Ishay Avraham, Tzemah Sharon, Nitzan Ronit, Jehassi Ayellet, Cohen Michael
Endocrine Unit, Haemek Medical Center, Afula, Israel; B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Urology, Haemek Medical Center, Afula, Israel.
Sex Med. 2019 Dec;7(4):409-417. doi: 10.1016/j.esxm.2019.06.011. Epub 2019 Aug 8.
Although there is increased public concern about low testosterone levels in aging men, the diagnosis and treatment of hypogonadism in this growing population is controversial.
To document the current practices of endocrinologists and urologists in the management of older men with low testosterone in Israel.
A 20-question survey of the management of hypogonadism was sent to members of the Israel Endocrine Society and the Israeli Urology Association MAIN OUTCOME MEASURES: Participants were interviewed about their practice in diagnostic workup, prescription habits and monitoring of testosterone therapy.
The response rate was low (range 8-12%). Significant differences were found between members of the 2 professional associations. Overall, endocrinologists take a more conservative approach to the diagnosis and initial workup, modes of treatment, and to concerns about the safety of testosterone therapy. A divergence from the published clinical guidelines was also noted in some aspects of the clinical practices in both groups.
Significant variances in the diagnosis and treatment approach of hypogonadism between endocrinologists and urologists, as well as divergences from clinical guidelines, may lead to misuse of testosterone therapy.
STRENGTHS & LIMITATIONS: This is the first study undertaken in Israel among urologists and endocrinologists of this increasingly recognized health issue. In our country, these 2 groups of physicians comprise nearly all of the testosterone treatment providers. The limitation of this study is linked to bias of all surveys based on subjective reporting, the fact that it was performed in only 1 country, and that we did not control for the specific assay used to measure testosterone levels.
These findings highlight the need for the implementation of coordinated guidelines to facilitate the appropriate diagnosis and treatment of men who can benefit from testosterone therapy and to minimize the risks of this therapy. Ishay A, Tzemah S, Nitzan R, et al. Testosterone Management in Aging Males: Surveying Clinical Practices of Urologists and Endocrinologists in Israel. Sex Med 2019;7:409-417.
尽管公众越来越关注老年男性睾酮水平低下的问题，但在这一不断增长的人群中，性腺功能减退的诊断和治疗仍存在争议。
记录以色列内分泌科医生和泌尿科医生对睾酮水平低的老年男性的当前治疗方法。
向以色列内分泌学会和以色列泌尿外科学会成员发送了一份关于性腺功能减退管理的20个问题的调查问卷。主要观察指标：就他们在诊断检查、处方习惯和睾酮治疗监测方面的做法对参与者进行访谈。
回复率较低（8%-12%）。在这两个专业协会的成员之间发现了显著差异。总体而言，内分泌科医生在诊断和初始检查、治疗方式以及对睾酮治疗安全性的关注方面采取更为保守的方法。在两组的临床实践的某些方面也注意到与已发表的临床指南存在差异。
内分泌科医生和泌尿科医生在性腺功能减退的诊断和治疗方法上存在显著差异，以及与临床指南的差异，可能导致睾酮治疗的滥用。
这是以色列首次针对泌尿科医生和内分泌科医生对这一日益受到认可的健康问题开展的研究。在我国，这两组医生几乎涵盖了所有睾酮治疗提供者。本研究的局限性与所有基于主观报告的调查的偏差有关，该研究仅在一个国家进行，并且我们没有对用于测量睾酮水平的特定检测方法进行控制。
这些发现凸显了实施协调一致的指南的必要性，以促进对可从睾酮治疗中获益的男性进行适当的诊断和治疗，并将该治疗的风险降至最低。伊沙伊·A、泽马·S、尼赞·R等。老年男性的睾酮管理：对以色列泌尿科医生和内分泌科医生临床实践的调查。《性医学》2019年；7：409-417。
