Improving Testosterone Therapy Adherence and Quality of Life Monitoring in Men With Hypogonadism: A Quality Improvement Project Using Patient-Reported Outcome Measures.

Testosterone deficiency syndrome in men is common and associated with substantial symptom burden and reduced quality of life. Although testosterone replacement therapy (TRT) can improve patient-reported outcomes, real-world benefit depends on consistent adherence and structured follow-up. In outpatient settings, adherence and symptoms are rarely assessed using validated patient-reported outcome measures (PROMs), limiting treatment monitoring. This project implemented a structured PROM workflow including the Morisky Medication Adherence Scale (MMAS-8), Aging Males' Symptoms (AMS) scale, and Short Form-8 Health Survey (SF-8™) to improve testosterone therapy adherence, symptom and quality of life monitoring in an outpatient men's health clinic. A quality improvement initiative was conducted among adult men receiving TRT. Participants completed validated PROMs at baseline, 6 weeks, and 12 weeks. Primary outcomes included adherence (MMAS-8) and PROM completion; secondary outcomes included follow-up attendance, quality of life (SF-8 PCS/MCS), symptom severity (AMS total/domains), and objective measures (testosterone and BMI). Fifty-four participants enrolled, and 50 completed 12-week follow-up (92.6% retention). MMAS-8 scores improved from baseline (M = 5.26, SD = 2.32) to 6 weeks (M = 6.29, SD = 1.52) and 12 weeks (M = 7.19, SD = 0.89) (p < .001). AMS total scores decreased over time (p = .006), with improvements across psychological (p = .032), somatic (p = .002), and sexual domains (p = .011). Testosterone levels increased (p = .014), while BMI remained unchanged. Integrating PROMs into routine TRT follow-up was feasible and associated with improved adherence, high engagement, and meaningful improvements in patient-reported symptoms and quality of life.

Duke Scholars

Author Eleanor Stevenson School of Nursing