Factors that may be influencing the rise in prescription testosterone replacement therapy in adult men: a qualitative study

Mascarenhas, Alekhya; Sayal, Radha; Knowles, Sandra R.; Gomes, Tara; Moore, Julia E.

doi:10.3109/13685538.2016.1150994

Cited by 11 publications

(24 citation statements)

References 34 publications

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“…Future research might also directly interview and/or survey testosterone providers and users. In this latter vein, Mascarenhas et al (2016) interviewed 9 men who have used testosterone and 13 testosterone providers in Toronto, Canada, to better understand the factors underlying increased testosterone supplementation, with these interviews highlighting the importance of Web content. A complementary question to how testosterone is marketed to consumers is why consumers use testosterone.…”

Section: Discussionmentioning

confidence: 99%

A Content Analysis of Testosterone Websites: Sex, Muscle, and Male Age-Related Thematic Differences

2017

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Male testosterone supplementation is a large and growing industry. How is testosterone marketed to male consumers online? The present exploratory study entailed a content coding analysis of the home pages of 49 websites focused on testosterone supplementation for men in the United States. Four hypotheses concerning anticipated age-related differences in content coding were also tested: more frequent longevity content toward older men, and more frequent social dominance/physical formidability, muscle, and sex content toward younger men. Codes were created based on inductive observations and drawing upon the medical, life history, and human behavioral endocrinology literatures. Approximately half (n = 24) of websites were oriented toward younger men (estimated audience of men 40 years of age or younger) and half (n = 25) toward older men (estimated audience over 40 years of age). Results indicated that the most frequent content codes concerned online sales (e.g., product and purchasing information). Apart from sales information, the most frequent codes concerned, in order, muscle, sex/sexual functioning, low T, energy, fat, strength, aging, and well-being, with all four hypotheses also supported. These findings are interpreted in the light of medical, evolutionary life history, and human behavioral endocrinology approaches.

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Section: Discussionmentioning

confidence: 99%

A Content Analysis of Testosterone Websites: Sex, Muscle, and Male Age-Related Thematic Differences

2017

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“…Alternatively, the diagnosis of LOH (characterized by consistently low testosterone levels and combinations of symptoms related to androgen deficiency but without identifiable mechanisms other than those related to aging or lifestyle) [13,16,17] is prevalent among western men [1,23]. While diagnostic criteria for classical hypogonadism seem clear [13,36], diagnosis of LOH varies by specialist, lab, medical society, and region [13,16,17,24,35,37]. Furthermore, much of the expansion of U.S. PT sales has been driven by off-label indications such as LOH or treatment of androgen levels without a reported diagnosis [7,31].…”

Section: Discussionmentioning

confidence: 99%

“…The survey included questions related to demographics (e.g., age, employment, education, family/marriage status), clinical characteristics (e.g., current or prior medical conditions, type of PT formulation, source of PT prescription, and duration on PT), perceived changes after taking PT (e.g., “Has your work motivation changed since taking prescription testosterone?”; if respondents chose “yes” they would be asked to explain how in an open-ended question) and 5-point Likert items to gauge aspects such as relationship satisfaction (e.g., “How satisfied are you with your current relationship/marriage status?”, rated from “extremely satisfied (5)” to “extremely dissatisfied (1)”). Survey questions were inspired and partially adapted from the semi-structured interview guide in Mascarenhas et al (2016) [24]. In addition, five open-ended questions (“How did you learn about prescription testosterone?”; “Why did you decide to take prescription testosterone?”; “What did you perceive as the benefits of testosterone?”; “Please explain any side effects or concerns you have about your testosterone prescription?”; “Describe when you first began to notice the effects of prescription testosterone”) were included toward the end of the survey to directly address our research questions.…”

