I’ve written here before about how many physicians and health experts are concerned about the rapid and rampant overprescribing of “low T” medications.
TV ads encouraging middle-age and older men to “talk to your doctor about whether you have low testosterone” are everywhere, it seems, even though, as New York Times reporter Elisabeth Rosenthal noted last fall, low testosterone is “in large part an invented condition.”
There is a condition for which testosterone supplementation is helpful. It’s called hypogonadism. But it affects less than 0.1 percent of men in their 40s and only 5.1 percent of those in their 70s.
Those “low T” TV ads play on men’s fears of growing older. And that marketing approach is working. Many men with normal, age-appropriate levels of testosterone are being tested and prescribed “low T” medications, mostly gels.
That’s where the concern comes in. Testosterone treatment that is not clinically indicated poses potentially dangerous health risks, especially an increased risk of heart attack and stroke.
A tale of two countries
Just how effective the drug industry’s marketing to anxious older men has been in the United States can be seen in the results of a study published online this month in the Journal of Clinical Endocrinology & Metabolism.
A team of researchers, led by J. Bradley Layton, a postdoctoral researcher at the University of North Carolina at Chapel Hill, analyzed commercial and Medicare insurance claims from the United States and compared them to general practitioner records from the United Kingdom for the years 2000 through 2011.
The analysis identified 410,019 American men and 6,858 British men who had begun taking testosterone during those 12 years. It also revealed that 1,114,329 men in the U.S. and 66,140 men in the U.K. had undergone new testosterone testing during that period.
The numbers of men in both countries who were using the drugs increased sharply from 2000 to 2011, but the increase was far and away more dramatic in the U.S. The number of U.S. men prescribed testosterone almost quadrupled during that period. In the U.K., on the other hand, the number rose by only a third.
Further analysis of the data revealed other startling differences between the two countries. Most notably, men in the U.S. were much more likely than their U.K. counterparts to have normal levels of testosterone when they were prescribed the drug. They were also more likely to be under the age of 65. In addition, many of the U.S. men were given the drug even though they had not had their testosterone levels tested within the previous 90 days.
A key factor
Direct-to-consumer marketing of drugs is prohibited in the U.K. — a likely key factor behind the countries’ differences, say Layton and his colleagues in their paper.
Internet searches for information about low testosterone is almost four times higher in the U.S. than in the U.K., the researchers point out.
“In the United States, we saw a clear trend where more and more men being tested actually had normal testosterone levels and non-specific symptoms,” said Layton in a prepared statement released with the study. “This is cause for concern as research examines potential risks associated with testosterone use.”
You can find an abstract of the study on the Journal of Clinical Endocrinology & Metabolism’s website.