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The frenzied drive to medicalize male aging — and sell testosterone

CC/Flickr/elbyincali
After years of marketing hormones to women, drug companies have now turned to medicalizing aging for men as well.

Associated Press reporter Matthew Perrone published a terrific article last weekend on the frenzy surrounding the “latest big marketing push” of Big Pharma: testosterone therapy for men.

As Perrone points out, sales of testosterone drugs, which totaled $1.9 billion globally in 2011, have almost doubled during the past five years. Yet many experts worry, he adds, that the treatments, which include easy-to-apply patches and gels (rolled on like a deodorant), “have gotten ahead of the science.”

Drug companies claim that testosterone therapy will help men ward off some of the dreaded signs of aging and maintain their energy, muscle mass, memory and sex drive.

But, as one expert at the National Institute on Aging told Perrone, “The problem is that we don’t have any evidence that prescribing testosterone to older men with relatively low testosterone levels does any good.”

In fact, it may do a lot of harm.

Perrone explains why:

Male testosterone is mainly produced in the testes and affects muscle mass, sperm production and various sexual characteristics. The hormone can easily be checked with a blood test, but doctors can’t agree on what constitutes a low reading in older men. Typical testosterone levels for younger men range between 300 and 1,000 nanograms per deciliter, but once levels begin dropping there is little consensus on what makes a “normal number.”

Some doctors believe testosterone levels below 300 lead to sexual dysfunction in older men, but the rule does not cover all cases. A 2010 study by researchers at the University of Manchester and other European institutions found that 25 percent of men with testosterone levels above that threshold had the same sexual problems used to diagnose low testosterone. Adding to the ambiguity is that testosterone levels change by the hour, so a man who takes a blood test for testosterone in the morning may get a completely different reading when tested in the afternoon.

Adding to the confusion over what defines “low testosterone,” there’s not much understanding of whether testosterone replacement therapy actually improves men’s symptoms. Evidence of the benefits of testosterone is mixed, and the potential health risks are serious. The largest study conducted to date, a 2008 trial involving 230 patients in the Netherlands, found no improvement in muscle strength, cognitive thinking, bone density or overall quality of life among men taking testosterone. …

The National Institute on Aging is currently conducting an 800-man trial to definitively answer whether testosterone therapy improves walking ability, sexual function, energy, memory and blood cell count in men 65 years and older. But those results aren’t expected until 2014.

In addition to concerns about testosterone’s effectiveness, the long-term side effects of the hormone are not entirely understood because most trials to date have only followed patients for a few months. But the most serious risks include heart problems and prostate cancer. …

In 2010, researchers at Boston University’s school of medicine halted a large study of testosterone in senior men because patients taking the hormone were five times more likely to suffer a serious heart event, including congestive heart failure, than those taking placebos. A review of 19 testosterone trials in 2006 found that prostate cancer was significantly higher among men taking testosterone.

A sales pitch familiar to women

This push to get men to think of aging as a hormone-deficiency disease is, of course, all too familiar to women. Drug companies have been selling hormone therapy (estrogen with or without progesterone) to healthy older women for decades, and with disastrous results.

Since a landmark 2002 randomized controlled trial, hormone therapy for post-menopausal women been shown repeatedly to raise the risk of blood clots, stroke, breast cancer, colon cancer, incontinence, dementia and gall bladder disease.

As I’ve pointed out here before, those findings haven’t stopped drug companies from continuing their attempts to persuade older women to take hormones — including, incredibly, testosterone. Big Pharma has been working hard in recent years to sell testosterone to women as a “cure” for “hypoactive sexual desire disorder,” or HSDD.

Women health activists and scientists unaligned with Big Pharma have called HSDD a pseudo-disease and “a textbook case of disease mongering.”

Needed: another perspective

The medicalization of menopause and female aging has been going on for a long time, ever since gynecologist Dr. Robert A. Wilson (who was quietly being paid by the drug industry) wrote his infamous 1966 best-selling homage to menopausal estrogen therapy, “Feminine Forever.” (Women who did not take hormones would lose their femininity, he claimed.)

Drug companies have now turned to medicalizing aging for men as well. But, as Perrone points out in his AP article, most aging experts stress that “doctors can do more to help seniors by focusing on lifestyle adjustments that keep them connected to their friends and family, rather than prescribing drugs.”

“We really ‘medicalize’ seniors so much that they think the secret always has to be scientific,” says one of those experts. “We need another perspective to understand the secrets to healthy aging, which by and large are not pills.”

You can read Perrone’s article in full online.

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Comments (2)

  1. Submitted by Ray Schoch on 09/12/2012 - 12:47 pm.

    Once again…

    …commerce over ethics in pharmaceuticals.

    We’re not constructed for immortality. We arrive. We live. We get old (if we’re lucky). We die. Back to the universe. Gender complicates things a bit, but I’m not aware of any significant alteration to the pattern in the past… several hundred thousand years. The “living” part lasts longer for more people in wealthier societies, but I’ve been reading about how we’re all going to live hundreds (plural) of years since I started reading science-fiction in my teens, which was half a century ago and more. So far, at least, the pattern continues to be that the vast majority of us exit well before our own centennial, no matter what pills we take.

  2. Submitted by Lance Groth on 09/12/2012 - 05:21 pm.

    Fear

    The American obsession with youth and fear of death is a disease in itself. How much time and money is spent, and how much anxiety induced, by this constant goading to chase after a fountain of youth that will never be found?

    I look at it as it was expressed in Pink Floyd’s “Great Gig in the Sky”:

    “And I am not frightened of dying, any time will do, I
    don’t mind. Why should I be frightened of dying?
    There’s no reason for it, you’ve gotta go sometime.”

    Much wisdom that is worth knowing can be found in Pink Floyd 🙂

    Or in the outlook of dogs (animals in general I guess – no Pink Floyd pun intended for either) – they don’t worry much about the future, they live in the moment, and when it’s time to shuffle off this mortal coil, they find a quiet place to do so, and so avoid much needless anxiety. Eminently sensible.

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