less professional experience and those in the endocrinology and urology fields compared with older providers, those with more experience and those in primary care, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“Our study clearly shows that there is a variation in both receipt of testosterone as well as guideline-concordant prescribing of testosterone in the VA,” Guneet K. Jasuja, PhD, of the Edith Nourse Memorial Veterans Hospital in Bedford, Massachusetts, and Boston University School of Public Health, said in a press release. “Provider’s age, number of years in practice and geographic area are all associated with variations in testosterone prescribing practices.”
Jasuja and colleagues evaluated provider- and site-level determinants for receipt of testosterone and of guideline-concordant testosterone prescribing in a national cohort of men who received at least one outpatient prescription with the VA during fiscal years 2008 to 2012. Data were collected from the national VA system, and provider (n = 38,648) and site (n = 130) characteristics of the patients were captured at the first testosterone prescription fill.
Testosterone prescriptions were more likely to be written by providers aged 31 to 60 years compared with those aged at least 61 years and providers with less than 1 year of experience in the VA compared with those with 16 or more years (adjusted OR = 1.29; 95% CI, 1.24-1.33). Testosterone prescriptions were also more likely to be written by physicians in endocrinology (aOR = 3.86; 95% CI, 3.31-4.49) and in urology (aOR = 1.5; 95% CI, 1.23-1.84) than in primary care.
Compared with sites in the Northeast, sites in the West (aOR = 1.75; 95% CI, 1.45-2.11), South (aOR = 1.63; 95% CI, 1.36-1.95) and Midwest (aOR = 1.37; 95% CI, 1.13-1.67) were more likely to prescribe testosterone. Patients who received some of their care at a community-based outreach clinic were more likely to receive a prescription for testosterone compared with patients receiving care at the main facility only (aOR = 1.22; 95% CI, 1.2-1.24).
To determine whether patients were appropriately tested before being prescribed testosterone, providers and sites were assessed for testing results of at least one low testosterone level, at least two low testosterone levels and at least two low testosterone levels in the morning. Compared with older providers, providers aged 31 to 40 years were more likely to prescribe after finding two low morning testosterone levels (aOR = 1.3; 95% CI, 1.12-1.5). Providers with 16 or more years of experience were more likely to check for two low testosterone levels in the morning compared with providers with less than 1 year experience in the VA (aOR = 0.82; 95% CI, 0.72-0.94). Female providers were more likely to check for two low testosterone levels in the morning compared with male providers (aOR = 0.88; 95% CI, 0.81-0.96). Two low testosterone levels were also more likely to be recorded by physicians in endocrinology compared with those in primary care (aOR = 2.14; 95% CI, 1.54-2.97).
Sites in the Northeast and patients receiving any care at a community-based outreach clinic were more likely to have two low testosterone levels recorded compared with sites in other areas and patients who received care only at the main facility.
“Our findings highlight the opportunity to intervene at the provider and local level to improve testosterone prescribing practices,” Jasuja said in the release. “The VA and other health care systems can use these insights to promote targeted efforts that can help decrease inappropriate prescribing of testosterone, while ensuring that those patients who can benefit the most can still receive it.” – by Amber Cox
Disclosures: Kasuja reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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