Study: Testosterone therapy may be overprescribed in US

Vial of testosterone. Wikipedia

American physicians may be applying too liberal of a standard for diagnosing late-onset hypogonadism, sometimes called "male menopause," and prescribing testosterone therapy in older men, according to a British study published in the New England Journal of Medicine. U.S. prescriptions for male testosterone therapy has increased 400 percent since 1999, according to researchers.

British researchers have named 32 symptoms associated with late-onset hypogonadism or “male menopause” caused by a reduction in testosterone production in ageing men.

Unlike female menopause which affects all women, male menopause affects only about 2 percent of elderly men. Hypogonadism is often linked to poor general health and obesity.

The findings should offer valuable guidance to physicians prescribing male testosterone therapy, a practice that has increased by 400 percent in the United States since 1999 but no where else, say researchers from the University of Manchester, Imperial College London and other partnering institutions. Their study is published in the New England Journal of Medicine.

Expert insight about testosterone replacement therapy: "Testosterone replacement therapy may stimulate growth of the prostate. If early prostate cancer is present, testosterone may stimulate the cancer’s growth. Therefore, men who have prostate cancer should not take testosterone replacement therapy. It is important for all men considering testosterone replacement therapy to undergo prostate screening before starting this therapy." -- Cleveland Clinic

The researchers tapped colleagues at eight European health centers to recruit 3,369 men between the ages of 40 and 79. They measured the participants’ testosterone levels and asked them detailed questions about their sexual, physical and psychological health.

Only nine of the 32 identified symptoms for late-onset hypogonadism were associated with low testosterone levels. The major symptoms associated with low testosterone levels were  decreased frequency of morning erection, decreased frequency of sexual thoughts or sex drive, and erectile dysfunction. All three sexual symptoms must be present along with low testosterone levels in order to diagnose late-onset hypogonadism, said the research team.

“Our findings have for the first time identified the key symptoms of late-onset hypogonadism and suggest that testosterone treatment may only be useful in a relatively small number of cases where androgen deficiency is suspected, since many candidate symptoms of classic hypogonadism were not associated with decreased testosterone levels in older men,” said lead author Fred Wu, University of Manchester School of Biomedicine.

The research is pary of the European Male Ageing Study which is funded by the EU. The study also identified the thresholds of testosterone below which certain symptoms become increasingly prevalent. Documentation of levels of testosterone below these thresholds is required to confirm the diagnosis of hypogonadism in symptomatic elderly men, according to the study.