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Trends in testosterone prescription amongst medical specialties: a 5-year CMS data analysis

International Journal of Impotence Research volume 35, pages 1–5 (2023)Cite this article

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Abstract

Testosterone Therapy (TTh) trends have changed as a result of clinical research and market forces over the past several years. Understanding the trends or preferences regarding testosterone prescriptions remains unknown. Our objective was to assess both regional and national trends in TTh prescriptions amongst medical specialties within the United States between 2013 and 2017. Publicly available data from the Center for Medicare and Medicaid Services (CMS) Part D Prescriber database with regards to TTh prescriptions across a 5-year span (January 1, 2013—December 31, 2017) were analyzed. TTh therapies were consolidated into four categories: Topical, Oral, Injection and Pellet. Statistical analysis utilizing R 4.0.2 was performed on the resulting data. Trends in prescription modality claim count and cost were plotted over the study period while statistical analysis evaluated associations between TTh modality and medical specialist. We found that Endocrinologists and Urologists prescribed topical testosterone more than all other specialties (60.4% and 53.5%, respectively), while Family and Internal medicine physicians were more likely to prescribe injections (59.82% and 50.69%, respectively). Oral and pellet testosterone were rarely prescribed across all specialties. In conclusion, the wide variation in modalities of testosterone prescriptions illustrates an opportunity for treatment guidelines to be streamlined across all specialists to improve patient outcomes.

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Fig. 1: Annual trends of testosterone claim counts across different medication forms.
Fig. 2: Five-year average of testosterone claim counts across the most prevalent specialties.
Fig. 3: Average testosterone claim count over 5 years across the most prevalent specialties.

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References

  1. Harman SM, Metter JE, Tobin JD, Pearson J, Blackman M. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86:724–31. https://doi.org/10.1210/jcem.86.2.7219.

  2. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173:1465–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zhou CK, Advani S, Chaloux M, Gibson JT, Yu M, Bradley M, et al. Trends and patterns of testosterone therapy among U.S. male medicare beneficiaries, 1999 to 2014. J Urol. 2020;203:1184–90. https://doi.org/10.1097/JU.0000000000000744.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Baillargeon J, Kuo YF, Westra JR, Urban RJ, Goodwin JS. Testosterone prescribing in the United States, 2002-2016. JAMA. 2018;320:200–2. https://doi.org/10.1001/jama.2018.7999.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rao PK, Boulet SL, Mehta A, Hotaling J, Eisenberg ML, Honig SC, et al. Trends in testosterone replacement therapy use from 2003 to 2013 among reproductive-age men in the United States. J Urol. 2017;197:1121–6. https://doi.org/10.1016/j.juro.2016.10.063.

    Article  CAS  PubMed  Google Scholar 

  6. Handelsman DJ. Global trends in testosterone prescribing, 2000-2011: expanding the spectrum of prescription drug misuse. Med J Aust. 2013;199:548–51. https://doi.org/10.5694/mja13.10111.

    Article  PubMed  Google Scholar 

  7. Kumar P, Kumar N, Thakur DS, Patidar A. Male hypogonadism: symptoms and treatment. J Adv Pharm Technol Res. 2010;1:297–301.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Araujo AB, Esche GR, Kupelian V, O’Donnell AB, Travison TJ, Williams RE, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92:4241–7. https://doi.org/10.1210/jc.2007-1245.

    Article  CAS  PubMed  Google Scholar 

  9. Corona G, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014;11:1577–92. https://doi.org/10.1111/jsm.12536.

    Article  CAS  PubMed  Google Scholar 

  10. Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, et al. EMAS Group. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363:123–35. https://doi.org/10.1056/NEJMoa0911101.

    Article  CAS  PubMed  Google Scholar 

  11. Rastrelli G, Corona G, Tarocchi M, Mannucci E, Maggi M. How to define hypogonadism? Results from a population of men consulting for sexual dysfunction. J Endocrinol Investig. 2016;39:473–84. https://doi.org/10.1007/s40618-015-0425-1.

    Article  CAS  Google Scholar 

  12. Traish A. Testosterone therapy in men with testosterone deficiency: are we beyond the point of no return? Investig Clin Urol. 2016;57:384–400. https://doi.org/10.4111/icu.2016.57.6.384.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Budoff MJ, Ellenberg SS, Lewis CE, Mohler ER, Wenger NK, Bhasin S, et al. Testosterone treatment and coronary artery plaque volume in older men with low testosterone. JAMA. 2017;317:708–16. https://doi.org/10.1001/jama.2016.21043.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Martinez C, Suissa S, Rietbrock S, Katholing A, Freedman B, Cohen AT, et al. Testosterone treatment and risk of venous thromboembolism: Population based case-control study. BMJ. 2016;355. https://doi.org/10.1136/bmj.i5968.

