“Low T” Regarded as Fiction

In Mid-October the New York Times reported that sales of testosterone gels were at record highs. The cause is likely tied to huge advertising efforts to push a condition called “Low T,” which anyone who even cursorily has caught daytime cable news in the last few years would likely have been introduced to. One manufacturer spent $80 million on advertising last year, the Times reported.
But many clinicians are now coming out to openly say they believe Low T is an invented problem, and not really a medical condition at all. The affliction, like the gels and pills that are there to “solve” it, is manufactured.

The Times quoted one endocrinologist as stating bluntly, “There is no such disease." Another doctor, a cardiologist, asks patients presenting with self-described Low T why they would even get tested, since “there isn't really a normal.”

A drug company spokesman said their product advertising is educational and meant to encourage patients to talk with their physicians “to determine if testing and treatment may be appropriate.” But even how educational their advertising is has come under close scrutiny in recent months.

Aimed, naturally, at aging men, the ads tout the benefits of opening up a dialogue with your doctor if you lack energy, suffer the doldrums, and don't feel as invigorated as you did, say, a decade ago. The ads site, or visually imply, such problems as declining athletic skills and a dialed-down sex drive. The trouble is, low testosterone truly low, as can be associated with serious medical problems—is rarely the main cause of erectile dysfunction.

Patients of any age may benefit from testosterone replacement if their levels are severely low because of endocrine tumors, hormonal deficiencies, or exposure to disruptive levels of chemotherapy. But testosterone normally declines as men age, as is true for estrogen in women. Prescription gels that are absorbed by the skin, then, were once a treatment limited to a small group of patients suffering from specific medical conditions. The recent widespread use of the gels as lifestyle products is disturbing to many doctors. The risks associated with long term testosterone replacement therapy are largely unknown. Another issue is that some clinicians have observed patients using the roll-on products to achieve abnormally high testosterone levels.

We do know there is an increased risk of coronary artery disease with prolonged testosterone replacement. Other side effects include enlarged prostate. Still, testosterone gels generated over $2 billion in U.S. sales last year.

NEJM Journal Watch, Oct. 16, 2013, http://tinyurl.com/mmreva6

The New York Times, Oct. 15, 2013, “A Push to Sell Testosterone Gels Troubles Doctors,” by Elisabeth Rosenthal

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