(525) Evaluation, Treatment, and Drawbacks of Late-Onset Hypogonadism: A Multi-Institutional Survey

Introduction Late-onset hypogonadism (LOH) is characterized by clinical symptoms of androgen deficiency accompanied by biochemical evidence of low testosterone levels in aging men. Despite the availability of international guidelines, the diagnostic and therapeutic approaches to LOH remain heterogeneous among practitioners. To gain insights into national practice patterns, a web-based survey was conducted among urologists in our country to assess their strategies for evaluation, treatment, and follow-up of LOH. Objective To investigate the current diagnostic and treatment practices for LOH among urologists and to identify potential variations related to institutional setting and clinical experience. Methods A web-based, cross-sectional survey consisting of 14 questions was distributed through a professional urological society network between May 2023 and February 2024. The questionnaire explored participants’ demographics, frequency of LOH diagnosis, diagnostic methodologies, treatment modalities, follow-up strategies, and perceived barriers to initiating androgen replacement therapy (ART). Statistical analyses were performed using appropriate descriptive and comparative tests, with p < 0.05 considered statistically significant. Results A total of 98 urologists completed the survey. More than half (56.1%) were employed at academic centers, while 21.4% worked in public hospitals, 16.3% in private hospitals, and 6.1% in private clinics. The median professional experience was 10.5 years (range: 1–41). One-third (33.7%) reported diagnosing more than five LOH cases monthly, whereas the median number of diagnoses per month was two (range: 1–25). Only 20.4% routinely questioned men over 40 years about hypogonadal symptoms regardless of their chief complaint. Routine metabolic work-up was performed by 84.7% of participants, and 52% routinely sought consultations, most frequently from endocrinology departments (60.8%). Diagnostic methods varied considerably: 63.3% used total testosterone, 22.4% both total and free testosterone, and 9.2% free testosterone alone. Validated questionnaires were used by 34.7% of participants, primarily the International Index of Erectile Function (IIEF). Nearly all respondents (91.8%) prescribed ART for LOH, with 95.6% conducting prostate cancer screening before initiation-most often with prostate-specific antigen testing and digital rectal examination. Parenteral formulations were the most preferred form of therapy. Eight urologists refrained from prescribing ART, citing concerns regarding follow-up and oncological safety. Monitoring practices mainly relied on serum testosterone (88.9%), prostate-specific antigen (87.8%), and patient-reported symptom improvement (55.6%). A minority used validated forms to assess treatment efficacy. Experience and workplace setting were associated with distinct clinical behaviors: senior urologists (>15 years in practice) and those in private hospitals were more likely to inquire about LOH symptoms (p < 0.05) routinely. Conclusions The evaluation and management of LOH among urologists in our country exhibit significant variability, particularly concerning diagnostic tools, use of validated questionnaires, and follow-up strategies. Although most clinicians appropriately screen for prostate cancer before initiating ART, a notable proportion do not routinely assess LOH symptoms or employ standardized instruments. These findings highlight the need for national consensus guidelines and educational initiatives to promote uniform, evidence-based practice patterns in LOH management. Disclosure No