Many Older Men Maybe too Many Start Testosterone
Therapy Without Clear Medical Need
Study finds increased testing among men with normal
hormone levels and notes worry about potential risks associated with
Jan. 9, 2014 - Testosterone use has sharply
increased among older men in the past decade and many appear to have
normal testosterone levels and do not meet the clinical guidelines for
treatment. There is rising concern about the potential risks from
unnecessary testosterone use, according to new research to be published
in the Endocrine Society's Journal of Clinical Endocrinology &
Testosterone is a key male sex hormone involved in
maintaining sex drive, sperm production and bone health. Since
testosterone levels tend to naturally decline as men age, lower levels
of the hormone do not necessarily mean that an individual has
hypogonadism, a condition that results from low testosterone.
As the population ages and an increasing number of
men struggle with obesity and diabetes, more men may experience low
testosterone levels without meeting diagnostic criteria or displaying
symptoms of hypogonadism.
"Over the past decade, older and middle-aged men
are increasingly being tested for low testosterone levels and being
prescribed testosterone medications, particularly in the United States,"
said one of the study's authors, J. Bradley Layton, PhD, of the
University of North Carolina at Chapel Hill.
"While direct-to-consumer advertising and the
availability of convenient topical gels may be driving more men to seek
treatment, our study suggests that many of those who start taking
testosterone may not have a clear medical indication to do so."
To study testosterone trends, the retrospective
incident user cohort study analyzed commercial and Medicare insurance
claims from the United States and general practitioner health-care
records from the United Kingdom during the period between 2000 and 2011.
The study identified 410,019 American men and 6,858 U.K. men who began
taking testosterone during this period. The analysis also found more
than 1.1 million U.S. men and 66,000 U.K. men who had their testosterone
levels tested during this time.
Since 2000, the number of men beginning
testosterone therapy has almost quadrupled in the United States while
only increasing by a third in the United Kingdom. The majority of these
patients had not had their testosterone levels measured recently or only
had them tested once prior to beginning treatment.
The Endocrine Society's
Guidelines on testosterone therapy in adult men recommend
making a clinical diagnosis of androgen deficiency, or low testosterone,
only in men with consistent symptoms and unequivocally low testosterone
While testosterone testing has increased
substantially in the United States and the United Kingdom, the study
found the testing appeared to be more targeted in the United Kingdom.
Many of the tests there identified men who did have reduced levels of
"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," Layton said. "This is cause for concern as
research examines potential risks associated with testosterone use."
The study was funded by the National Institute of
Health's National Institute on Aging.
Other authors of the study include: D. Li, J.
Sharpless, T. Stόrmer and M.A. Brookhart of the University of North
Carolina at Chapel Hill; S.S. Jick of Boston University; and C.R. Meier
of the University of Basel in Basel, Switzerland.
The study, "Testosterone Lab Testing and Initiation
in the United Kingdom and the United States, 2000-2011," was published
online, ahead of print.
Founded in 1916, the Endocrine Society reports to
be the world's oldest, largest and most active organization devoted to
research on hormones and the clinical practice of endocrinology. The
Endocrine Society's membership consists of over 17,000 scientists,
physicians, educators, nurses and students in more than 100 countries.
Society members represent all basic, applied and clinical interests in
endocrinology. The Endocrine Society is based in Chevy Chase, Maryland.
To learn more about the Society and the field of endocrinology, visit
http://www.endocrine.org. On Twitter at
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