I am grateful to be one of the recipients of the AUA Data Grant. This grant opened the door for me to pursue academia in urology during my training. It also allowed me to collaborate with health care colleagues from many disciplines, including my mentor, Dr Goldenberg, who continues to persist through the ups and downs of this project!

Symptomatic hypogonadism affects many men. Testosterone replacement is approved for management of men with this disorder as it improves quality of life, libido, depression, and erectile function.¹ There was a 3- to 8-fold rise in US prescribing practices of testosterone replacement between 2001 and 2014.^1-3 Coinciding with the general increased rate of testosterone replacement prescriptions over recent decades, there has been a growing concern regarding inappropriate prescribing of testosterone and lack of adherence to guidelines in both the UK and US.³ Multiple international guidelines recommend that symptomatic men may benefit from testosterone replacement only if their symptoms were associated with biochemical confirmation of hypogonadism (ie, a total testosterone level ≤300 ng/dL [<10.4 nmol/L] on 2 or more morning samples).^4-7 Despite congruent international guidelines, an increasing number of men may be receiving testosterone replacement despite being eugonadal, or even without any testosterone testing for a biochemical diagnosis, and thus without medical indication.

In this data grant, we sought to explore adherence to prescribing and monitoring practices as outlined by international guidelines in a Canadian health care environment that does not have the same fiscal pressures as are present in other privatized health care environments. With the funding we accessed, linked, and analyzed 4 longitudinal provincial databases to address these pertinent issues.

Our work is summarized in the Canadian Urological Association Journal article entitled, “Testosterone Therapy: Prescribing and Monitoring Patterns of Practice in British Columbia.”⁸ We found that most prescriptions are being written by general practitioners, followed by urologists, internal medicine physicians, and endocrinologists. Furthermore, many men prescribed testosterone replacement did not continue beyond a short trial. While the practice of checking pre– and post–testosterone therapy testosterone levels improved over the study period, it is concerning that only one-third had a follow-up serum testosterone level and half remained biochemically low.

The implication of this study’s results is that education is needed for current and future prescribers of testosterone replacement therapy. Focus should be around testosterone replacement prescribing, dose titration, and monitoring to ensure both effective and safe prescribing practice.

Throughout this study we encountered several challenges and deficits in mining British Columbia’s provincial data. It took us an additional 5 years to work with the data holders to collect, collate, and verify the data before publication due to lack of collected data and inaccurate recording of data. We hope that organizers of this data can learn from working through these issues with investigators and from the example of other provincial data holders to better facilitate high quality population-based studies. After all, the goal of this and all data studies is to better the care of patients from a population perspective.

I am grateful to have been a part of this project. I am forever thankful to have received funding from the AUA grant for this work. It has helped me recognize the challenges of our health system at a higher level and learn to advocate for my patients on the ground. It has helped Dr Flannigan and I, in both academic and community settings, create patients’ health programs to better serve this and other urologic populations. Lastly, it has helped form guidelines for physicians to provide evidence-based medicine for our patients.