Testosterone Replacement Therapy: Low T Clinics Proliferating

May 5, 2014

Testosterone prescriptions written in the U.S. have more than tripled in the past decade. But researchers suspect this assessment could be low because many prescriptions given at “Low T” clinics aren’t tracked, since patients often buy the substances with cash. NPR and Kaiser Health News reported that the increased prescriptions by Low T clinics are troubling to doctors who specialize in hormonal problems, like Dr. Bradley Anawalt of the Hormone Health Network. Dr. Anawalt and others like him believe that Low T clinics, while in the business of selling testosterone, are not in the business of treating the complex medical problems that can be behind low testosterone levels.

But business is on the rise for the Low T clinics. Sarah Varney, a health reporter for KQED’s California Report and contributing reporter for NPR, interviewed the Chief Medical Officer of a popular Low T clinic chain based in Texas. The CMO stated the company expects to more than double its number of sites over the next year, estimating they’ll reach approximately 70,000 customers.

In an article for BBC News, William Kremer of BBC World Service reports that the global market for prescription testosterone has increased 12-fold since 2001, and in 2011 it was valued at $1.8 billion.

Doctors Say Low T Can Be Resolved by Treating Underlying Medical Issues

According to another NPR story, many doctors are concerned about the prevalence of the Low T clinics because they only treat low testosterone rather than a particular medical condition. This is a concern because low testosterone levels can be a symptom of a larger problem affecting the patient.

In this NPR story, Patti Neighmond, health policy correspondent at NPR, spoke with Dr. Ronald Tamler, an endocrinologist and clinical director of the Mount Sinai Diabetes Center. Dr. Tamler is reported to say that in the patients he has treated, obesity is the most common factor behind low testosterone levels. Tamler explained that this is because fat tissue, especially abdominal fat, can turn testosterone into the female hormone estradiol, which decreases overall testosterone in the body and disrupts the signals to the brain that stimulate testosterone production. Dr. Tamler conducted a study published in Gender Medicine in October 2011 with some of his colleagues that found obese patients who lost weight experienced increased testosterone levels. Dr. Tamler further explained to NPR that conditions like sleep apnea, depression, heart disease, and obesity can all cause low testosterone levels, and if these conditions are found, he recommends treatment for them before undergoing testosterone replacement therapy.

More Clinical Studies Needed to Assess Possible Cardiovascular Risks of Prescription Testosterone 

Dr. Lisa Schwartz of Dartmouth College told BBC News that she believes many patients are drawn to testosterone therapy because it feels like a quick fix to complex problems. “All the testosterone drugs have been approved on the basis that they raise testosterone level – not on the basis that they make anybody’s life better.” Schwartz described a patient to BBC News who came to her while using prescription testosterone whose symptoms came and went, and she wasn’t convinced testosterone had anything to do with his issues. She took him off testosterone and he was diagnosed with depression. “He really benefited from therapy [for depression],” Dr. Schwartz was reported to say.

Dr. Richard Quinton, a consultant endocrinologist at Royal Victoria Infirmary in Newcastle, England was also interviewed by BBC News. He explained that high levels of testosterone increase red blood cell count, which makes the blood thicker which can, in turn, increase the risk of heart attack and stroke-like events. He believes older men should avoid testosterone products: “Testosterone is not the elixir of life. It’s a great treatment for men with true testosterone deficiency, but it’s not a life-extending drug for those who aren’t properly deficient.”

According to a comment in The Lancet Diabetes & Endocrinology by Professor Stephanie Page of the University of Washington and Harborview Medical Center, physicians do not have sufficient information from clinical trials to understand the risks associated with the use of prescription testosterone in older men.

In a press release about her Lancet comment, Professor Page stated that “testosterone is a billion dollar industry, probably fueled partly by direct to consumer advertising and some degree of over prescription.” She said that support is urgently needed to fund “an appropriate clinical study to assess the risk and benefits of testosterone treatment in older men” because physicians do not fully understand the associated risks. Page recommends that prescribing physicians “use conservative treatment guidelines, such as those provided by the Endocrine Society,” when prescribing testosterone to their patients.

Have you experienced an injury while taking prescription testosterone supplements?

If you or a loved one took prescription testosterone, such as Axiron or Androgel, and suffered a cardiovascular injury, such as a heart attack or stroke, you may want to speak with an attorney to learn about your rights. Free and confidential consultations with our testosterone lawyers are available by calling toll-free (866) 981-4800 or filling out the form to the right.