Testosterone Therapy Often Initiated without Medical Need

Although testosterone supplementation has increased among older men in the past decade, study results show that many of these patients may not meet clinical guidelines for treatment.

A study titled “Testosterone Lab Testing and Initiation in the United Kingdom and the United States, 2000-2011,” published ahead of print in the Journal of Clinical Endocrinology & Metabolism, revealed that in the United States, there has been an increase in testosterone testing and in the use of testosterone treatment, particularly gel formulations. The study also found there is substantial testosterone use in men whose levels do not meet the clinical guidelines for treatment.

In a news release accompanying publication of the study, author J. Bradley Layton, PhD, of the University of North Carolina at Chapel Hill, said, “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.” He also noted that “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.”

The study identified 410,019 American men and 6,858 U.K. men who began taking testosterone during 2000-2011. The study also identified more than a million American men and 66,000 U.K. men whose testosterone levels were checked during this period. The testing appeared to be more concentrated in the United Kingdom than the United States, though use has increased substantially in both nations.

In what the scientists are saying is possibly cause for concern, the number of men in the United States beginning testosterone therapy has almost quadrupled since 2000. In that same time frame, therapy has only increased by about a third in the United Kingdom. “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 Endocrine Society’s Clinical Practice Guidelines on testosterone therapy in adult men encourage therapies in men with consistent symptoms and definitively low testosterone levels. Low levels of testosterone does not always indicate hypogonadism, a condition that results in low testosterone; testosterone levels tend to naturally decline as men age.