Wide variations in use of testosterone therapy among VHA facilities

Background: Use of exogenous testosterone is growing quickly among older men, fueled in part by industry promotion and availability of new, transdermal formulations. Objectives: To examine age-adjust ed rates of exogenous testosterone administration among 129 sites of care in the Veterans Health Administration (VHA), the nation's largest integrated healthcare system, during fi scal year 2011 (FY11; October 1, 2010, to September 30, 2011). Study Design: Cross-sectional. Methods: The study sample consisted of male patients without the human immunodefi ciency virus (HIV) who had at least 1 outpatient visit or hospitalization during FY11 at 1 or more of the 129 VHA sites of care (N = 5,196,156). The mean age of the sample was 62.4 years (range, 20-105 years; standard deviation, 15.8 years). Results: Overall, 1.6% of male VHA patients without HIV received exogenous testosterone during FY11. Most patients receiving testosterone (85%) were older than 50 years. VHA sites of care differed widely in their age-adjusted proportion of male patients receiving testosterone, from a low of 0.3% to a high of 3.7%. Testosterone injections were the most commonly prescribed route of administration, representing 61% of all prescriptions. Conclusions: There was wide variation in the age-adjusted rates of exogenous testosterone therapy among VHA sites. The magnitude of this variation cannot easily be attributed to biologic differences among patients, but is instead likely to represent the effects of a limited evidence base and its uneven application in practice. These findings underscore the importance of a consistent policy for prescribing testosterone across the VHA system.