Intended for healthcare professionals

Observations Yankee Doodling

Getting your “T” up

BMJ 2014; 348 doi: (Published 10 January 2014) Cite this as: BMJ 2014;348:g182
  1. Douglas Kamerow, chief scientist, RTI International, and associate editor, BMJ
  1. dkamerow{at}

Big pharma creates a new disease: low testosterone

I’ve been seeing a lot of TV commercials for testosterone replacement therapy (TRT) recently. It must be because the manufacturers like the demographics of the two main types of programs I watch: network news and sports. That’s where you find the middle aged and older guys, as well as their wives, who can actually get them to see their doctors. Pushing through the ads for overactive bladder, arthritis pain, and, yes, erectile dysfunction treatments are now numerous questions about whether I have “low T” or not.

It used to be that TRT was reserved for clear cases of hypogonadism, either primary (due to testicular failure) or secondary (such as from pituitary tumors). Because oral testosterone is largely ineffective, these patients would be treated with regular testosterone injections, at considerable cost and inconvenience, resulting in widely varying blood concentrations. Now we have several non-injectable ways to deliver stable testosterone levels: patch, gel, subdermal pellet, buccal tablet, and even an underarm roll-on.

Until recently, however, TRT was a relatively small market. In 2002 only about …

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