Testosterone Prescribing in UK General Practice: Are patients being monitored correctly for associated risks whilst on treatment?

In the UK, much of the long term pharmacovigilance and therapeutic monitoring of testosterone replacement therapy falls upon the general practitioners, and this responsibility is moved to them from hospital endocrinology and urology departments, often without adequate communication of the safety monitoring requirements. Furthermore, the local, national and international recommendation guidelines differ. An audit was performed of testosterone prescribing by general practitioners in an area of eastern England. The adherence to agreed local and national guidelines regarding therapeutic monitoring was assessed. It was discovered that guidance on annual blood testing and digital rectal examination was not being universally followed. This preliminary study has shown that the monitoring of patients on replacement testosterone fell below the standards set by existing guidelines, both in terms of blood testing and physical examination. If verified by further detailed study across the UK, this is very significant as it shows that monitoring of testosterone has fallen behind acceptable standards, when compared to the monitoring of drugs such as levothyroxine or immunosuppressive rheumatological drugs. It would mean that improved education of general practitioners of the risks of testosterone therapy would be essential for the near future.