“Low T” Treatment: Necessity or Drug Company Bonanza?

low_t_hypeMiddle-aged men are being barraged with ads – in print and on the air – telling them that their fatigue, decreased energy and muscle strength, and diminished libido could be due to low testosterone, which can be treated by prescription medicines like AbbVie’s AndroGel.

But Drs. Lisa M. Schwartz and Steven Woloshin of Dartmouth Medical School describe the “low T” (T for testosterone) awareness campaign as an exercise in how to sell a “disease” —and its cure—to a potentially huge and profitable market, the Chicago Tribune reports. Medical Marketing and Media newsletter reported that more than 3 million AndroGel prescriptions were written in 2012, adding up to $1 billion in sales.

In a commentary published this week in JAMA Internal Medicine, Schwartz and Woloshin say that the low-T “disease awareness campaign” ignores evidence that testosterone therapy may increase men’s risk of heart attacks, strokes, blood clots, and prostate cancer. Men are exposing themselves “to the harms of treatment unlikely to fix problems that may be wholly unrelated to testosterone levels.” Clinical trials have shown that testosterone replacement therapy has inconsistent or no benefits for weight, depression, or lower extremity strength and modest benefits in lean body mass and body fat, libido and sexual satisfaction, the Tribune reports. Further, physicians have little firm guidance on when treatment is warranted, according to the Tribune.

The low-T campaign is similar to campaigns that convinced millions of menopausal women that hormone replacement therapy was needed to treat what for many were normal signs of aging, write Schwartz and Woloshin. According to the Tribune, these campaigns often create large patient populations before the balance of benefits and harms in a large population has been calculated.

Consumer Reports magazine recently published an article on testosterone replacement therapy. The magazine’s medical experts warned about the risks to the men using these medications and to members of their households. For men using the products, risks include breast enlargement, reduced fertility, heart attacks, and, possibly, faster-growing prostate cancer, according to Consumer Reports. The gel forms of testosterone, which are applied to underarms and upper arms, can be transferred to those the man comes into contact with, exposing women and children to serious unwanted side effects. Children exposed to testosterone can experience early puberty and women can develop male characteristics. Pregnant or nursing women can transfer the hormone to their babies, Consumer Reports warns.


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