Global trends in testosterone prescribing, 2000–2011: expanding the spectrum of prescription drug misuse
Abstract
OBJECTIVE: To provide the first multinational survey of temporal trends in testosterone prescribing, given that anecdotal evidence indicates that it is increasing in some countries, including Australia. DESIGN: Sales data for all testosterone products were obtained for 41 countries for each year from 2000 to 2011. For each testosterone product type (injectable, implantable, oral, transdermal), units sold were converted into defined monthly doses per year, reflecting total testosterone prescribing per product. MAIN OUTCOME MEASURES: National testosterone prescribing rate overall and per product type on a per capita basis. RESULTS: For every region and 37 of 41 countries, there was a major and progressive increase in defined monthly doses per year per capita over the 11 years surveyed. In most countries, the increases were steeper for the last half of the survey period. The proportion of testosterone prescribing represented by transdermal testosterone products, a surrogate measure of prescribing for older men, increased even more than did the total usage of testosterone products. CONCLUSIONS: In the absence of any new indications, off-label testosterone prescribing has increased in most countries in 2000-2011, especially over the last half of the period. The increased testosterone prescribing appears to be primarily for older men and driven by clinical guidelines that endorse testosterone prescribing for age-related functional androgen deficiency (andropause). By eliminating the fundamental distinction between pathological and functional androgen deficiency, these guidelines tacitly promote increased testosterone prescribing, bypassing the requirement for high-quality clinical evidence of safety and efficacy and creating dramatic increases in prescription of testosterone products.
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Prescription of T supplements has increased phenomenally over the past 2 decades, especially for functional hypogonadism.
“Prescription of T supplements has increased phenomenally during the past 2 decades, especially in the larger group of men suffering from functional hypogonadism [247].”
From Role of sex hormone-binding globulin in the free hormone hypothesis and the relevance of free testosterone in androgen physiology (2022) · cites this paper as [247]
The number of patients diagnosed and treated for hypogonadism over the past decade has increased significantly, with an exponential rise in prescribed testosterone in many developed countries.
“the number of patients diagnosed and treated for hypogonadism over the past decade has increased significantly, with an exponential rise in prescribed T in many developed countries.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [7]
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- Authors
- Handelsman, D. J.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Handelsman, David J
- ORCID
- Handelsman, David J
- Venue
- Medical Journal of Australia
- Publisher
- AMPCo
- Published
- 2013-10
- Volume
- 199
- Issue
- 8
- Pages
- 548-551
- ISSN
- 0025-729X (ISSN-L)
- 1326-5377
- OpenAlex
- W2068541344
- Cited by
- 253
- References
- 34
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 15 · 2023: 14 · 2022: 19 · 2021: 14 · 2020: 18 · 2019: 12 · 2018: 26 · 2017: 32 · 2016: 21 · 2015: 30 · 2014: 22
- FWCI
- 19.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Medical Journal of Australia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- prescription drug misuse, off-label drug use, andropause, transdermal testosterone, testosterone implants, clinical guidelines, older men
- MeSH terms
- Australia, Cross-Cultural Comparison, Forecasting, Health Surveys, Humans, Male, Practice Patterns, Physicians', Testosterone, Health Care Costs, Evidence-Based Medicine, Hormone Replacement Therapy, Andropause, Off-Label Use, Prescription Drug Misuse
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