Abstract
BACKGROUND: Prevalence of late-onset testosterone deficiency (TD) ranges between 6-30% depending on diagnostic criteria. Recent data highlights various benefits of testosterone replacement therapy (TRT), including increased libido, mood, bone mineral density, and lean body mass. This study investigated the personal experiences of men with TD around low testosterone and TRT, including barriers to accessing TRT. METHODS: Previous or current TRT users were recruited via email from private clinics' emailing lists, professional medical organisations and researchers' professional networks. Participants completed a 52-item structured questionnaire on Qualtrics XM, exploring their perceptions and experiences of TRT on their symptoms and quality of life. Associations between demographics, duration of symptoms and effectiveness were assessed using logistic regressions. RESULTS: Among the 905 men on TD treatment, 86% delayed treatment for at least a year, including 24% who experienced symptoms for over 5 years before seeking care. Older men (aged 51+ years) were 1.61 times more likely to delay treatment. The majority (85%) reported TRT as effective or very effective, with longer-term users 2.6 times more likely to report TRT as very effective compared to recent starters. Primary motivations for seeking TRT included improving personal relationships (79%) and physical appearance (53%). Most (81%) relied on online sources for information; fewer (18%) felt comfortable discussing hormonal health with their peers. Patient expectations during medical consultations focused on diagnosis (77%), treatment options (64%) and learning about potential side effects (51%). The most common side effects were acne (24%), testicular shrinkage (24%) and nipple itchiness/gynaecomastia (19%). TRT users reported notable improvements in overall quality of life (75%), mental wellbeing (71%), self-esteem and self-confidence (69%) and appearance (61%). CONCLUSIONS: A significant proportion of men aged over 50 years surveyed reported experiencing prolonged symptoms of TD prior to seeking care. There is a need for greater awareness and education regarding TD symptoms, including streamlining timely and equitable access to effective treatment options.