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Testosterone use has sharply increased among older men in the past decade, many patients appear to have normal testosterone levels and do not meet the clinical guidelines for treatment, according to new research.
Testosterone is a key male sex hormone involved in maintaining sex drive, sperm production and bone health. Since testosterone levels tend to naturally decline as men age, lower levels of the hormone do not necessarily mean that an individual has hypogonadism, a condition that results from low testosterone. As the population ages and an increasing number of men struggle with obesity and diabetes, more men may experience low testosterone levels without meeting diagnostic criteria or displaying symptoms of hypogonadism.
“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,” said J. Bradley Layton of the University of North Carolina at Chapel Hill, an author of the research. “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.”
To study testosterone trends, the new research analyzed commercial and Medicare insurance claims from the United States and general practitioner health-care records from the United Kingdom during the period between 2000 and 2011. The study identified 410,019 American men and 6,858 U.K. men who began taking testosterone during this period. The analysis also found more than 1.1 million U.S. men and 66,000 U.K. men who had their testosterone levels tested during this time.
Since 2000, the number of men beginning testosterone therapy has almost quadrupled in the United States while only increasing by a third in the United Kingdom. The majority of these patients had not had their testosterone levels measured recently or only had them tested once prior to beginning treatment.
The Endocrine Society’s Clinical Practice Guidelines on testosterone therapy in adult men recommend making a clinical diagnosis of androgen deficiency, or low testosterone, only in men with consistent symptoms and unequivocally low testosterone levels. The research will be published in the society’s Journal of Clinical Endocrinology & Metabolism.