Popular ‘low T’ therapy divides the medical field

They seem to be everywhere - drug ads warning aging men about low testosterone, with "symptom quizzes" asking: Are you sad or grumpy? Is your work suffering? Has your strength or sex drive waned?

It's a powerful marketing campaign that is driving men to doctors in droves for testosterone-replacement therapy. A study this month in the journal JAMA Internal Medicine said the percentages of men 40 and older being treated for "Low T" more than tripled from 2001 to 2011.

A study this spring in Nature Review Endocrinology said prescription sales of testosterone nationally reached $1.6 billion in 2011, up from about $18 million in 1988.

But despite the treatment's skyrocketing popularity, medical professionals are deeply divided about it.

Branden Bledsoe, a nurse practitioner at Body Shapes Medical in Louisville, Ky., said replacing the male hormone can boost energy, libido and strength for some middle-aged men. "Why would you want to feel bad for 40 years?"

But Dr. Adriane Fugh-Berman, director of PharmedOut, a Georgetown University Medical Center project advancing evidence-based prescribing, said the treatment "offers no proven benefits for healthy men. Low T syndrome is invented by pharmaceutical companies to sell treatment products."

Doctors disagree about who should be treated and what is an acceptable level of testosterone for treatment. Experts say normal levels for men range from 300 to 1,200 nanograms per deciliter, with testosterone peaking during the teens and 20s and declining about 1% a year after 30.

Skeptics point to possible side effects, such as acne, enlarged breasts, prostate problems, testicle shrinkage and limited sperm production, and some evidence of increased cardiovascular risk in elderly men.

The stakes are high, said Dr. Stephen "Kyle" Dreisbach, a family practice physician with Norton Healthcare who treats some men for Low T. "Once you start on it, you are going to suppress your own production of testosterone. It's a lifetime commitment."

Testosterone 'boost'

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Popular 'low T' therapy divides the medical field