Endocrine Abstracts

Male hypogonadism is characterised by sexual dysfunction, loss of muscle bulk, central obesity, fatigue, mood and sleep disturbances, osteoporosis and anaemia. Although these features are associated with low serum testosterone concentration, not all men with a low serum testosterone are definitively hypogonadal, and there is a large symptom overlap with obesity and non-endocrine illness. Importantly, testosterone replacement therapy may not be appropriate for men with mild, functional and/or transient hypotestosteronaemia. Despite the lack of long-term safety data and inconsistent improvement in symptoms, pharma companies have nevertheless run aggressive marketing campaigns promoting testosterone replacement that have sought to equate hypogonadism with low testosterone, most notably BAYER’s “Restore the Man”. We collated data about the use of testosterone preparations from the Departments of Health Prescription Cost Analysis for community pharmacies 2000–2010, for England, Scotland and Wales. Community requests for serum total testosterone assay in males to the Biochemistry Department at the Newcastle upon Tyne Hospitals Trust were also examined over the same time period. The number of prescriptions for testosterone preparations increased by nearly 90% from 157,602 to 298,134 dispensed items annually, over the last 10 years. The cost of this medication to the NHS showed a 267% escalation, from £3.2 to £11.7 million yearly over the same period. The increase in prescribing was most striking for transdermal preparations (a five-fold increase). Local requests for serum testosterone measurement in males from primary care also increased, from 347 requests in 2000 to 823 requests in 2010, a 137% increase. However, the number of men with unequivocal hypogonadism (testosterone less than 6.0 nmol/l) remained constant at 5.2% in 2000 and 6.3% in 2010. Many men in the UK are receiving unnecessary testosterone replacement therapy. Regulation of industry advertising to primary care is inadequate. National guidance on the indications for testosterone replacement is urgently needed.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.