Endocrine Abstracts

Testosterone deficiency syndrome (TDS) may well contribute to a number of co morbidities and multitude of symptoms which may affect one’s daily activities adversely. TDS prevalence in UK is 1:500 and certain groups of patient’s are at higher risk of TDS, in particular elderly and patients with diabetes mellitus where 42% are known to have TDS. A retrospective audit was carried out to bench mark our practice in line with a publication of a recommended National/European guidelines of ‘A practical guide for the management of men with suspected testosterone deficiency’. We obtained and analysed the medical records of 35 patients who attended our endocrine services over a 6 month period. 31 of them had already been started on testosterone from the year before. Seven patients were excluded due to lack of data availability. The age in our cohort ranged from 31 to 72 years with a mean age being 53 years. Initial testosterone and PSA results ranged between 0.4 nmol/l to 9.4 nmol/l (normal 8.4–28.7 nmol/l) with mean of 5.9 nmol/l and 0.1 ug/l to 2.1 ug/l (normal 0–3.0 ug/l) with a mean of 0.7 ug/l respectively. We found, the time lapse between initial blood results and testosterone initiation where from 1 to 18 months, with a mean of 7 months. The guidelines suggests; prior to testosterone initiation PSA and a rectal examination (PR) should be carried out. Within our patient group only 5/28 (18%) had a PR, 21/28 (75%) had PSA,16/28 (57%) had USS of prostate and 16/28 (57%) of our patients have had neither a PR nor an USS. 18/28 (64%)of the patients who had been started on testosterone were on Nebido 1 g injection, 15 of whom had this administered by their GP, the other 3 by the hospital Endocrine Specialist Nurse (ESN). The 3 ESN treated patients had an ultra sound scan (USS) before commencing treatment. Recommended on-going monitoring of 3 to 6 monthly intervals in the first year was achieved on 23/25 (92%) of our patients.

Conclusion: We recommend a dedicated andrology service and a shared care pathway with community colleagues to ensure all patients have received the best possible care by means of investigations, treatment and follow up care in line with National/European guidelines.