‘Low T’: The peril of medicating grumpy old men
Could you have low testosterone?
That’s the question Abbott Laboratories (now AbbVie) has been urging men to consider with its “Is It Low T?” awareness campaign, an effort to change how doctors and the public think about managing aging in men.
Since 2008, this massive marketing endeavor has targeted middle-age men who have put on some weight, sometimes feel grumpy or get sleepy after meals, encouraging them to have their testosterone levels tested and to consider treatment if levels are low. It has helped persuade legions of men to take a drug that might not help and might actually do harm for a condition they probably don’t have.
In a recent article in JAMA Internal Medicine, we described the tactics such campaigns use to sell disease. Since the start of the campaign, testosterone sales, which had been stable for years, have risen more than 1,800 percent, exceeding $1.9 billion in 2012.
By targeting men worried about weight, muscle tone, energy levels, mood and sexual satisfaction, the campaigns imply that treatment will help them become thinner, more muscular, more energetic, less grumpy and more sexually satisfied. But there’s a big problem: We really don’t know if diagnosing and treating “low T” does any good. More important, there is some evidence it may cause harm.
Last month, a new study of men found that older men taking the drug were more likely to have heart attacks. Soon after the study’s release, the Food and Drug Administration announced a new investigation into the possible harms of testosterone.
Testosterone drugs were initially developed for a narrow use: treating men with a reduced ability to produce testosterone because of such things as trauma, chemotherapy, genetic abnormalities or undescended testicles. For these men, testosterone replacement provides a clear quality-of-life benefit, permitting normal sexual development or restoring male appearance and sexual function.
In the years since the drug was first developed, the FDA has approved a whole medicine cabinet of testosterone products — gels, pills, patches and even an underarm roll-on.
As physicians who study communication about prescription drugs, we find the marketing of low T eerily reminiscent of another campaign: the hyper-promotion of hormone replacement for post-menopausal women. While these drugs can have an important quality-of-life benefit for women with severe menopausal symptoms, a gold-standard randomized trial showed that for most women the hormones did more harm than good.
For men with severe hormone deficiency from a medical problem, testosterone replacement is a major advance. But for the aging men targeted by the low T campaign, the balance of benefits and harms is unknown. And there is good reason to worry about heart attacks, especially in men with heart disease and in the frail and elderly.
When it comes to testosterone, the pharmaceutical industry has gone too far — and the FDA not far enough. Maybe the problem isn’t low T; maybe instead it is low R — low regulation.
Steven Woloshin and Lisa M. Schwartz are internists and professors of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H. They are the authors of “Know Your Chances: Understanding Health Statistics.”