Improving the recognition, diagnosis, and management of male testosterone deficiency across the NHS: a Delphi consensus.

Introduction: Testosterone deficiency (TD) is a clinical and biochemical syndrome marked by the reduced production of testosterone. TD is associated with a decrease in quality of life, alongside increasing the risks of various comorbidities, including cardiovascular disease and type 2 diabetes. A lack of guidance concerning TD for healthcare professionals (HCPs) exists, leading to many men going undiagnosed and a broad variation in care.

Aim: Establish the views of UK HCPs working in male TD and develop recommendations that support improved diagnosis and management of TD across the NHS.

Methods: Using a modified Delphi method, a panel of experts developed 43 Likert-scale statements across 5 main domains. Statements were used to develop an online survey that was distributed via a "snowball sampling" approach through Microsoft Forms. The survey was distributed to HCPs working within male TD throughout the United Kingdom. The threshold for consensus was set at 75%.

Results: Fifty-five responses from UK HCPs were analyzed. Of the 43 statements, 30/43 reached very strong agreement (90%) and 13/43 attained strong agreement (<90 and 75%). Consequently, the authors developed 6 recommendations to improve the recognition, diagnosis, and management of male TD in the NHS.

Conclusion: The strength of agreement demonstrates that the respondents acknowledge that awareness of TD, along with its health and cost impacts, among UK HCPs is lacking. Respondents are clear on where the limitations in care currently exist. The proposed set of recommendations provides a framework to help improve the diagnosis and management of testosterone deficiency.