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A faulty production line

Testosterone prescribing soars as ‘male menopause’ is increasingly medicalised

Exclusive GPs are warning that the so-called ‘male menopause’ is being wrongly medicalised, following an analysis of figures that show a continued rise in testosterone prescribing.

They warn that much of this increase has been due to extra demand driven by more sophisticated marketing of the drug, including claims that it will give men their ‘oomph’ back.

As a result, symptoms such as fatigue, erectile dysfunction, reduced physical endurance and mood disturbance are wrongly being put down to age-related decreasing testosterone, often labelled the ‘male menopause’.

However, research shows the decline in testosterone – termed ‘late-onset hypogonadism’ - is usually caused by underlying factors, such as obesity and diabetes in older age.

A Pulse analysis of prescribing figures show that GP prescribing of testosterone has risen 20% since 2012, costing the NHS £20m a year.

Some GPs have expressed concern this ongoing trend could put men at risk.

It continues a shift that has seen prescriptions more than double in primary care over the past decade. The overall number of testosterone prescription items dispensed has increased since 2012, with two different drugs - testosterone and of testosterone undecanoate – among the top ten most prescribed controlled drugs for the first time.

Royal College of GPs prescribing advisor and North Wales GP Dr Martin Duerden said he is concerned testosterone is increasingly being used in the UK to treat ‘the male menopause’ among those with reduced energy and libido, ‘rather like oestrogen has been used in women as an “anti-ageing” product in the past’.

He added: ‘I think we should use these products very cautiously unless there are clear clinical explanations for hypogonadism other than age.’

But Professor Mike Kirby, GP and visiting professor to the Prostate Centre, London, says: ‘Since the introduction of Viagra, and more interest in erectile problems, more men are being tested for testosterone deficiency – that’s been a major driver of it.’

He adds the rise shows GPs responding to greater awareness of the problem of testosterone deficiency, and to guidelines promoting testing and treatment of it in men presenting with erectile dysfunction, such as those from the British Society of Sexual Medicine (BSSM).

However, there is still contention around the appropriateness of such recommendations, with some experts advising against treatment in these groups

Dr Andrew Green, prescribing spokesperson for the BMA’s General Practitioners Committee and a GP in East Yorkshire, says: ‘Patients with non-specific symptoms or indeed just the normal changes in sexual function that happen with age are influenced by articles in magazines and request testing, which can then result in expectation to prescribe for low-normal readings.’

 

 

 

Readers' comments (18)

  • And we haven't even mentioned the issue of women asking for testosterone prescriptions, I've met a few.

    In many instances this is a 'life style' prescription, requested by 'informed' patients after online research, I guess fed largely by American consumer medicine.

    The pros and cons of this are up for debate but I don't believe this is something the NHS should be routinely dishing out to older men who want to feel 30 again.

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  • Medicalization (sic) of healthcare. All pushed in by pharma and I couldn't disagree more with the first post on this thread. What will happen when they all file a mass action suit against pharma as they've developed prostate cancer?

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  • Well once all the gps have gone, pharma may try to wangle selling their carcinogenic wares directly to patients!

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  • Thanks for the sexism June Greaves.

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  • Testosterone prescription should be left to Specialists in Hospital Medicine.

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  • In answer to anonymous 12.14 the association between testosterone levels and prostate cancer is not entirely clear
    Abraham Morgantaler and BSSM will tell you there is no evidence that giving testosterone to restore physiological level is associated with prostate cancer
    Paradoxically however they strongly advise very close monitoring for prostate cancer
    These are BSSM guidelines not NICE not royal college and not health authority you are personally responsible for validating their authority to issue these guidelines
    By the age of 100 we will nearly all have prostate cancer
    The specialist treating you will block your testosterone
    What are the chances that a patient having this explained will question whether the testosterone his GP gave could in any way be associated
    Put simply: it stands to reason
    The GP will have to prove it didn't not the other way round
    Add to this the virtual guarantee that the patient has not been monitored precisely according to the guidelines and you are virtually guaranteed to be found guilty

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  • pretty common to treat low T here in Canada and having been to education session son it the advice is IHD and ca prostate are increased if you push the levels up too high but not if in physiological range and of course you warn them of this risk like with any other treatment and they understand so I don't know how far they would get trying to sue you. Of course Canadians don't due doctors much like in UK and we have more time to monitor + are paid per visit. In uk with capitation then of course all the commentors say forget this its more work and are risk averse.

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  • Giving HRT to females is not medicalising?
    What happened to EQUALITY and non judgemental medicine? Feminists are double standard terrorists wrecking havok to 50% of the population.

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