Has Use of Testosterone Become Abusive?
Written by Editor   
Wednesday, May 28, 2014 11:23 AM

Do current prescribing practices for testosterone constitute abuse?  Both sides of the testosterone issue stated their cases during a first-ever Crossfire session at the American Urological Association meeting. Citing data and clinical guidelines and interspersing their remarks with a little humor, speakers at the AUA forum offered their take on the reasons behind the growing use of testosterone, the one point on which the two sides agreed.

Testing has failed to keep pace with the number of prescriptions.  An increase in the number of new prescriptions for testosterone logically should be accompanied by an increase in tests for serum testosterone levels. Instead, "a terrible issue" has emerged, as the frequency of testing has decreased or remained flat, at best.  "A large number of men who have normal testosterone levels are initiating testosterone therapy."

One speaker pointed to a recent report showing that more than 12% of American men 18 to 39 use testosterone.  What we are starting to see is iatrogenic infertility.  The Endocrine Society guideline states that testosterone should be prescribed only when medical indications exist.  There are too many signs and symptoms that one can ascribe to medical conditions of all kinds, including lifestyle concerns.

One recent study examined diagnoses associated with testosterone prescriptions from 2001 to 2011 for almost 11 million men. Hypogonadism accounted for 51% of the prescriptions, followed by fatigue (35%), erectile dysfunction (32%), and psychosexual dysfunction (12%).  "It is unknown what percentage of these men actually had low T.  Even more concerning, 25% of new testosterone users did not have a serum testosterone drawn."

Clinics devoted to treatment of low testosterone have sprung up across the country, adding fuel to the testosterone prescription frenzy. Many of the clinics are run by clinicians who are not specialists trained in the diagnosis and management of male hormone problems.  "Even if the clinics are appropriately managed, there are a lot of them that prescribe testosterone that has been bought with cash, so it cannot be tracked," he said. "This is giving all of us a bad name."

Testosterone carries clear risks.  A placebo-controlled clinical trial of testosterone replacement therapy (TRT) in older men, almost half of whom had cardiovascular disease. The patients were treated to a serum testosterone target of >500 ng/dL.  The trial stopped early because of an excess number of cardiovascular events in the group randomized to TRT. Since then, several other studies and meta-analyses have added to the evidence that TRT is associated with increased cardiovascular risk.  "The long-term safety of testosterone use is unclear."

In contrast, at least a dozen studies have shown a mortality benefit in association with normal serum testosterone and an increased mortality risk in association with low testosterone.

"It's clear that there is a lot of debate. We see a lot of direct-to-consumer ads. It's imperative that appropriately stratified trials need to be conducted to provide us with some clear-cut answers in men who truly have hypogonadism."

Source:  http://www.medpagetoday.com/MeetingCoverage/AUA/45957