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VA Research Currents archive
March 19, 2015
A study in VA's Pacific Northwest region found that despite increases in testing, and in the actual proportion of men with low testosterone levels, the number of VA patients who received testosterone therapy has actually decreased. (Photo by Michael Moody)
Testosterone therapy rates are on the rise worldwide, with some reports citing an "epidemic" of testosterone prescribing. VA may be bucking the trend, however, according to research by a team with the University of Washington and VA's Pacific Northwest region.
The results, published online in Andrology on Feb. 13, 2015, suggest that despite increases in testing, and in the actual proportion of men with low testosterone levels, the number of VA patients who received testosterone therapy has actually decreased.
Testosterone therapy isn't necessarily a bad thing. Numerous studies have shown the negative effects of testosterone deficiency, from erectile dysfunction and decreased libido to increased risk of osteoporosis, weight gain, and depression. But while the hazards of low testosterone are well-documented, so too are the risks of therapy. Recent studies have suggested a link between testosterone therapy and heart disease, sleep apnea, and even prostate cancer. Currently, the Food and Drug Administration is investigating the risk of stroke, heart attack, and death in men taking FDA-approved testosterone.
The medical term for low testosterone is hypogonadism. It describes diminishing function of the gonads—the testes in men and ovaries in women. People's chances of developing hypogonadism increase as they age, which is why clinicians see low testosterone mainly in older patients.
For the study, researchers with VA and at the University of Washington set out to identify trends in testing and treatment for low testosterone within one VA region. They identified male Veterans aged 40 - 89 years and examined what proportion were tested, diagnosed, and subsequently treated for low testosterone between 2002 and 2011.
First off, the researchers saw an increase in the total number of male VA patients within the target age group, from 129,247 in 2002 to 163,572 in 2011. Part of the increase, they say, is due simply to the fact that men are living longer.
The proportion of men in the target group who were tested for low testosterone also increased during the same time frame, from slightly more than 3 percent to nearly 6 percent.
Among those tested, the overall number of men with low testosterone levels increased as well, from 35 percent to more than 47 percent.
Despite that increase, though, the number of men who received testosterone therapy within a given year decreased during the study period, from 31 to 28 percent. That contrasts with results from studies outside VA looking at testosterone therapy trends.
The researchers explain that for one thing, Veterans in VA care are more likely to have comorbidities that directly contribute to lowered testosterone.
Rather than prescribe testosterone therapy, clinicians may choose to address what they believe is the root cause—being overweight, for example. In many cases, write the researchers, it's more relevant to try and remedy the underlying cause rather than simply try to raise testosterone levels.
What's more, VA, compared with private health systems, has more formulary restrictions on the use of testosterone therapy.
The restrictions are there for a good reason, say the experts. Patients caught up in the marketing may focus so much on the benefits of testosterone therapy that they fail to see the risks.
