Trends in testosterone prescription during the release of society guidelines.

The number of testosterone prescribers across nine specialties grew by a mean of 8.8% annually from 2016 to 2019.

• Nine specialties with over 100 testosterone prescribers were included in the analysis.
• Specialties analyzed in descending order of prescription frequency: family practice, internal medicine, urology, endocrinology, nurse practitioners, physician assistants, general practice, infectious disease, and emergency medicine.
• Medicare prescriber data from 2016 to 2019 was used as the data source.

There was a significant increase in average testosterone claims per provider from 2016 to 2019.

• Average claims per provider increased from 26.4 in 2016 to 28.7 in 2019 (p < 0.0001).
• The steepest increase occurred between 2017 and 2018, the year the AUA and Endocrine Society guidelines were released (27.2 to 28.1, p = 0.015).
• The largest increase in claims per provider was observed among urologists.

Advanced practice providers (nurse practitioners and physician assistants) comprised a growing share of Medicare testosterone claims over the study period.

• Advanced practice providers accounted for 7.5% of Medicare testosterone claims in 2016.
• This proportion increased to 11.6% of Medicare testosterone claims by 2019.
• The changing demographics of prescribers was noted to justify targeted education and further research.

The American Urological Association and Endocrine Society published guidelines for the management of testosterone deficiency in 2018.

• These guidelines were released during the study observation window of 2016–2019.
• Testosterone prescription patterns had varied widely due to increased public interest and emerging data on the safety of testosterone therapy.
• The effect of guideline publication on testosterone prescribing was previously unknown prior to this study.