Guideline for Male Testosterone Therapy: A European Perspective

Extract

Why are we suddenly assailed with a plethora of guidelines for testosterone (T) therapy in androgen deficiency (1–3), a condition that has been managed with relative success and apparent patient satisfaction for nearly seven decades?

Prescriptions for T in the United States have increased by 400% since 1999 (4), mainly in middle-aged men. Interestingly, this trend has not been duplicated in Europe [Intercontinental Marketing Services (IMS) Health Inc., New York, unpublished data] or Australasia (5). Has there been an epidemic of male hypogonadism in North America, or does this reflect a substantial shift in approach to the diagnosis and treatment of androgen deficiency?

The age-related decline in T (6) in an increasing elderly male population is the likely drive behind this trend, fueled by a number of factors specific to the United States. These include direct-to-patient pharmaceutical advertising, ready availability of reimbursement by health-care providers, willingness of patients to pay for prescriptions, prevalence of an antiageing ethos, and, most importantly, clinicians’ attitude in accepting perceived novel therapeutic opportunities. The use of T in men with chronic illnesses is still underappreciated and is unlikely to have contributed substantially to the prescribing increase.