Table 2. Testosterone prescribing patterns worldwide—summary of key studies.
| Study | Years | N | Region | Significant findings |
|---|---|---|---|---|
| Baillargeon et al., 2013 | 2001–2011 | >11 million | USA | 3-fold increase in TRT (0.81% to 2.91%); only 75% had TT measured before T was prescribed |
| Canup et al., 2015 | 2007–2011 | Unknown | USA military | 2-fold increase in TRT use over study period (27%/year); largest increase (33%) in age range of 35–44 |
| Jasuja et al., 2015 | 2009–2012 | 111,631 | USA Military | 2-fold increase in TRT use over study period; only 3% of patients met criteria for “ideal” evaluationa; often did not follow guidelines for TRT: did not check TT, PSA, or hematocrit in 17%, 24%, and 15%, respectively |
| 57 | USA | 100% of physicians would prescribe T to patients with PC, 94% if previous RP, 94% with history of PC, 92% after external beam therapy, 51% with previously untreated PC, and 50% to patients on active surveillance | ||
| Layton et al., 2014 | 2000–2011 | 416,877 | USA + Europe | TRT/10,000: 75.7 in USA vs. 4.5 in Europe; TRT despite normal TT level: 4–9% in USA vs. 1% in Europe; TRT initiated for low TT: 43% in USA vs. 10% in Europe |
| Hall et al., 2014 | 1976–2008 | 11,521 | Canada | TRT/1,000: 1.6 in 1976, to 4.6 in 2000; decrease in TRT from 2000 to 2006, unlike USA |
| Gan et al., 2013 | 2001–2010 | Unknown | Europeb | 90% increase in TRT use over study period; five-fold increase in prescription of more expensive transdermal T, increasing cost by 267% to 11.7 million lbs/yr; 137% increase in patient requests for TRT |
| Bjerkeli et al., 2016 | 2006–2014 | 234 | Europec | TRT/1,000: 3.3 in 2006, to 6.0 in 2014; TRT twice as common in highest income quintile when compared to lowest (0.68% vs. 0.25%); 89% of TRT users did not have a dx of HG |
| Gooren et al., 2007 | 2007 | 353 | Globald | 73% of Europeans associated TRT with more risk than benefit, vs. 61% in other countries; 67% of Europeans put more weight on HG symptoms than lab values for dx, vs. 80% in other countries; 74% of physicians regularly measure TT, and 42% regularly measure FT; 56% of physicians choose short- or medium-term T treatment instead of long-term |
| Gooren et al., 2012 | 2006–2010 | 353 | Globale | 70% of European physicians put more weight on symptoms than lab values for dx, compared to 80% in other countries; 82% of physicians regularly measure TT, and 36% regularly measure FT; decreasing concern about effect of TRT on prostate cancer over study period; increasing concern about side effects of TRT: 54% in 2006, 78% in 2010; 75% of patients with HG received TRT |
| Gooren et al., 2015 | 2006–2015 | 731 | Globalf | 83% of physicians put more weight on symptoms than laboratory values for diagnosis; 77% of Europeans measure TT vs. 86% in other countries; 41% regularly measure FT; most commonly used cut-offs: Europe (9.8 mmol/L), Latin America (8.8 mmol/L); 85–87% of patients with HG received T |
| Handelsman, 2012 | 1992–2010 | Unknown | Australia | 4.5-fold increase in TRT over 20 years-modest when compared to other parts of the world |
a, “Ideal” evaluation in this study consisted of (I) low morning testosterone levels; (II) measurement of luteinizing hormone and or follicle stimulating hormone and (III) no contraindications to testosterone therapy; b, European countries included England, Scotland, and Wales; c, European country was Sweden; d, global study included Germany, Spain, the United Kingdom, Brazil, Saudi Arabia, and South Korea; e, global study included Germany, Spain, the United Kingdom, Brazil, and Saudi Arabia; f, global study included Germany, the United Kingdom, Spain, Italy, Switzerland, Sweden, Norway, South Africa, Brazil, Mexico, and Colombia. TT, total testosterone; TRT, testosterone replacement therapy; T, testosterone; HG, hypogonadism; dx, diagnosis; lab, laboratory.