Many Men With Low Testosterone Levels Do Not Receive Treatment

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Main Category: Men's health
Also Included In: Endocrinology;  Primary Care / General Practice;  Public Health
Article Date: 26 May 2008 - 13:00 PDT

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Despite having access to care, many men with androgen deficiency may not be receiving treatment, according to a report released on May 26, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Lower than normal levels of male hormones, including testosterone, in the body indicate a deficiency in androgens. Symptoms of androgen deficiency can include low libido, erectile dysfunction and osteoporosis, and victims might also suffer from sleep disturbance, depressed mood and tiredness. Knowledge about and access to care for this condition have increased in recent years, according to the article, but the treatment patterns for androgen deficiency have not been well described in community-dwelling males in the United States.

To investigate this, Susan A. Hall, Ph.D., of New England Research Institutes, Watertown, Mass., and colleagues studied data collected from 1,486 men in the Boston area between April 2002 and June 2005. They were tested to estimate the number of men are actually receiving treatment for androgen deficiency, in the hopes of explaining what variance existed between treated and untreated men to understand the potential barriers to health care.

Of the men, 97 met the criteria for androgen deficiency. Of these, 86 were symptomatic and untreated, while 11 were prescribed testosterone treatment. The treatment types varied: 1 was using a testosterone gel, 3 used a testosterone patch, 1 used testosterone cream, 1 used the injectable form of testosterone cypionate, and 5 used unspecified formulations of treatment. The unspecified forms were self-reported as being in intervals defined in weeks, implying that they were likely also injectable forms. If this is true, a total of 6 were using testosterone injection treatment.

According to the authors, the frequency of treatment was heavily influenced by economic factors: "Men with untreated androgen deficiency were the most likely of the three groups to have low socioeconomic status, to have no health insurance and to receive primary care in an emergency department or hospital outpatient clinic." However, men with androgen deficiency, with or without treatment, tended to visit the doctor and receive regular care more often throughout the year. That is, per year, men with untreated androgen deficiency averaged 15.1 visits, with treated androgen deficiency averaged 12 visits, while men without the condition averaged 6.7.

They conclude that this indicates that the ultimate reason for the lack of treatment in the population was not access to medical care: "Under our assumptions, a large majority (87.8 percent) of 97 men in our groups with androgen deficiency were not receiving treatment despite adequate access to care," they say. "The reasons for this are unknown but could be due to unrecognized androgen deficiency or unwillingness to prescribe testosterone therapy."

Treatment of Symptomatic Androgen Deficiency: Results From the Boston Area Community Health Survey
Susan A. Hall; Andre B. Araujo; Gretchen R. Esche; Rachel E. Williams; Richard V. Clark; Thomas G. Travison; John B. McKinlay
Arch Intern Med. 2008;168(10):1070-1076.
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Written by Anna Sophia McKenney
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