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 Testosterone levels naturally decline with age, and some men with
extremely small amounts of the hormone may be diagnosed with what's
known as hypogonadism and prescribed needed testosterone therapy,
researchers note in JAMA.
Far more men take testosterone than have hypogonadism or clear
evidence of a medical problem tied to low hormone levels, however.
Many of them may have been convinced to seek unnecessary treatment
by ads promoting "low T" as a health problem associated with issues
like reduced libido or fatigue, said lead study author Bradley
Layton, a public health researcher at the University of North
Carolina at Chapel Hill.
"The original approval for testosterone intended it to be used only
in a very narrow group of men with very clearly-defined diseases
which stop the production of testosterone," Layton said by email.
"However, much of the use recently has been in men with reduced
testosterone levels or some non-specific symptoms like fatigue, loss
of muscle mass, reduced libido or lowered mood which may be related
to normal aging or other disease conditions," he said.
"There is very little evidence that testosterone would benefit men
without a clear indication for taking it, and there are still
unresolved safety concerns about testosterone that just don't
justify widespread treatment of older men with normal age-related
reduced testosterone," Layton added.
In 2014, U.S. drug regulators raised safety concerns about the
potential for testosterone to increase the risk of heart problems.
For the current study, researchers examined data on testosterone ad
viewership, testosterone testing and prescriptions of the hormone
from 2009 to 2013. They looked at insurance claims data for 17.2
million men in 75 distinct television markets nationwide.
During the study period, more than 1 million men got new tests for
testosterone levels and more than 283,000 initiated testosterone
treatment, the study found.
Among men who started taking testosterone, 59 percent used gels and
36 percent got injections, while a small minority of them got
patches or implants.
Prior to 2012, ads for "low T" were the most common type of
marketing. Then, after two new products - Axiron and a more
concentrated form of Androgel - debuted in 2011, ads for specific
products became more common and promotions for "low T" started to
decrease.
During some months of the study, there were no ads at all, while in
other months some men might have seen as many as 14 ads on average.
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The most concentrated advertising efforts occurred in the Southeast
and in the Great Lakes region, the study found.
Each additional ad men saw was associated with a 0.6 percent
increase in testing as well as a 0.7 percent climb in new
prescriptions for testosterone. There was also a 0.8 percent
increase in new prescriptions that were not preceded by testing.
Although the impact of a single ad was slight, ads were widespread
and frequent during the study period and cumulative exposure was
close to 200 ads in some markets, the authors note.
The study wasn't a controlled experiment designed to prove that ads
directly influence whether men get testing or treatment for low
testosterone, the researchers caution. They also relied on data for
prescriptions, which doesn't necessarily reflect how often men took
the drugs.
Still, the findings should put consumers on alert to be wary of ads,
said Dr. Richard Kravitz, a researcher at the University of
California, Davis, and author of an accompanying editorial.
"Direct-to-consumer advertising is designed to be persuasive,"
Kravitz said by email. "Patients can't really avoid this. All they
can do is reflect on the fact that ads are designed primarily to
increase sales, not inform and educate the public, and they should
try to present their symptoms and concerns as objectively as
possible to their physician."
SOURCE: http://bit.ly/2o13N0q and http://bit.ly/2n4wmLn JAMA, online
March 21, 2017.
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