Letters Reflections on testosterone

Many men are receiving unnecessary testosterone prescriptions

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5469 (Published 21 August 2012) Cite this as: BMJ 2012;345:e5469
  1. Earn H Gan, clinical research fellow in endocrinology1,
  2. Stewart Pattman, specialty registrar, chemical pathology (metabolic medicine)2,
  3. Simon Pearce, professor of endocrinology1,
  4. Richard Quinton, consultant and senior lecturer in endocrinology3
  1. 1Institute of Genetic Medicine, Newcastle upon Tyne NE1 3BZ, UK
  2. 2Department of Clinical Biochemistry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  3. 3Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  1. earn.gan{at}ncl.ac.uk

Male hypogonadism is characterised by sexual dysfunction, loss of muscle bulk, central obesity, fatigue, mood and sleep disturbances, osteoporosis, and anaemia. Although these features are associated with low serum testosterone, not all men with low serum testosterone are definitively hypogonadal, and there is a large symptom overlap with obesity and non-endocrine illness. Importantly, testosterone replacement may not be appropriate for men with mild, functional, or transient hypotestosteronaemia.

As Delamothe points out,1 drug companies have run aggressive marketing campaigns that equate hypogonadism with low serum testosterone, despite the lack of long term safety data and inconsistent improvement in symptoms. We collated data on the use of testosterone preparations from the Department of Health’s prescription cost analysis for community pharmacies 2000-10, for England, Scotland, and Wales. We also examined community requests for serum testosterone assays in men to the biochemistry department at the Newcastle upon Tyne Hospitals Trust over the same period.

Prescriptions for testosterone increased by nearly 90%—from 157 602 to 298 134 items annually—in that period. Prescriptions for transdermal testosterone increased fivefold after testosterone gels were introduced in 2003. Costs increased by 267%, from £3.2m (€4.1m; $5m) to £11.7 million yearly over the same period, with more than half being spent on transdermal testosterone. Local requests from primary care for serum testosterone measurement also increased, from 347 requests in 2000 to 823 requests in 2010. However, the number of men with unequivocal hypogonadism (testosterone <6.0 nmol/L) remained roughly constant at 5.2% in 2000 and 6.3% in 2010. We believe that many men in the UK are receiving unnecessary testosterone replacement. Similar trends have been seen in Australia and Switzerland.2 3 Regulation of industry advertising to primary care is inadequate. National guidance on the indications for testosterone replacement is urgently needed.

Notes

Cite this as: BMJ 2012;345:e5469

Footnotes

  • Competing interests: None declared.

References