Testosterone Boom: Pharma Firms Spread Male Menopause Myth

By Jörg Blech

Photo Gallery: The Male Menopause Myth Photos
DPA

A supposed epidemic of male menopause is upon us -- but in reality, this is a prime example of how pharmaceutical companies create and exploit new markets. Treatments such as testosterone gels could be doing more harm than good.

"Man, oh man," read the words emblazoned on a white tent set up in the pedestrian zone of the German city of Erfurt. Those who ventured inside received information on a dramatic scientific finding: One in three men over the age of 60 suffers from "testosterone deficiency syndrome." If left untreated, this dastardly condition can cause excess weight, anemia, hot flashes, osteoporosis, lowered sex drive and bad moods.

This same tent will be making appearances through November in Augsburg, Saarbrücken, Hanover and other German cities. Here, men over the age of 40 can have their testosterone level checked at no cost. They can also learn how to counteract testosterone deficiency: either get more exercise, or apply testosterone gel to their skin.

This traveling testosterone counseling service provided by the "German Society for Men and Health" was not born out of a purely charitable impulse -- there is a marketing angle at work here as well. The organization is funded by pharmaceutical company Jenapharm, the leading manufacturer of testosterone gel.

It's one of five companies that sell the male sex hormone, which is rubbed into the skin, and business couldn't be better. This can be seen in the number of prescriptions issued through Germany's statutory health insurance funds. The Scientific Institute of AOK, one of Germany's largest insurers, analyzed this data on behalf of SPIEGEL and found that prescriptions for testosterone gel more than tripled between 2003 and 2011. The most recent statistics show 390,000 daily doses per year. In Germany, a month's supply of the product costs around €60 ($80).

Unnecessary Prescriptions

These gels are also doing a roaring trade in other countries, such as Switzerland and the United States. A survey of over 10 million members of one American health insurance company showed that nearly 3 percent of all men over 40 are now prescribed testosterone. At the same time, this analysis also revealed that, medically speaking, most of these prescriptions were unnecessary.

The testosterone trend comes with attendant risks. Used in excess, the male hormone can promote the growth of prostate cancer and increase the risk of heart attacks and strokes. American doctors Lisa Schwartz and Steven Woloshin recently warned in the medical journal JAMA Internal Medicine that this widespread use of testosterone is "a mass, uncontrolled experiment that invites men to expose themselves to the harms of a treatment unlikely to fix problems ... that may be wholly unrelated to testosterone levels."

The booming business in testosterone gel provides a prime example of the ways in which pharmaceutical companies exaggerate illnesses to create new markets for their products.

Experts agree that men with hypogonadism -- in which the testicles produce little or no testosterone -- do indeed benefit from receiving supplements of the hormone. But few men actually suffer from serious hypogonadism. So when the newly developed testosterone gel hit the market, doctors and pharmaceutical companies looked for other symptoms the product might treat -- and found them in male menopause.

The idea of male menopause -- also known as andropause or male climacteric -- existed even in ancient times. The Romans considered age 63 to be a dangerous moment of change, and congratulated one another for having survived this "annus climactericus maximus."

Salt Baths and Cold Rubdowns

Around 100 years ago, some neurologists observed a menopause-like change in men. Berlin neurologist Kurt Mendel, for example, believed he had diagnosed a "very noticeable tendency toward emotional reactions and crying, which had not previously been present" among his older male patients. He prescribed salt baths and cold rubdowns.

Later, with advances in the study of glands, this supposed andropause was explained as being a hormone deficiency. Chemists at first obtained testosterone by extracting it from bulls' testicles by the ton and male human urine by the hectoliter, before achieving laboratory production of artificial testosterone in 1935.

"But it wasn't until the late 1960s, as the field of andrology expanded, that medical attention began to turn once again to the male climacteric," says medical historian Hans-Georg Hofer, 41, at Bonn University. Neologisms such as "andropause" and "PADAM" -- for "Partial Androgen Deficiency in Aging Men" -- started to catch on.

The idea of andropause took off in earnest a few years ago, when scientists developed a way to administer testosterone as an easy-to-use gel, rather than through shots and patches. Suddenly there was a new epidemic, too, to match this new product. In March 2003, pharmaceuticals company Jenapharm announced that male climacteric affects "at least 2.8 million Germans, according to epidemiological estimates."