  15. Xu L, Freeman G, Cowling BJ, Schooling CM. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med. 2013;11:1–12. https://doi.org/10.1186/1741-7015-11-108.

    Article  CAS  Google Scholar 

  16. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use | FDA n.d. 2015. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due.

  17. Corona G, Rastrelli G, Di Pasquale G, Sforza A, Mannucci E, Maggi M. Testosterone and cardiovascular risk: meta-analysis of interventional studies. J Sex Med. 2018;15:820–38. https://doi.org/10.1016/j.jsxm.2018.04.641.

    Article  PubMed  Google Scholar 

  18. EMA Testosterone Article 31: No consistent evidence of an increased risk of heart problems with testosterone medicines | European Medicines Agency. 2014. https://www.ema.europa.eu/en/medicines/human/referrals/testosterone-containing-medicines#:~:text=Medicines%20containing%20testosterone%20are%20licensed,on%20the%20heart%20and%20circulation.

  19. Balasubramanian A, Yu J, Srivatsav A, Spitz A, Eisenberg ML, Thirumavalavan N. et al. A review of the evolving landscape between the consumer Internet and men’s health. Transl Androl Urol. 2020;9 Suppl 2:S123–34. https://doi.org/10.21037/tau.2019.09.29.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Layton JB, Kim Y, Alexander GC, Emery SL. Association between direct-to-consumer advertising and testosterone testing and initiation in the United States, 2009-2013. JAMA. 2017;317:1159–66. https://doi.org/10.1001/jama.2016.21041.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Callegari M, Jella T, Mahran A, Alfahmy A, Muncey W, Patel A, et al. Opioid prescription patterns among urologists as compiled from within Medicare. Can Urol Assoc J. 2021;15:E574–81. https://doi.org/10.5489/cuaj.7086.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sethi RKV, Miller AL, Bartholomew RA, Lehmann AL, Bergmark RW, Sedaghat AR, et al. Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery. Laryngoscope. 2019;129:1046–52. https://doi.org/10.1002/lary.27672.

    Article  PubMed  Google Scholar 

  23. Lopez CD, Boddapati V, Jobin CM, Hickernell TR. State medical cannabis laws associated with reduction in opioid prescriptions by orthopaedic surgeons in medicare part D cohort. J Am Acad Orthop Surg. 2021;29:e188–97. https://doi.org/10.5435/jaaos-d-19-00767.

    Article  PubMed  Google Scholar 

  24. U.S. Centers for Medicare and Medicaid Services. Medicare Provider Utilization and Payment Data: Part D Prescribers. 2013–2017. https://data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers/medicare-part-d-prescribers-by-provider-and-drug.

  25. Houman JJ, Eleswarapu SV, Mills JN. Current and future trends in men’s health clinics. Transl Androl Urol. 2020;9:S116–22. https://doi.org/10.21037/tau.2019.08.33.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shahinyan RH, Amighi A, Carey AN, Yoff DA, Hodge DC, Pollard ME, et al. Direct-to-consumer internet prescription platforms overlook crucial pathology found during traditional office evaluation of young men with erectile dysfunction. Urology. 2020;143:165–72. https://doi.org/10.1016/j.urology.2020.03.067.

    Article  PubMed  Google Scholar 

  27. Tsametis CP, Isidori AM. Testosterone replacement therapy: for whom, when and how? Metabolism. 2018;86:69–78. https://doi.org/10.1016/j.metabol.2018.03.007.

    Article  CAS  PubMed  Google Scholar 

  28. Jasuja GK, Bhasin S, Reisman JI, Hanlon JT, Miller DR, Morreale AP, et al. Who gets testosterone? patient characteristics associated with testosterone prescribing in the veteran affairs system: a cross-sectional study. J Gen Intern Med. 2017;32:304–11. https://doi.org/10.1007/s11606-016-3940-7.

    Article  PubMed  Google Scholar 

  29. Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, et al. ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;159:507–14. https://doi.org/10.1530/EJE-08-0601.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Goodman N, Guay A, Dandona P, Dhindsa S, Faiman C, Cunningham GR, et al. American Association Of Clinical Endocrinologists and American College of Endocrinology Position Statement on The Association of Testosterone and Cardiovascular Risk. Endocrine Practice. 2015;21:1066–73. https://doi.org/10.4158/EP14434.PS.