Section: Methodsmentioning

confidence: 99%

“…Comparisons made by Layton et al (2014) show U.S. men may have different concerns and motivations (such as less concern for sexual dysfunction but more concern over lack of energy) regarding PT compared to patients in the United Kingdom [23]. From a sample of nine interviewees in Canada, Mascarenhas et al (2016) identified both provider (e.g., whether testosterone was viewed as a legitimate therapy) and patient (e.g., access to information about effects of testosterone) insights into why men might seek prescription testosterone [24]. Here, we employ an exploratory online survey featuring open-ended questions answered by a convenience sample of U.S. men 21 years of age and older on prescription testosterone.…”

Section: Introductionmentioning

confidence: 99%

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Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men’s Experiences on Prescription Testosterone

Straftis

Gray

2019

IJERPH

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Prescription testosterone sales in the United States have skyrocketed in the last two decades due to an aging population, direct-to-consumer advertising, and prescriber views of the benefits and risks to testosterone, among other factors. However, few studies have attempted to directly examine patient experiences on prescription testosterone therapy. The present exploratory study involved an online self-report survey of U.S. testosterone patients who were at least 21 years of age. The primary focus was on patient perspectives concerning motivations leading to the initiation of testosterone therapy and the perceived effects of treatment. Responses to open-ended questions drew upon a coding scheme incorporating both inductive and deductive approaches, influenced by the clinical, male life history theory, and behavioral endocrinology literature. Results indicated that the most frequent reasons men gave for taking prescription testosterone were low testosterone (37.1%), well-being (35.2%), energy (28.7%), libido (21.9%), and social energy (19.4%); older men claimed libido as a motivation for testosterone initiation more frequently than younger men (p < 0.001). Men most frequently claimed testosterone improved their energy (52.3%), libido (41.9%), and muscle (28.5%). Results are interpreted in the context of medical, life history theoretical and behavioral endocrinology approaches, including an emphasis on sex and energy.

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“…A subsequent increase in TRT was noted in 2008. In another Canadian study, nine men who had used TRT, and 13 providers, were interviewed for a qualitative analysis of therapy (44). The factors that were found to influence testosterone prescription for providers included concerns about diagnostic ambiguity of age-related HG (which tests to use, what is the adequate threshold value for HG, etc.)…”

Section: Testosterone Prescribing Patternsmentioning

confidence: 99%

Testosterone deficiency in adults and corresponding treatment patterns across the globe

Anaissie

DeLay

Wang

et al. 2017

Transl. Androl. Urol.

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The global prevalence of testosterone deficiency (TD) ranges from 10–40%. The actual diagnosis of TD is controversial, as a wide range of total testosterone (TT) thresholds are used for diagnosis (200–400 ng/dL), and physicians differ in their emphasis placed on clinical symptoms. There are also significant global differences in the prescription patterns of testosterone replacement therapy (TRT). In the United States, prescription of TRT is significantly higher than the rest of the world, increasing 3-fold over the last 10 years and more so in eugonadal men. The majority of treating physicians emphasizes clinical symptomology of TD over laboratory values, and up to one-fourth of their patients do not even have serum testosterone levels. There are significant inter-physician differences in willingness to prescribe TRT in the setting of prostate cancer. Data is scarce on testosterone prescribing patterns in Africa, Asia, and the Middle East. More literature is needed to better characterize how physicians from different regions diagnose TD.

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Factors that may be influencing the rise in prescription testosterone replacement therapy in adult men: a qualitative study

Abstract: The findings of this study highlight that much work still needs to be done to improve diagnostic accuracy and encourage appropriate TRT prescription in adult men. In addition, both patients and providers need more information about the risks and long-term effects of TRT in men.

Cited by 11 publications

References 34 publications

A Content Analysis of Testosterone Websites: Sex, Muscle, and Male Age-Related Thematic Differences

A Content Analysis of Testosterone Websites: Sex, Muscle, and Male Age-Related Thematic Differences

Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men’s Experiences on Prescription Testosterone

Testosterone deficiency in adults and corresponding treatment patterns across the globe

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