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Physicians' attitudes towards androgen replacement therapy for male and female sexual dysfunction

Abstract

Androgen deficiency syndrome is a commonly diagnosed condition. The aim of this study was to investigate common clinical practices of specialists in the field of sexual medicine regarding androgen replacement treatment for men and women. Attendees of the 16th Annual Congress of the European Society of Sexual Medicine held in January 2014 in Istanbul, Turkey, were asked to participate in a survey during the congress days. A 24-item self-report, closed-question questionnaire was distributed. Three sections were accessed: sociodemographic data, professional background and personal practice patterns regarding androgen substitution in men and women. A total of 133 physicians (mean age 47 years; range 25–79) completed the survey. Responses were inconsistent regarding the lab tests used for primary evaluation of male androgen deficiency. The majority of participants (62%) recommended testosterone replacement therapy for symptomatic men with testosterone levels <8 nmol l−1 (231 ng dl−1). Similarly, most physicians (88%) recognized a correlation between libido and testosterone levels in women. Only 42% and 53% reported they would prescribe testosterone to women with low libido, premenopausal and postmenopausal, respectively. This survey showed discrepancies among physicians regarding testosterone replacement therapy for men and women.

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Correspondence to L Lowenstein.

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Appendix 1. The Questionnaire

Appendix 1. The Questionnaire

Section 1

Demographic data:

Please specify your

Age: _________ years

Gender: □Male □Female

Country of origin: _________

Country of practice: _________

Section 2

Professional background:

1. Please specify your occupation:

Physician 1□

Psychologist 2□

Sexual therapist 3□

Physical therapist 4□

Nurse (RN) 5□

Preclinical researcher 6□

Other, please specify _________

2. If you are a physician, please specify your specialty

Urologist 1□

Gynaecologist 2□

Psychiatrist 3□

Endocrinologist 4□

Cardiologist 5

General practitioner 6□

Other, please specify _________

3. For how long have you been practicing sexual medicine?

1□Less than 5 years 2□Between 5 and 10 years 3□More than 10 years

4. Do you practice in a private clinic or in the public health care system?

Academic hospital 1□

Private clinic/private practice 2□

Public health care system 3□

Both private and public health care system 4□

Other, please specify _________

Section 3

Male:

1. How often do you encounter men with suspected hypogonadism?

□Frequently

□Occasionally

□Almost never

□Never

2. For which indications do you order testing for serum testosterone levels in males?

All males with erectile dysfunction 1□

Only males with symptoms of androgen deficiency 2□

All males with metabolic syndrome (hypertension, diabetes, overweight and hyperlipidaemia) 3□

All males above the age of 50 years 4□

3. Which lab test do you order for primary evaluation of hypogonadism?

Free testosterone 1□

Free androgen index 2□

Total testosterone 3□

All the above 4□

4. What is the cutoff level of total testosterone under which you recommend androgen replacement treatment in symptomatic men?

8 nmol ml−1 1□

10 nmol ml−1 2□

12 nmol ml−1 3□

5. Do you prescribe androgen replacement treatment for symptomatic patients with total testosterone level above 12 nmol\ml

Yes, no need for further evaluation 1□

Yes, if free testosterone level is low 2□

No 3□

6. What is your drug of choice for treating androgen deficiency?

Short acting, Testosterone Enanthate injection 1□

Long acting, Undecanoate Testosterone injection 2□

Transdermal androgen preparate 3□

7. In your opinion, does treatment with androgen replacement in hypogonadal males result in an increased risk of prostate cancer?

Yes 1□

No 2□

Female:

8. In your opinion, is there a correlation between libido and testosterone level in women?

Yes 1□

No 2□

9. In your opinion, does testosterone prescription for women affect their libido?

Yes 1□

No 2□

10. Would you prescribe testosterone to pre menopausal women with low libido?

Yes 1□

No 2□

11. Would you prescribe testosterone to menopausal women with low libido?

Yes 1□

No 2□

12. In your opinion, which of the following sexual function domains in women are affected by a low level of androgen?

Libido 1□

Lubrication 2□

Sexual arousal 3□

Orgasm 4□

13. Do you test for serum testosterone level in women with sexual disorder?

Yes 1□

No 2□

14. How do you treat, if at all, postmenopausal women with low libido?

Transdermal testosterone gel 1□

Testosterone injection 2□

Tibolone tablets 3□

15. How do you prescribe testosterone to women?

Continuous treatment 1□

On demand before intercourse 2□

I don't prescribe 3□

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Lowenstein, L., Shechter, A., Porst, H. et al. Physicians' attitudes towards androgen replacement therapy for male and female sexual dysfunction. Int J Impot Res 28, 57–61 (2016). https://doi.org/10.1038/ijir.2016.2

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