Testosterone Therapy Prescribing Practices in VA Setting

Veterans receiving testosterone therapy may experience variability in prescribing practices based on clinic size and location and clinician age, according to research published in the Journal of Clinical Endocrinology and Metabolism.

Guneet K. Jasuja, PhD, from the Center for Healthcare Organization and Implementation Research at the Bedford VA Medical Center in Massachusetts, and fellow researchers conducted a cross-sectional study of patients at a Veterans Health Administration (VA) health center who received outpatient testosterone therapy from 2008 to 2012.

 

Prescribing practices of 38,659 clinicians across 130 VA health centers were reviewed.

The researchers found that clinicians between ages 31 and 60 years were more likely to prescribe testosterone therapy than clinicians aged 61 years and older; similarly, those with less experience in the VA health system (≤1 year of service) were also more likely to prescribe testosterone (adjusted odds ratio [aOR], 1.29; 95% CI, 1.24-1.33). Furthermore, clinicians with a specialty focus (endocrinology and urology vs primary care) were more likely to prescribe testosterone therapy (aOR, 3.86 [95% CI, 3.31-4.49] and aOR, 1.50 [95% CI, 1.23-1.84] for endocrinology and urology, respectively).

Location also played a factor in prescribing practices. Patients treated at clinics in the West, South, and Midwest were more likely to receive testosterone (aOR, 1.75 [95% CI, 1.45-2.11]; aOR, 1.63 [95% CI, 1.36-1.95]; and aOR, 1.37 [95% CI 1.13-1.67], respectively) compared with patients treated in clinics in the Northeast. Those patients who received care from community-based outreach clinics were also more likely to receive testosterone (aOR, 1.22; 95% CI, 1.20-1.24).

Appropriate testosterone testing practices were also examined. Younger clinicians (age range, 31-40 years) had a higher likelihood of measuring 2 low morning testosterone levels (aOR, 1.30; 95% CI, 1.12-1.50). In addition, clinicians in sites in the Northeast were more likely to check for 2 low morning testosterone levels before the onset of testosterone therapy. The largest VA sites (categories 1a, the largest/most complex sites, and 1c) were most likely to follow proper testing protocols vs category 3 sites (OR, 1.33 [95% CI, 1.18-1.49] for category 1a sites vs OR, 1.23 [95% CI, 1.08-1.41] for category 3).

“[O]ur results highlight the opportunity to intervene [in testosterone prescribing practices] at both the provider and the site level,” the investigators wrote. “[A] variety of interventions…have been used to improve and standardize proper provider providing practice…. Through such efforts, providers’ knowledge of how to manage male hypogonadism could be increased, which could help promote adherence to existing clinical practice guidelines for testosterone prescribing.”

Study Limitations

• The available data set does not allow investigators to examine provider attitudes and whether these attitudes affect prescribing practices.
• Provider- and site-level determinants of testosterone prescribing may differ outside the VA system.
• The current study did not consider dual care of veterans; for example, if care had been initiated in the private sector and then transferred to the VA.

Disclosures: Dr Bhasin reports receiving research grants from and serving on the advisory boards of AbbVie, Eli Lilly, and Regeneron. Dr Bhasin also holds equity interests in Johnson & Johnson, Roche, and FPT, LLC. He serves on the council of the American Board of Internal Medicine and the Endocrine Society.