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Low T, marketing, youth, and sex

Hormone replacement therapy is back in the news: not estrogen/progesterone for women, but testosterone for men.

There are some similarities between the two therapies. Each was/is heralded by claims for the amazing cures it would/will provide for a multitude of life’s ailments. Estrogen/progesterone was prescribed for legions of women with a lot of assumptions that it would do wonderful things like help dementia and cardiovascular disease, but without good data that it would actually provide much benefit (beyond helping hot flashes); testosterone is being prescribed for increasing numbers of men worldwide with a lot of assumptions that it will help things like low energy and “unwanted body changes,” but without good data that it provides much benefit (outside of specific deficiency states). Estrogen/progesterone was promoted to “treat” something that was traditionally thought of not as a disease, but as a “natural” part of aging (i.e., menopause). Testosterone is increasingly used to “treat” what is a “natural” part of aging (that is, the normal gradual decline in testosterone levels that occurs after about age 40).

Testosterone has been hyped by some as a fountain of youth, although it hasn’t been recommended for general consumption the way estrogen was — yet. However, aggressive marketing suggests that if you have a lack of energy, can’t play sports as well as you used to, or fall asleep after dinner, then testosterone may be the quick fix for these and other “unwanted body changes.” These symptoms cover, well, just about everybody past a certain age.

Testosterone’s rapidly growing popularity is driven by aggressive direct-to-consumer marketing (“Low T is a a pharmaceutical-company-recognised condition affecting millions of men with low testosterone, previously known as getting older” – Stephen Colbert), our culture’s obsession with youth, and our culture’s obsession with sex. In a medical climate that is driven increasingly by consumer demand, this is leading to increasing numbers of prescriptions for questionable indications, with as yet unknown potential harms. Testosterone is a useful medicine for men with specific deficiencies; physicians should resist prescribing it to satisfy the cultural bias that says that old age (or even middle age) is inherently an unhealthy state that needs treatment.

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