Audit on testosterone therapy in adult males with testosterone deficiency

Abstract

Introduction: Hypogonadism is estimated to affect between 2.1 and 12.8% of the adult male population. Method: A review of 235 patients suffering from hypogonadism was undertaken. Local standards of care were compare to the Endocrine Society Clinical Practice Guideline of 2010 (ESCG). Results: Patients complained of 0, 1-4, 5-8 symptoms suggestive of hypogonadism in 17%, 67% and 16% respectively. 76.5% of the patients had repeatedly low testosterone. 20% suffered from primary hypogonadism. 77% suffered from secondary hypogonadism secondary. Karyotype was obtained in 35% and 5% of the patients suffering from primary and secondary hypogonadism respectively. Patients suffering from secondary hypogonadism had serum TSH (94%), prolactin (92%), cortisol (91%), GH levels (89%) and iron studies (43%) analysed. 77% of patients suffering from secondary hypogonadism had an MRI of the pituitary, with an abnormality reported in 53% of the patients. Prior to starting treatment 7% of the patients were assessed for prostate nodules and PSA was taken in 39% of the patients. Only 33% of the patients had bone mineral density (BMD) taken prior to starting testosterone treatment. Patients were reviewed 3-6 months (35%) and then annually (88%) after treatment was initiated. Conclusion: The study identifies the need for documentation of signs and symptoms. Testosterone levels should be repeated prior to starting treatment. It also highlights the need for karyotyping in patients with primary hypogonadism as well as the need to measure BMD and PSA before and after prescribing testosterone. Patients need review at 3-6months after initiation of testosterone supplementations.