Decreased energy. Depressed mood. Diminished muscle mass. Dampened sex drive. These are the daily woes facing millions of middle-aged American men. It is all caused by a deficiency of the mighty male hormone testosterone, a condition better known these days as Low-T. The problem is that the principal promoter of this diagnosis is not from within the medical establishment. It is the drug maker AbbVie, the Abbott spinoff that makes the leading testosterone replacement product AndroGel. This has prompted several doctors recently to question whether Low-T is really a treatable condition, or simply a marketing campaign to sell a disease that does not really exist.
By all accounts, it is a masterful campaign. Just watch a bit of sports or late-night TV or read some of the more popular consumer magazines. You will quickly see how pervasive is the drive to convince those sagging plus forty-somethings that with just a little bit of T, they can reclaim their waning youth and vitality. AbbVie even has a dedicated Low-T website, complete with an online quiz sure to make most mid-life males muse about the benefits of a testosterone boost. The campaign is obviously working. Last year there were roughly 3 million prescriptions for the wonder drug, accounting for more than a billion dollars in sales. These numbers are projected to climb even higher in the coming years.
It is this success that is causing serious concern in the medical community. Not that there isn’t a real medical condition for abnormally low testosterone levels. It is called hypogonadism. But apparently, only a small percentage of men over 40 actually have this condition, and an even smaller percentage ever develop the clinical symptoms associated with it. The concern is that scores of healthy men are using testosterone replacement products when there is no evidence that they have any kind of deficiency that needs to be treated.
This was the finding of a recent study published in JAMA Internal Medicine. It tracked the testosterone prescribing patterns of nearly 11 million men and found that a sizeable chunk of them never even had their blood tested for the deficiency before they received the hormone treatment. The study further showed that even for those who were tested, it was unclear how many of them had an actual deficiency. The lead author of the study, Jacques Baillargeon out of the University of Texas, concluded from this that many of these individuals are exposing themselves to the unknown risks associated with extended hormone therapy without any real benefits. It is a trend he believes “has been driven, in large part, by direct-to-consumer marketing campaigns” like the one pushed by AbbVie.
Two recent commentaries also in the JAMA journal reinforce the concern over the formidable Low-T marketing machine. The first commentary comes from Stephen Braun, a professional medical writer who was paid to ghostwrite articles in a variety of popular magazines for a leading endocrinologist espousing the benefits of testosterone treatment. As Braun explains, “I knew what I was getting paid to do: trumpet the party line.” For one particular piece he wrote for the original maker of AndroGel, he described his role as being “a shill for the sponsor,” providing “an uncritical, unbalanced presentation of ‘facts’ that serves primarily to drive people to their physicians seeking the holy grail of ‘energy, positive mood, and sexuality’ in the form of testosterone.”
The other commentary, written by Lisa Schwartz and Steven Woloshin of Dartmouth Medical School, was even more stark in its rebuke of the Low-T crusade, calling it the “perfect template” on how to sell a disease. According to Schwartz and Woloshin, it blurs the line between public health and marketing through three basic strategies: “lower the bar for diagnosis, raise the stakes so people want to get tested, and spin the evidence about drug benefits and harms.” And they say it should be recognized for what it is — “A mass, uncontrolled experiment, which invites men to expose themselves to the harms of a treatment unlikely to fix problems which they may not really have.” They even draw on the satiric insight of Stephen Colbert to bring their point home:
A man on TV is selling me a miracle cure that will keep me young forever. It’s called Androgel . . . for treating something called Low-T, a pharmaceutical company recognized condition affecting millions of men with low testosterone, previously known as getting older.
So, if you are a middle-aged man suffering from general malaise and a noticeable decline in your strength and virility, what is the takeway from all of this? You may have a real condition for which testosterone treatment can be of use. Or, you may just be suffering through the common effects of the ordinary aging process. It is important to figure out which of these conditions is really at play before undertaking the much ballyhooed Low-T solution, the full benefits and risks of which have yet to be determined.
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