TY - JOUR
T1 - Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System
T2 - a Cross-Sectional Study
AU - Jasuja, Guneet K.
AU - Bhasin, Shalender
AU - Reisman, Joel I.
AU - Hanlon, Joseph T.
AU - Miller, Donald R.
AU - Morreale, Anthony P.
AU - Pogach, Leonard M.
AU - Cunningham, Francesca E.
AU - Park, Angela
AU - Berlowitz, Dan R.
AU - Rose, Adam J.
N1 - Publisher Copyright:
© 2016, Society of General Internal Medicine.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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/m2 (adjusted odds ratio = 3.01, p < 0.001) were more likely to receive testosterone than non-opioid users and men with BMI <25 kg/m2. 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.
AB - 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/m2 (adjusted odds ratio = 3.01, p < 0.001) were more likely to receive testosterone than non-opioid users and men with BMI <25 kg/m2. 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.
KW - patient
KW - predictors
KW - prescribing
KW - testosterone
UR - http://www.scopus.com/inward/record.url?scp=85006415594&partnerID=8YFLogxK
U2 - 10.1007/s11606-016-3940-7
DO - 10.1007/s11606-016-3940-7
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C2 - 27995426
AN - SCOPUS:85006415594
SN - 0884-8734
VL - 32
SP - 304
EP - 311
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 3
ER -