(195) Trends in Testosterone Prescribing by Specialty from 2017 to 2023

Abstract Introduction Testosterone replacement therapy (TRT) is increasingly common. Though typically prescribed for sexual health, TRT has important implications for muscle mass, body fat, and overall health. Patient selection and patient monitoring are critical, as side effects of TRT can range from infertility to hematologic and dermatologic manifestations. Establishing consistent standards for TRT initiation and monitoring across all prescribing specialties is essential for optimizing sexual health outcomes. It is therefore important to understand current trends in TRT prescribing across the US. Objective We sought to characterize current TRT prescribing patterns across specialties as a first step to better understand real-world clinical decision-making, usage, and potential sexual health outcomes. Methods Using the publicly available 2017-2023 Medicare Part D claims data, we assessed TRT prescriptions by prescriber in the United States. Prescribers were grouped by specialty to further characterize trends on the specialty-level, with nurse practitioners and physician assistants grouped as advanced practice providers (APPs). Growth in TRT prescriptions and prescribers were defined as the relative percent change in the number of prescriptions and prescribers between 2017 and 2023. Results From 2017 to 2023, total TRT prescriptions increased by 61.5%, from 621,442 to 1,003,470 (Figure 1). The number of TRT prescribers increased by 208.6%, 28.9%, and 13.0% among APPs, endocrinologists, and urologists, respectively (Figure 2). As of 2023, most TRT prescriptions were distributed by family medicine (24.2%), followed by internal medicine (20.6%), urology (20.5%), and APPs (19.4%). Conclusions Most TRT prescriptions were distributed by non-urologists and non-endocrinologists. The greatest growth in TRT prescribers was among APPs, which had more than tripled over 6 years. Given the overall and sexual health implications of TRT, our findings underscore the importance of engaging a broad range of physicians and APPs in guideline dissemination to ensure appropriate patient counseling and access. Disclosure No