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- Title
Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study.
- Authors
Jasuja, Guneet; Bhasin, Shalender; Reisman, Joel; Hanlon, Joseph; Miller, Donald; Morreale, Anthony; Pogach, Leonard; Cunningham, Francesca; Park, Angela; Berlowitz, Dan; Rose, Adam; Jasuja, Guneet K; Reisman, Joel I; Hanlon, Joseph T; Miller, Donald R; Morreale, Anthony P; Pogach, Leonard M; Cunningham, Francesca E; Berlowitz, Dan R; Rose, Adam J
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>To evaluate patient characteristics associated with receipt of testosterone.<bold>Design: </bold>Cross-sectional.<bold>Setting: </bold>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.<bold>Participants: </bold>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.<bold>Main Measures: </bold>Conditions and medications associated with testosterone prescription.<bold>Key Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
UNITED States; THERAPEUTIC use of testosterone; DRUG prescribing; OFF-label use (Drugs); MEN'S health; UNITED States. Dept. of Veterans Affairs; ANDROGEN drugs; OBESITY complications; ANALGESICS; ANDROGENS; HYPOGONADISM; VETERANS; MEDICAL prescriptions; NARCOTICS; RESEARCH funding; TESTOSTERONE; COMORBIDITY; BODY mass index; CROSS-sectional method; CASE-control method; ODDS ratio
- Publication
JGIM: Journal of General Internal Medicine, 2017, Vol 32, Issue 3, p304
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-016-3940-7