Identifying the outcomes important to men with hypogonadism: A qualitative evidence synthesis.

The qualitative evidence synthesis identified five studies published in nine reports assessing a total of 284 participants with male hypogonadism.

• Systematic searches of major electronic databases were conducted to identify qualitative data from men with hypogonadism, with or without TRT.
• Two independent authors performed the selection, extraction, and thematic analysis of data.
• Quality of eligible studies was assessed using the Critical Appraisals Skills Programme (CASP) and GRADE-CERQual tools.
• All published data were only available within North America, with no ethnic minority or other underserved groups included.

Men with male hypogonadism experienced adverse changes in physical strength, perceptions of masculinity, cognitive function, and quality of life, in addition to sexual dysfunction.

• Thematic analysis identified these domains as important to men with hypogonadism beyond the commonly recognized symptom of sexual dysfunction.
• The experience of MH appeared dependent on the source(s) of educational material.
• These findings suggest that symptoms of MH extend across multiple functional and behavioral domains not fully captured by randomized controlled trials.
• A patient-centred approach to clinician interactions was proposed rather than focusing on discrete MH symptoms.

The geographic and ethnic scope of existing qualitative evidence on male hypogonadism experience is severely limited, being confined to North America and predominantly white ethnicity.

• No ethnic minority or other underserved groups were included in any of the identified studies.
• All five eligible studies were published within North America.
• The authors note this may not be broadly applicable to other geographic regions.
• Broadening understanding of the MH experience may improve the targeting of information to patients.

Randomized controlled trials provide little consensus on functional and behavioural symptoms in hypogonadal men, which are often better captured by qualitative information from individual patient experience.

• Sexual dysfunction is commonly recognized as improving with testosterone replacement therapy (TRT) in RCTs.
• Functional and behavioural symptoms such as changes in cognition, masculinity perceptions, and physical strength are underrepresented in RCT outcomes.
• The authors argue that qualitative data better captures the breadth of patient experience with MH.
• A multidisciplinary approach may better address symptoms neither attributable to MH nor alleviated by TRT.

The authors propose a patient-centred approach to clinician interactions and a multidisciplinary approach to address the full spectrum of symptoms experienced by men with hypogonadism.

• A patient-centred approach was recommended rather than focusing on discrete MH symptoms.
• A multidisciplinary approach was suggested to better address symptoms neither attributable to MH nor alleviated by TRT.
• The experience of MH appeared dependent on the source(s) of educational material, suggesting the importance of targeted patient information.
• These recommendations emerged from thematic synthesis of qualitative data from 284 men across five studies.