He's Lost That Youthful Feeling, Oh That Manly Feeling

Androgen replacement therapies for low testosterone have gone up since 2001

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Lots of men might be hesitant to ask the doc if they might have low testosterone. But an increasing number of prescriptions for some hormone replacement shows men could be opening up.

Prescriptions for androgen replacement therapy have increased significantly since 2001, new research shows.

The study is significant because conflicting data on the short and long-term risks of testosterone therapy has been reported.

"Talk to your MD about androgen replacement options."

Jacques Baillargeon, PhD, from the Department of Preventive Medicine and Community Health at the University of Texas Medical Branch in Galveston, Texas, led an investigation into the trends of androgen replacement therapy (ART) sales and prescriptions over a 10-year period.

Androgen replacement therapy is used to treat hypogonadism, a condition where a man is unable to produce the normal levels of testosterone. Lack of testosterone can affect sexual function, sleep patterns and cause emotional and physical changes. 

Researchers looked at data from Clinformatics DataMart, one of the largest commercial health insurance populations in the US, between 2001 and 2011.

The study included almost 10,800,000 men who were at least 40 years of age. The researchers tracked the number of men who received a prescription for androgen replacement therapy in a particular year and compared it to all the men covered in that year.

Different kinds of androgen therapy were taken into account, including therapy as a pill, topical ointment and intramuscularly with a shot. For each 100 milligrams of the replacement hormone, researchers counted that equal to one week of the oral therapy.

The researchers looked for any diagnoses that showed the body was not producing enough sex hormones, including erectile dysfunction, psychosexual dysfunction and fatigue.

Androgen use increased three-fold among men over age 40, the researchers found. In 2001, 0.81 percent of the male population used androgen therapy, however 2.91 percent used it in 2011.

By age, 2.29 percent of men in their 40s and 3.75 percent of men in their 60s took some form of androgen replacement therapy.

Topical gels were the most widely used kind of therapy and had the highest rate of increase. Among androgen prescriptions, most covered 150 days from the start of treatment.

At the same time, about 19 percent all one-time androgen therapy users who filled just one prescription received a maximum of 30 days of the therapy.

In the South, 3.77 percent of all men over age 40 used androgen therapy. The West, Midwest and Northeast followed at 2.61 percent, 1.78 percent and 1.6 percent, respectively.

Hypogonadism, or the inability to create enough sex hormone, was diagnosed in just over half the participants in the year prior to starting androgen therapy.

Other diagnosed conditions included fatigue in about 35 percent of participants, erectile dysfunction in about 32 percent and psychosexual dysfunction in 12 percent.

"Our findings that almost 20 percent of all new users received treatment for 30 days or less and that most men did not have clear evidence of a potential indication for ART suggests that the clinical reasons for initiating therapy are complex," the researchers wrote in their report.

The researchers also found that a little more than a third of new androgen users had their testosterone levels checked in the year prior to starting treatment.

The authors noted the participants of the study might not be representative of the general population at large, as the participants were generally older.

The prescription claims also do not confirm whether patients adhered to their prescriptions. In addition, the researchers are not sure how many men had low testosterone levels among those who were tested.

Future studies should look into how often men with normal testosterone levels and random symptoms of erectile dysfunction actually seek and are prescribed androgen replacement therapy, according to the researchers.

The study, funded by the National Institutes of Health, was published online June 3 in the journal JAMA Internal Medicine. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
June 2, 2013
Last Updated:
August 8, 2013