Testosterone often used without clear indication

Although testosterone use has increased significantly among older men in the past decade, many patients appear to have normal testosterone levels and do not meet the clinical guidelines for treatment, according to new research.

Since testosterone levels tend to naturally decline as men age, lower levels of the hormone do not necessarily mean that an individual has hypogonadism. As the population ages and an increasing number of men struggle with obesity and diabetes, more men may experience low testosterone levels without meeting diagnostic criteria or displaying symptoms of hypogonadism, researchers say.

“Over the past decade, older and middle-aged men are increasingly being tested for low testosterone levels and being prescribed testosterone medications, particularly in the United States. While direct-to-consumer advertising and the availability of convenient topical gels may be driving more men to seek treatment, our study suggests that many of those who start taking testosterone may not have a clear medical indication to do so,” said first author J. Bradley Layton, PhD, of the University of North Carolina, Chapel Hill.

For this retrospective incident user cohort study, published online in the Journal of Clinical Endocrinology & Metabolism (Jan. 1, 2014), the authors analyzed commercial and Medicare insurance claims from the United States and general practitioner health care records from the United Kingdom during the period between 2000 and 2011. The study identified 410,019 American men and 6,858 UK men who began taking testosterone during this period. The analysis also found more than 1.1 million U.S. men and 66,000 UK men who had their testosterone levels tested during this time.

Since 2000, the number of men beginning testosterone therapy has almost quadrupled in the U.S. while increasing by one-third in the UK. The majority of these patients had not had their testosterone levels measured recently or only had them tested once prior to beginning treatment.

While testosterone testing has increased substantially in the U.S. and the UK, the study found the testing appeared to be more targeted in the UK. Many of the tests there identified men who did have reduced levels of the hormone.

“In the United States, we saw a clear trend where more and more men being tested actually had normal testosterone levels and non-specific symptoms. This is cause for concern as research examines potential risks associated with testosterone use,” Dr. Layton said.

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