Selling Testosterone: Review of the American Market

In the United States, testosterone replacement therapy is approved by the FDA for treatment of classical hypogonadism. Off-label indications have resulted in a dramatic expansion in prescriptions in the American market.

It is the belief of many that marketing – to potential patient and doctor are impacting prescriber behavior. PubMed, Embase, and Scopus were searched up to July 2017 for all relevant publications reporting on assessments of the TRT market size, economic costs associated with hypogonadism, trends in TRT prescriptions, drug discontinuation rates, and advertising and sales efforts in the USA.

  • PubMed, Embase, and Scopus were searched up to July 2017 for all relevant publications reporting on assessments of the TRT market size, economic costs associated with hypogonadism, trends in TRT prescriptions, drug discontinuation rates, and advertising and sales efforts in the USA.
  • Twenty retrospective studies were included in the final analysis.
  • The market size for hypogonadism constitutes 5.6–76.8% of men in the USA, with the lower end of the range representing the strictest criteria for diagnosis.
  • Men with a diagnosis of hypogonadism consume $14,118 in direct and indirect costs to the payer.
  • Over the last 2 decades, TRT prescriptions have increased between 1.8- and 4-fold.
  • A minority of patients undergo PSA and hematocrit testing, with 10–26.6% of men not having undergone serum testosterone testing at all prior to initiating therapy.
  • After one year, 80–85% of men discontinue TRT.
  • There is an association between direct-to-consumer advertising and testosterone testing, TRT prescriptions, and TRT without testosterone testing.
  • There is a high prevalence of misinformation on Internet advertising.

“Marketing and Testosterone Treatment in the USA: A Systematic Review,” European Urology, 2017 10/16,http://www.eu-focus.europeanurology.com/article/S2405-4569(17)30256-0/fulltext