A UK epidemic of testosterone prescribing, 2001–2010

Abstract

Many men in the UK might be receiving testosterone replacement therapy with neither clearly established indications nor robustly diagnosed hypogonadism. A national registry for men treated with testosterone and further evidence to improve current guidance (national and/or international) on the indications for testosterone replacement would be beneficial.

Age-associated changes in hypothalamic–pituitary–testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study

“…More recently, longitudinal studies have also confirmed that these findings have fuelled a substantial worldwide increase in testosterone prescription (10,11,12,13). Testosterone decline may not be an inevitable part of ageing, being related to adverse health and lifestyle factors, such as obesity; it may, therefore, be potentially preventable and reversible (5,6,7,14).…”

Screening for hypogonadism: real‐world considerations

“…For men over the age of 50 years, a higher BMI was associated with a lower total testosterone level (Spearman's rho -0.24, p<0.001). 18 This study has demonstrated that of those men screened for hypogonadism, 21.2% were potentially hypogonadal. Thus, over a 10-year period, screening in primary care identified a significant minority of men who had potential hypogonadism, regardless of whether the local Cheshire accredited laboratory cut-off was used or the BSSM criteria were applied.…”

Current topics in testosterone replacement of hypogonadal men

“…Until then mostly intramuscular testosterone enanthate or cypionate had been . Currently mostly transdermal gels and intramuscular testosterone undecanoate tend to be used [7,8] and these preparations, if properly administered, result in physiologic serum testosterone levels.…”

“…Some recent publications indicate that testosterone is frequently prescribed without proper patient follow-up [7,8,87,88]. However, although careful monitoring at regular intervals is emphasized in most of the current guidelines [6], they are not consistent concerning follow-up intervals and the parameters to be evaluated.…”

“…This seems to be more prevalent in the USA than in Europe as US sales of testosterone preparations have quadrupled from 2000 to 2011 although the number of low testosterone levels revealed in laboratory testing has remained constant [7]. In comparison, in the UK testosterone prescriptions have doubled within a decade [8], almost in pace with low testosterone levels detected in laboratory testing [7]. Prescribing testosterone at random without documented low testosterone levels and symptoms of testosterone deficiency is not in accordance with current good medical practice and borders on testosterone abuse, culminating in doping with androgens to enhance physical performance in sports and bodybuilding.…”