Be Aware of These Nine Questionable Clinics

John Watson

Disclosures

August 20, 2018

In This Article

"Low T" Brings High Returns

The FDA approves testosterone replacement only for men who have low testosterone from disorders of the testicles, pituitary gland, or brain that cause hypogonadism.[32] However, critics argue that the pervasive direct-to-consumer "low T" advertising campaign has taken advantage of disease-mongering to extend treatment indications to often ambiguous symptoms associated with the normal aging process, such as decreased sense of vigor.[33]

"The advertisers are doing their job—increasing sales by distortion of the truth without actually lying, but exaggerating, overemphasizing, or highlighting the connection between hypogonadism and vague symptoms," said Bradley D. Anawalt, MD, chief of medicine at the University of Washington Medical Center, Seattle, and an expert in male reproductive endocrinology.

It's been a successful strategy. In the past decade, prescriptions for testosterone have increased by 10- and 40-fold in the United States and Canada, respectively, with annual US sales alone now thought to exceed $2 billion.[33] Because testosterone replacement clinics are often cash operations in which it is difficult to track sales, these numbers may underestimate the true scale of the rise.[34]

"They have also reduced hypogonadism to a diagnosis made by a blood test alone; that is incorrect," said Anawalt. "Male hypogonadism is defined by specific symptoms and/or signs (objective findings) of male hypogonadism, plus a low blood testosterone concentration measured on at least two occasions in the early morning (7-10 AM) with an accurate blood test."

They have also reduced hypogonadism to a diagnosis made by a blood test alone; that is incorrect.

Patients seeking out these clinics run the risk of being treated by practitioners who may not have the experience or interest to diagnose the true underlying causes of their symptoms, which may include depression, diabetes, or other common chronic diseases. Testosterone therapy has also been linked with an increased risk for venous thromboembolism[35] and myocardial infarction,[36] among other adverse outcomes.

"It is helpful for men to know that daily exercise has many of the same benefits that are being advertised about testosterone therapy for 'low T,' including increased muscle and leanness, improved bone mass and strength, and for some men there is improved sexual function," Anawalt said.

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