Who Needs Extra Testosterone? Is "Low T" a Dangerous Drug Company Scam to Make More Billions?

Most everyone has heard “old age is not for sissies.” But that truism might be the unofficial slogan of another seemingly unstoppable and absurd American lifestyle trend with billions in profits: the anti-aging testosterone supplement industy for men.

It hardly matters that as the decades add up, otherwise healthy men’s physiology and mental stamina change. A friend in his mid-70s laughs and says he has PHPT: pains here, pains there. But across America, 7.5 million men are taking testosterone in some form to ward off mid-life changes that come with aging: lower sex drives, fatigue, depression, decreased strength or bone loss. It’s known as “low T,” according to drug company brochures, which advise immediately calling your doctor to get some.

“Hypogonadism is a condition in which a man has low T and may experience symptoms,” a website triggered by a pop-up ad for a T cream, said. “Talk to your doctor if you experience any of the symptoms,” it advised, omitting crucial details.

Never mind that men could change their diets, work out, shed a few pounds and feel years younger by boosting their own T levels. Drug makers, whose prescription sales yielded $2.4 billion in 2013 and may reach $3.8 billion by 2018, according to Time.com, aren’t giving the public the facts. It is normal for testosterone levels to drop as men age. The hyped problem of “low T” is not the same medical issue as men with real hormone deficiencies. Using the creams or pills can cause cardio complications, including heart attacks.     

“The new use of testosterone in the United States is 17 times higher—adjusted for the population in the United States—than it is in the UK,” Sidney Wolfe, founder of Public Citizens Health Research Group, said last winter on a health radio show. “And direct-to-consumer advertising is certainly a reason.”

It’s not just advertising. America is obsessed with staying forever young, and men can be just as vain as women. Time’s profile of the trend in a recent cover story overflows with these vain clichés as it follows a low-T entrepreneur who “is enough of a businessman to realize that America’s beer bellies could be worth their weight in gold.”

It gets worse. As Time notes that federal regulators are moving to decide if warning labels are warranted, drug makers have increased marketing by “2,800 percent” preying on “the fathomless fear and loathing among men staring time in the face.”

Anyone who taken steroids—testosterone is one—knows they can be very effective at first, but then one’s body and psyche will pay a price. The big lift is often followed by a very hard crash. Increased energy can be tied to a propensity toward easily provoked anger. Then, there are long-term medical questions concerning increased heart disease, which the Journal of the American Medical Association said in a late 2013 editorial needs to be studied more: “There is mounting evidence of a signal of cardiovascular risk. This signal warrants both cautious testosterone prescribing and additional investigation.”

“There probably is some legitimate use for it, but the number of prescriptions would be more like three-quarters of a million, as opposed to 7.5 million,” Public Citizen’s Wolfe said last winter. “I would guess it would go down by 80 or 90 percent. And this is what eventually is going to happen. The question is, is it going to happen soon enough for people who are going to be injured in the interim?”

The federal Food and Drug Administration is studying what to do, but so far hasn’t told drug companies to do much more than put additional warnings about possible blod clots in product boxes. The agency is still evaluating the risk of heart attack, stroke and death from testosterone products, it said when announcing the blood clot warnings this June.

Other government agencies are less tentative. In early 2014, Wolfe said a study “funded by the NIH [National Institutes of Health] showed that the rate of heart attacks after starting testosterone was high enough so that one out of 100 men using testosterone per year—extra one out of 100 per year—had a heart attack. That’s not some rare, rare kind of risk.”

Another notable feature of the low T phenomena is how many of the sales pitches aren’t all that different from what middle-aged women faced when estrogen replacement therapy was widely prescribed for menopause. Large-scale studies found that long-term estrogen use raised the risk of heart attack and stroke, and these supplements and therapies have subsequently been prescribed more carefully. But there’s been no comparable long-term study for men who are self-medicating with testosterone creams and pills.      

In the meantime, a curious juxaposition of doctors and scientists bluntly say, on one hand, that men taking these supplements are more than a little nuts, while, on the other hand, a parallel universe of Internet ads and infomercials continues peddling it.

“We’re giving people hormones that we don’t know they need for a disease that we don’t know they have, and we don’t know if it’ll help them or harm them,” Lisa Schwartz, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, told the New York Times. She wrote a paper in 2013 for JAMA about how low T was being marketed as a disease in need of a prescription. Grandpa’s grumpy—give him some!

“A man on TV is selling me a miracle cure that will keep me young forever,” a Colbert Report parody began, which Schwartz quoted in JAMA. “It’s… for treating something called low T, a pharmaceutical company-recognized condition affecting millions of men with low testosterone, previously known as getting older.”

But other public health experts said the overuse of the hormone was not a joke.

“There are what I would label testosterone factories out there, and it’s terrifying because we don’t know what the long-term safety profile is,” Brad Anawalt of the University of Washington in Seattle told the Times. “For people with truly low testosterone levels, the benefits outweigh the risks… But for millions of others, it’s in the same category as snake oil.”