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Our Stories

Testosterone replacement therapy among elderly men has more than tripled

Toronto, July 14, 2014

By Geoff Koehler

Tara Gomes
Tara Gomes

Use of testosterone replacement therapy more than tripled over the past 15 years, but only 6.3 per cent of men receiving this treatment were diagnosed with the main clinical condition it is approved for under the Ontario government drug plan, a new study found.

Testosterone replacement is most commonly used to treat hypogonadism – a condition that manifests when the body doesn't produce enough of the hormone. Hypogonadism may be congenital or acquired and can lead to symptoms including anemia, loss of muscle mass, decreased bone density, sexual dysfunction and fatigue. In recent years, there has been an increased focus on marketing these products for age-related declines in testosterone.

The study by researchers at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences, published today in the journal PLOS ONE, found that one in every 90 Ontario men age 66 and older is being treated with testosterone replacement therapy. Only 6.3 per cent of these men, however, have a documented diagnosis of hypogonadism.

“We have seen considerably increased rates of testosterone replacement therapy use among older men in Ontario, many of whom don’t appear to have clinically diagnosed hypogonadism,” said Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and at ICES. “This is concerning given lacking evidence of long-term safety for this drug in the elderly.”

A total of Ontario 28,477 men aged 66 and older were dispensed testosterone between Jan. 1, 1997, and March 31, 2012.

The body's testosterone levels naturally decline as men age, which can lead to aging men feeling more tired, experiencing lower sex drive or decreased athletic performance. However, these declines in testosterone do not always lead to a clinical diagnosis of hypogonadism that would require testosterone replacement therapy.

Furthermore, there is growing evidence of an association between testosterone replacement therapy and cardiovascular events, such as heart attacks and strokes. This led to Health Canada issuing a warning on July 15 suggesting that men should not use these products unless they have had their low testosterone confirmed with lab tests.

This study found that older men treated with testosterone replacement in Ontario often have multiple health issues, including high blood pressure and diabetes – all conditions that may put them at greater risk of these cardiovascular risks.

"The rising use of these products in older men with multiple comorbidities is particularly concerning given the emerging evidence of their cardiovascular risks,” said Gomes. "Clinicians may want to reconsider prescribing these drugs to older men with non-specific symptoms of low testosterone until more is known about their long-term safety."

In 2006, the Ontario government restricted reimbursement for testosterone replacement therapy in an attempt to avoid use of these drugs for non-specific symptoms associated with age-related declines in testosterone. The restriction temporarily led to a sharp, 27.9 per cent decline in use. However, testosterone replacement use quickly resumed its upward trend, largely driven by increased popularity of topical formulations of these drugs. These rates continue to increase, with no sign of abating.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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