The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK.
Clin Endocrinol (Oxf). 2021 May;94(5):827-836. doi: 10.1111/cen.14412. Epub 2021 Mar 7.
We have previously reported rates of diagnosis of male hypogonadism in United Kingdom (UK) general practices. We aimed to identify factors associated with testosterone prescribing in UK general practice.
We determined for 6741 general practices in England, the level of testosterone prescribing in men and the relation between volume of testosterone prescribing and (1) demographic characteristics of the practice, (2) % patients with specific comorbidities and (3) national GP patient survey results.
The largest volume (by prescribing volume) agents were injectable preparations at a total cost in the 12-month period 2018/19 of £8,172,519 with gel preparations in second place: total cost £4,795,057. Transdermal patches, once the only alternative to testosterone injections or implants, were little prescribed: total cost £222,022. The analysis accounted for 0.27 of the variance in testosterone prescribing between general practices. Thus, most of this variance was not accounted for by the analysis. There was a strong univariant relation (r = .95, P < .001) between PDE5-I prescribing and testosterone prescribing. Other multivariant factors independently linked with more testosterone prescribing were as follows: HIGHER proportion of men with type 2 diabetes(T2DM) on target control (HbA1c ≤ 58 mmol/mol) and HIGHER overall practice rating on the National Patient Survey for good experience, while non-white ethnicity and socio-economic deprivation were associated with less testosterone prescribing. There were a number of comorbidity factors associated with less prescribing of testosterone (such as T2DM, hypertension and stroke/TIA).
Our analysis has indicated that variation between general practices in testosterone prescribing in a well developed health economy is only related to small degree (r = 0.27) to factors that we can define. This suggests that variation in amount of testosterone prescribed is largely related to general practitioner choice/other factors not studied and may be amenable to measures to increase knowledge/awareness of male hypogonadism, with implications for men's health.
我们之前报道了英国（UK）普通诊所男性性腺功能减退症的诊断率。我们旨在确定与英国普通诊所睾酮处方相关的因素。
我们确定了英格兰 6741 家普通诊所中男性的睾酮处方水平，以及睾酮处方量与（1）实践的人口统计学特征，（2）特定合并症患者的百分比和（3）国家全科医生患者调查结果之间的关系。
最大剂量（按处方量）的药物是注射用制剂，2018/19 年 12 个月的总成本为 8172519 英镑，其次是凝胶制剂：总成本为 4795057 英镑。曾经是睾酮注射或植入物唯一替代方案的透皮贴剂处方量很少：总成本为 222022 英镑。该分析解释了普通诊所之间睾酮处方差异的 0.27。因此，大部分方差无法通过分析来解释。PDE5-I 处方与睾酮处方之间存在很强的单变量关系（r=.95，P<.001）。与更多睾酮处方相关的其他多变量因素如下：目标控制（HbA1c≤58mmol/mol）下的 2 型糖尿病（T2DM）男性比例更高，以及国家患者调查中对良好体验的整体实践评级更高，而非白人种族和社会经济贫困与更少的睾酮处方相关。有一些合并症因素与睾酮处方减少有关（如 T2DM、高血压和中风/TIA）。
我们的分析表明，在一个发达的健康经济中，普通诊所之间的睾酮处方差异仅与我们可以定义的因素有很小的关系（r=0.27）。这表明，睾酮处方量的差异在很大程度上与全科医生的选择/其他未研究的因素有关，并且可能可以通过增加对男性性腺功能减退症的知识/意识的措施来解决，这对男性健康有影响。
