This site is intended for Healthcare Professionals only

istock-1169924346-copy
Clinical bookmark icon off

Testosterone deficiency: breaking the stigma

Dr David Edwards, men’s health specialist and chair of the Primary Care Testosterone Advisory Group, emphasises the importance of pharmacists supporting men who may show signs of testosterone deficiency.

Testosterone deficiency (TD) is a frequently overlooked condition that significantly affects men’s quality of life, mental health and relationships. It often remains untreated because of limited awareness and the social stigma around the condition.

A recent qualitative study published in the Journal of Men’s Health reveals the barriers men face in seeking help for TD, showing that challenges arise at every stage of care – from recognising symptoms to starting treatment. However, with the right training, education and patient consultation methods, pharmacists can play a pivotal role in initiating the care pathway.

The study, Barriers to Diagnosis and Accessing Effective Treatment and Support for Testosterone Deficiency,1 involved interviews with 20 men aged 45-62 years, 30 GPs and 10 endocrinologists. The interviews revealed significant challenges in diagnosing and treating TD, largely due to lack of knowledge about the condition and its symptoms.

Patient perspectives

The undiagnosed men in the study managed their symptoms themselves. The research found that a sense of stigma, embarrassment and ‘machismo’ was a major factor preventing them from discussing their symptoms openly with GPs. Limited GP consultation time was a further barrier to meaningful conversations.

The men interviewed for the study, which was commissioned and paid for by Besins Healthcare UK, described a slow onset of symptoms like fatigue, loss of energy and muscle weakness, which they often attributed to ageing or work stress. Few men connected these symptoms to testosterone deficiency, and even fewer were aware of the link between TD and sexual symptoms. Most only sought help when sexual problems began to strain their relationships.

Links and risk factors

Testosterone deficiency is more common in middle-aged and older men, particularly those with obesity and other health conditions. An estimated 40 per cent of men with type 2 diabetes will experience symptomatic TD.

Men presenting with erectile dysfunction or loss of spontaneous erections, or those with reduced sexual desire, may also benefit from screening for TD. Men taking long-term opiate or other pain medications including co-codamol, antipsychotic or anticonvulsant medication are also at risk.5

Role of primary care

Pharmacists, as key primary care healthcare providers, can support GP colleagues and patients who may be presenting with symptoms suggestive of, or risk factors for, TD by initiating conversations to enable men to receive the right support.

The Besins study showed that many GPs were unaware of the full range of TD symptoms and may not think to check testosterone levels when presented with non-specific complaints. It also revealed that many GPs lacked confidence in managing TD and expressed a need for improvements in standardisation of care in line with evidence-based guidelines to support diagnosis and treatment in primary care.5

Initiating conversations

Pharmacists and their teams can confidentially and sensitively provide proactive support and education to men who may be at greater risk of TD. For example:

  • Consider adding a note inside prescription bags, discreetly inviting patients for a consultation about testosterone health. This approach opens the door to a conversation without putting the patient on the spot
  • Partners can be powerful ambassadors and some men might feel more comfortable with their partner in the consultation room.

Improving diagnosis and management

Despite evidence-based guidelines, many men with symptomatic TD are still undiagnosed and untreated,1 impacting their quality of life and long-term wellbeing.5 TD can also be a factor in increased morbidity and all-cause mortality.5

This new study highlights the need for greater awareness, better healthcare professional education and more consistent care pathways to improve outcomes for men with TD. Alongside lifestyle and other interventions, testosterone replacement therapy may improve many sexual, psychological, and physical signs and symptoms, given time.5 Some symptoms may improve in months, but others may take years – so it is important that patients are regularly monitored by a healthcare professional with experience of TD to encourage adherence to treatment.

Pharmacists can play a critical role by helping men to identify symptoms and supporting them to access the appropriate care. As more men become aware of the condition, pharmacists can serve as essential partners, together with other clinicians, in ensuring diagnosis and creating a bespoke management plan for patients with TD.

  • Besins Healthcare UK is a pharmaceutical company that specialises in hormone therapies for conditions including menopause, endometriosis, reproductive health and testosterone deficiency. Dr Edwards was paid an honorarium by the company for his involvement in authoring this educational article.

Stronger Voices raising TD awareness

Besins Healthcare UK has developed the Stronger Voices campaign to empower healthcare providers, men and their partners to recognise the symptoms of testosterone deficiency and ensure men displaying symptoms suggestive of the condition seek advice from their healthcare provider. Resources like the Androgen Deficiency in Aging Males (ADAM) questionnaire are available on Besins’ educational website, providing tools to help men initiate conversations with healthcare providers. The public-facing disease education awareness website can be accessed at www.strongervoices.co.uk

References

  1. Journal of Men's Health. 2024. Doi: 10.22514/jomh.2024.001
  2. J Clin Endocrinol Metab. 2017. Doi: 10.1210/jc.2016-3580
  3. Diabetes Care. 2007. Doi: 10.2337/dc06-1426
  4. Trends in Urology & Men’s Health. 2023. Doi: 10.1002/tre.914
  5. The World Journal of Men’s Health. 2023. doi: 10.5534/wjmh.221027.
Copy Link copy link button

Clinical

Let’s get clinical. Follow the links below to find out more about the latest clinical insight in community pharmacy.

Share:

Change privacy settings