Jenapharm then hired Hermann Behre, director of the Center for Reproductive Medicine and Andrology at Halle University Hospital, to speak at a press conference about testosterone gel. Behre will also speak at an upcoming "Jenapharm Symposium" on testosterone in Münster this December.

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1. optional
danm 08/29/2013
Any drug can be over prescribed. Any doctor can misdiagnose a patient. Doctors do it all the time. We could apply your same standard to other medications and condemn them just as easily. The endocrine system is an amazingly complex thing and often doctors guess wrong. That being said, testosterone gels and patches are a godsend for those of us with testosterone levels that are significantly below normal. If this article had given a little more recognition to the positive benefits of this drug when used properly then I believe the article would have been better.
2. optional
peskyvera 08/29/2013
A pill for every ill...and an ill for every pill. Gotta keep making money, folks.
3. Poor journalism unworthy of Spiegel
goatfarmer 08/30/2013
"Used in excess, the male hormone can promote the growth of prostate cancer and increase the risk of heart attacks and strokes." Obviously. Water drunk in excess will kill you too. This is a straw man argument. How about attendant benefits? Should we not balance risks of moderate dosage with benefits? "Low testosterone levels don't inevitably bring symptoms with them. In fact, quite the opposite is true, and a slight decline in testosterone level over the course of a lifetime is normal." Ah, so older men should be content to fade away quietly. "We all grow older," says Stephan Wächter, 59, an urologist practicing in the city of Fürth. He finds the entire concept of "male menopause" dubious. "That's pretty undefined," he says. "Where is the dividing line between being sick and being well?" A false dichotomy. There is more to optimal health than not being sick. There is vitality. If testosterone supplementation can revive an older man's vitality why should he be denied because he is not sick and because there dangers of excessive dosage? "In truth, well-being is in no way dependent on hormone level." You have one quote that poorly supports this preposterous claim. Yet the medical community, often misguidedly, relies solely on hormone adequacy to determine well-being in the case of thyroid. "A comparable scandal occurred previously in women's health. For years, gynecologists downplayed indications that administering artificial sex hormones during the menopause years was risky. As a result, many women who had unhesitatingly taken these hormones subsequently developed breast cancer." Yes, and now estrogen is prescribed transdermally so that it does not react in the liver to clause blood clots. In summary, an unbalanced and illogical argument based on the straw man fallacy which will have the effect of scaring people from trying something, which, if used responsibly, will improve their quality of life and longevity. I suggest, Mr Blech, that you do a little research before shooting off such journalistic dirt bombs.
4. What did you expect?
peterboyle.4848 08/30/2013
It is not whether or not these medicnes can do good, of course they can - in certain instances. It is the ability to market directly that is the issue. Marketing drugs directly to the consumer bypasses the safety valve of Doctors to decide which medications a person takes. Do you trust your doctor or do you trust advertising? Everyone knows the power of advertising by now, and that is the issue. Convince people that this pill (salve, potient, medication) will cure your problems (make your penis hard, firm your breasts, flatten your tummy, grow hair and lose weight) and people will demand it. Once so convinced, they will shop for a doctor that will prescripe it for them. This advertising was brought to you by your politicians, who sold you on the idea by telling you that the Free Market was good for you and advertising was needed to 'inform' you. Capitalism Unleashed (Vampire Capitalism) is in charge now, and there is little you can do about it.
5. OTC Testosterone Gel????
gkroumani 08/30/2013
George Clemenceau said: "War is too serious a matter to entrust to military men" The same wisdom applies here. Pharmaceutical companies have no business promoting such remedies to the uneducated public. Yes Testosterone replacement therapy does is effective in the treatment of hypogonadism. There are guidelines that need to be adhered to so the use of theses medications is scientifically supervised and are properly indicated. Let's first agree in the medical community on what is a "normal" level of Testosterone. This fundamental issue is not yet solved. Opinions vary widely among experts. Which labs are doing the assays? How well are these labs controlled? Are the symptoms we are treating, strictly related to the alleged hypogonadism? Can we answer these questions in a tent environment? Are the patient made fully aware of the risks and benefits and the lack of indisputable cause and effect before agreeing to this form of therapy? Once these questions are answered and the accurate interpretation of the lab results and patients' complaints are accomplished, the controversy will be objectively addressed. It is wise here to wait till all the answers are in before causing harm.
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