Streamlined Testosterone Order Template to Improve the Diagnosis and Evaluation of Hypogonadism in Veterans

Poor adherence to evidence-based guidelines for diagnosing hypogonadism prior to initiating testosterone replacement therapy (TRT), has prompted recommendations for clinical practice improvement. This quality improvement study examined whether a testosterone order template (TOT) could improve adherence to evidence-based guidelines.

A retrospective review examined male patients aged > 18 years with no prior VA testosterone prescription and ≥ 2 clinic visits who received a new testosterone prescription before TOT implementation vs postimplementation. Signs and symptoms of hypogonadism, ≥ 2 serum testosterone and gonadotropin measurements, TRT risks and benefits, and an updated hematocrit test within 6 months prior to TRT were documented.

Fifty-six patients in the pretemplate period and 40 patients in the posttemplate period were included. In the posttemplate period, 37 patients (93%) had documented signs and symptoms of hypogonadism compared with 40 patients (71%) in the pretemplate period (P = .002). Measurements of testosterone, gonadotropins, and hematocrit were higher in the posttemplate period (78%) vs pretemplate period (55%) (P = .03). Education regarding the risks and benefits of TRT was provided to 58% of patients posttemplate vs 34% of patients pretemplate (P = .02). Documentation of guideline recommendations was higher in the posttemplate period (45%) vs the pretemplate period (18%) (P = .004).

TOT implementation is a feasible approach to improve clinical diagnosis and hypogonadism evaluation before TRT. The low proportion of men who received education regarding the risks and benefits of TRT and adherence to guideline recommendations after implementation underscores the need for additional efforts to improve guideline adherence and clinical practice.