May 20, 2024

Testosterone use rising dramatically without evidence of safety and efficacy

Spiralling demand for testosterone over the past decade has result in a world market estimated at US$2 billion.

Name a drug which is produced for $10 and sold for $1,000. It’s a mark-up which would warm the cockles of a mafioso’s heart, but the answer is not cocaine or heroin but testosterone. Spiralling demand over the past decade has result in a world market estimated at US$2 billion.

In articles in the Medical Journal of Australia and the New England Journal of Medicine, David J. Handelman, of the University of Sydney, argues that the use of testosterone is equivalent to prescription drug misuse.

“The sole unequivocal therapeutic indication for testorsterone is in replacement therapy for pathological androgen deficiency (AD),” says Dr Handelsman. However, the potential market size for testosterone is, he estimates, between 5 and 100 times bigger than the need for treating AD. He blames “permissive guidelines promoting evidence-free prescribing”.

There is very little clinical evidence of the drug’s efficacy, safety and cost-effectiveness. Testosterone, says Dr Handelsman, is a “cheap, old drug” which is experiencing “surging overuse from off-label prescribing for diverse unproven indications, including use in older men as an anti-aging or sexual tonic and in younger men for bodybuilding or doping”.

“We are in the midst of an epidemic of over-use driven by the internet, rejuvenation fantasies and a professional and public misunderstanding of what testosterone does,” he told the Australian Financial Review.

Michael Cook
Creative commons