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Do you need to be treated for low testosterone?

Drugmakers spent more than $100 million advertising the drugs last year, but our experts aren't buying it

Consumer Reports magazine: July 2013

“Feeling like a shadow of your former self?” “Lost your appetite for romance?” If you believe the ads, the problem could be “low T,” and a daily dose of testosterone could restore your lost libido.

Drugmakers spreading the word of testosterone’s supposed wonders have spent lavishly on ads in recent years, from $14.3 million in 2011 to $107.3 million in 2012, mostly for two drugs, AndroGel 1.62% and Axiron. And the ads are working: Testosterone prescriptions—and drug company revenue from them—have skyrocketed, as shown in the chart below.

But our medical experts aren’t sold. They say the benefits of testosterone are overblown and the risks underappreciated. Those risks include breast enlargement, reduced fertility, heart attacks, and possibly faster-growing prostate cancer. Women accidentally exposed to the hormone can develop male characteristics, and children can enter an early puberty. And the drugs can be expensive—up to $570 a month.

The American Urological Association is so concerned by the trend that it recently added testosterone therapy to a list of overused and potentially dangerous medical treatments, as part of campaign called Choosing Wisely.

Real risks

The ads do describe the risks. But they are spoken as you watch a vibrant middle-aged man cruising in a convertible with his lady friend, or a peppy guy canoodling with his wife in the kitchen. So it’s easy to focus instead on the prospect of feeling like a teenager again.

That’s a mistake, says John Santa, M.D., director of the Consumer Reports Health Ratings Center. “The risks are substantial,” he says. In a 2010 New England Journal of Medicine study, for example, men 65 and older with low testosterone and obesity or other conditions were treated with Testim 1%. After six months, they had increased physical strength compared with men not on the drug—but they also had more heart attacks and other cardiovascular events.

Other research suggests that the hormone might fuel the growth of prostate cancers. Established risks include blood clots in the legs, sleep apnea, an enlarged prostate, enlarged or painful breasts, and swollen feet or ankles.

Children exposed to testosterone can experience growth of pubic hair, increased libido, and aggressive behavior.

Another concern is reduced sperm counts. “I see men every week who are infertile thanks to testosterone therapy,” says Craig Niederberger, M.D., head of the department of urology at the University of Illinois at Chicago.

The gel forms of testosterone, applied under your arm or on your upper arm and shoulder, can be transferred to others if you don’t wash the area after applying it. Children exposed to the hormone have experienced enlargement of the penis or clitoris, growth of pubic hair, increased libido, and aggressive behavior. Women can experience acne and the growth of body hair and, if they are pregnant or breast-feeding, can transfer the hormone to their babies.

Finding the cause

Still want a testosterone boost? Don’t expect too much.

For one thing, a modest decline in testosterone as you age is normal, but there’s little correlation between that decline and sex drive or performance, and little evidence that extra doses improve sexual satisfaction.

The Food and Drug Administration has approved the hormone for men with levels well below normal. That condition, called hypogonadism, is linked to fatigue, depression, and the loss of libido, bone, muscle, and facial and pubic hair.

Even then you shouldn’t rush to treatment. Stress, lack of sleep or exercise, and feelings about your partner can also sap your vim and vigor. Plus, diabetes, obesity, and pituitary tumors can contribute to low testosterone, as can some drugs. So they should be ruled out first.

Our advice. There’s nothing romantic or age-defying about a drug that comes with long-term risks to you and the people you live with. Try safer ways to bring back that lovin’ feeling: Eat right, exercise, reduce stress, and have a long talk with your partner and your doctor. If you do start treatment, reassess after a few months and watch for worrisome side effects in you and those around you.

Photo: Source Healthcare Analytics, Kantar Media and Bloomberg Industries
   

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