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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)

  • I am rather biased on this as I do work for pharma.

    But to be fair a large chunk of modern medicine is about counter acting normal non lethal processes - fertility and menopause being the major ones.

    If men are looking to have better quality of lives we should embrace it( with usual provisos of needing evidence and safety etc).

    Greater awareness of these issues will lead to more prescribing, It's the direction of travel !

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  • Someone needs to have the balls (maybe on testosterone) to draw a line between essential NHS services and silliness like this which needs to be in private clinics.

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  • 10:02am could not agree more. We, as society, need to have a grown up disussion as to what the NHS should be (if it exists at all) what it should do and what we must be prepared to pay for. The 1948 guise has long passed its sell by date. It cannot be afforded and the politicians dissemble (hey what's new).

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  • As if there wasn't already too much testosterone around in the world !! I suspect there will be some female GPs sitting on their hands !!

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  • I once saw a TV documentary about an African doctor aged about 30 who had never been through puberty. He was working in a Midlands Hospital and studying for his memberships of the Royal Colleges. He had a very nice (platonic) black girlfriend. Growing up in Africa he had been so embarrassed at being the only one of his classmates not achieving sexual adulthood that he buried himself in his studies and in this matter was successful by becoming a doctor. But having not been through puberty and nevertheless wanting to have a family of his own, he consulted an endocrinologist who advised him he had the testosterone level of an infant and offered him an implant. As soon as he had the implant, he could no longer concentrated on his Royal College Membership studies. He went to a sports trainer to control the teenaged and adult development of his musculature which was still that of a young boy. This story both sad and glorious at once should serve as a warning against adopting the barely controllable passions of a teenager when one is a responsible or retired adult: just make sure you can cope with it. I am glad my sexual drive has declined now I am aged 70, because I can now get on with other things such as campaigning against the privatisation of NHS services for which I belong to two campaigns in Brighton and Chichester, and with some sterling successes.

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  • It's not the middle aged men I worry about it is the teenagers and young men who use huge amounts of testosterone in order to bulk up in the gym. The desire for the body beautiful is putting them at risk from dodgy dealers.
    The male menopause needs much more evidence based analysis to determine who will benefit though my experience is replacement in men with low levels does improve their wellbeing.

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  • Please forgive my ignorance, but isn't high testosterone levels linked with PROSTATE CANCER?
    Are we just about to see en exponential increase of the disease, which is of course excellent news for testosterone producers, who also produce treatment for ca prostate!

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  • At the age of 78 my testicular testosterone was reduced to 0.0?? for prostate cancer treatment.
    I continued to work(sessional GP 3 sessions a week) and play (swimming 40 lengths 3-4 x a week)with my usual zest for life. Lost some body hair but did not get more on my head. There was the expected specific functional deficiency which returned to baseline when the treatment stopped.
    I believe that eunuchs were able to perform but not reproduce and thus were able to help their masters out in some duties when he was overextended!. Also the male singers know as "castrato" were eagerly sought by some ladies due to their performances when they were not singing.

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  • Vinci Ho

    One thing we don't have (yet) is vigorous TV advertising on prescription drugs like in America. One will be amazed what could be said about a new precription drug on American TV adverts . Sheer capitalism , happy days to drug companies . The wind is clearly blown towards our side of the Atlantic Ocean. You can imagine what could be proclaimed in a TV advert on testosterone replacement therapy. It is more problematic than PD5 inhibitors (which are not without side effects as well). Monitoring CVD risks , PSA and even LFT follows. Rationing becomes an inevitable subject in NHS . Everybody will come out to say their 'conditions' justify a prescription on NHS. Politicians are hiding and passing the buck to us. On the day when NHS collapses , the blame will only go to all medical professionals , as highlighted by Julian Tudor Hart in his BMJ article recently .

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  • Minor point, but if the link is followed testosterone is in the top 10 of schedule 4 controlled drugs (the only non Z or benzo), not all controlled drugs.

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