Audit of testosterone replacement therapy at South Tyneside
Ibrahim M Ibrahim, Alice Jordan, John Parr & Shahid Wahid
Aims: Despite the plethora of testosterone therapies, Successful testosterone replacement remains a challenge. We assessed patient empowerment, treatment satisfaction and adherence to current testosterone replacement guidelines.
Methods: Data were collected from case notes and a testosterone diary questionnaire in 16-patients with testosterone deficiency.
Results: Median age was 46-years (range 2169). All patients received an education package at baseline. 53.5% were on Nebido and 46.5% on Testogel. At baseline 87% had decreased libido with 40% improvement on treatment; 66% had mood change with 30% improvement after treatment; 86% had reduced muscle mass with 33% improvement following treatment; 90% had low energy levels with 34% improvement on treatment. One patient (6%) had evidence of osteopaenia, however only 3-patients (19%) had a DEXA scan. 87% of patients were well informed about the cause of their disease. 87% were well informed about the present form of their treatment. 40% were not well informed about other forms of treatment. 25% were naïve to androgen replacement therapy, 50% had tried gel preparations in the past, 13% had tried patches and 18% had tried oral preparations. 20% preferred Nibido from the start and no patient was changed from Nebido to other testosterone preparation. 20% changed their testosterone preparation due to inconvenience, 20% because of side-effects and 13% thought treatment was ineffective. One patient had a raised PSA on follow up, however no patient had a rectal examination at baseline. Mean serum testosterone was 5.6±0.8 nmol/l rising to 17.3±2.4 nmol/l after treatment, with no correlation between serum testosterone and treatment satisfaction.
Conclusion: Our audit has identified shortfalls in assessing bone density and direct rectal examination. Most testosterone therapy is well tolerated by patients with Nebido preferred by most patients. Additional resources are necessary in order to meet government standards, in particular empowering patients with their treatment.