    Article  PubMed  Google Scholar 

  31. Grossmann M, Anawalt BD, Wu FCW. Clinical practice patterns in the assessment and management of low testosterone in men: an international survey of endocrinologists. Clin Endocrinol. 2015;82:234–41. https://doi.org/10.1111/cen.12594.

    Article  CAS  Google Scholar 

  32. Kovac JR, Rajanahally S, Smith RP, Coward RP, Lamb DJ, Lipshultz L. Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. J Sex Med. 2014;11:553–62. https://doi.org/10.1111/jsm.12369.

    Article  PubMed  Google Scholar 

  33. Smith RP, Khanna A, Coward RM, Rajanhally S, Kovac JR, Gonzales MR, et al. Factors influencing patient decisions to initiate and discontinue subcutaneous testosterone pellets (Testopel) for treatment of hypogonadism. J Sex Med. 2013;10:2326–33. https://doi.org/10.1111/jsm.12226.

    Article  CAS  PubMed  Google Scholar 

  34. Qaseem A, Horwitch CA, Vijan S, Etxeandia-Ikobaltzeta I, Kansagara D, Forciea MA, et al. Testosterone treatment in adult men with age-related low testosterone: a Clinical Guideline From the American College of Physicians. Ann Intern Med. 2020;172:126. https://doi.org/10.7326/M19-0882.

    Article  PubMed  Google Scholar 

  35. Maggi M, Corona G, Vignozzi L, Sforza A. Risks and benefits of late onset hypogonadism treatment: an expert opinion. World J Mens Health. 2013;31:103–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Borst SE, Yarrow JF. Injection of testosterone may be safer and more effective than transdermal administration for combating loss of muscle and bone in older men. Am J Physiol Endocrinol Metab. 2015;308:E1035–42. https://doi.org/10.1152/ajpendo.00111.2015.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Skinner JW, Otzel DM, Bowser A, Nargi D, Agarwal S, Peterson MD, et al. Muscular responses to testosterone replacement vary by administration route: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2018;9:465–81. https://doi.org/10.1002/jcsm.12291.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Corona G, Vignozzi L, Sforza A, Manmucci E, Maggi M. Obesity and late-onset hypogonadism. Mol Cell Endocrinol. 2015;418:120–33. https://doi.org/10.1016/j.mce.2015.06.031.

    Article  CAS  PubMed  Google Scholar 

  39. Layton JB, Meier CR, Sharpless JL, Sturmer T, Jick SS, Brookhart MA. Comparative safety of testosterone dosage forms. JAMA Intern Med. 2015;175:1187–96. https://doi.org/10.1001/jamainternmed.2015.1573.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Shoskes JJ, Wilson MK, Spinner ML. Pharmacology of testosterone replacement therapy preparations. Transl Androl Urol. 2016;5:834–43. https://doi.org/10.21037/tau.2016.07.10.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nieschlag E. Current topics in testosterone replacement of hypogonadal men. Best Pract Res Clin Endocrinol Metab. 2015;29:77–90. https://doi.org/10.1016/j.beem.2014.09.008.

    Article  CAS  PubMed  Google Scholar 

  42. Corona G, Maggi M. Deciding which testosterone therapy to prescribe. J Sex Med. 2018;15:619–21. https://doi.org/10.1016/j.jsxm.2018.02.006.

    Article  PubMed  Google Scholar 

  43. Salter CA, Mulhall JP. Guideline of guidelines: testosterone therapy for testosterone deficiency. BJU Int. 2019;124:722–9. https://doi.org/10.1111/bju.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Isabelle V. Carter, Tarun K. Jella & Thomas B. Cwalina

  2. Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Michael J. Callegari, Amr Mahran, Wade Muncey, Aram Loeb & Nannan Thirumavalavan

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Contributions

Concept—MJC, TBC, TKJ, and NT. Design—TBC, TKJ, MJC, IVC, and WM. Supervision—NT, AM, and AM. Materials—AM, TBC, TKJ, and IVC. Data collection and/or processing—TKJ, TBC, and IVC. Analysis and/or interpretation—TKJ, TBC, IVC, AM, and WM. Literature search—MJC, IVC, and TBC. Writing paper—IVC, MJC, TBC, AM, and WM. Critical review—WM, AM, NT, and AL.

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Correspondence to Michael J. Callegari.

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Carter, I.V., Callegari, M.J., Jella, T.K. et al. Trends in testosterone prescription amongst medical specialties: a 5-year CMS data analysis. Int J Impot Res 35, 1–5 (2023). https://doi.org/10.1038/s41443-021-00497-6

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