Selling Testosterone: Review of the American Market

[CoastWatcher]

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

 

[LTChris]

• 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.

those 2 points alone are surprising.

 

[CoastWatcher]

I feel certain that the high attrition rate is due to the fact that almost all of those men, the 80-85% who abandon TRT within a year, had terrible protocols prescribed. TRT didn't fail them, their doctors did.

 

[FeelingLost]

I feel certain that the high attrition rate is due to the fact that almost all of those men, the 80-85% who abandon TRT within a year, had terrible protocols prescribed. TRT didn't fail them, their doctors did.

I could not agree more. So many bad protocols out there.
When I read the first post all I could think about is all the T pellet shops advertizing in my town. $2-3K /month membership fees.
It's no wonder so many guys give up. They are spending big bucks and feeling awful.
Then you have guy like me where your PCP tries to help but get over his head on the second blood test.

 

[ratbag]

It doesn't help that on testosterone vials and their instructions it states to take 200mg once every two weeks! Testosterone was developed in the mid 50's, right about the period where all the muscle men first started their early careers, on test they looked totally ripped, and huge, a whole new look for the body builders back then.

 

[CoastWatcher]

It doesn't help that on testosterone vials and their instructions it states to take 200mg once every two weeks! Testosterone was developed in the mid 50's, right about the period where all the muscle men first started their early careers, on test they looked totally ripped, and huge, a whole new look for the body builders back then.

This is the sticking point for so many men. They have spent some time reading about testosterone administration, they realize that injecting every two weeks is a ticket to failure, but their doctor can stand behind th FDA-approved package insert and insist on sending them down the road to hormone hell.

Interestingly, the "Merck Manual", now online, changed the language on testosterone injections and is open to more frequent dosing. It is something that can sway the mind of some doctors.

 

[madman]

I feel certain that the high attrition rate is due to the fact that almost all of those men, the 80-85% who abandon TRT within a year, had terrible protocols prescribed. TRT didn't fail them, their doctors did.

Most definitely and also the fact that a majority of people pursuing or being treated with trt are uneducated about testosterone let alone the many variables that can affect ones trt protocol! Never ceases to amaze me how many people I speak with regarding trt and they have this look on their face as if testosterone is some dangerous evil drug .

 

[CoastWatcher]

Most definitely and also the fact that a majority of people pursuing or being treated with trt are uneducated about testosterone let alone the many variables that can affect ones trt protocol! Never ceases to amaze me how many people I speak with regarding trt and they have this look on their face as if testosterone is some dangerous evil drug .

I've had the same experience. On a few occasions people have learned I am on TRT and they look at me as if I also must also be selling opiates to school children.

 

[FeelingLost]

I've had the same experience. On a few occasions people have learned I am on TRT and they look at me as if I also must also be selling opiates to school children.

I wonder if this is because the average person learns about testosterone thru the TV sports news. Doping on the Tour de France, Athletes getting booted from with big scandals in Baseball, the Olympics.
There are no good testosterone stories the average folks see. Even the T-mill commercials on TV has a sinister feel to them. I'm in the don't ask don't tell boat. At my Gym it is the ultimate slam to be accused of juicing at any lvl.

 

[Country23030]

I've had the same experience. On a few occasions people have learned I am on TRT and they look at me as if I also must also be selling opiates to school children.

That's why the only person other than doctors that know I'm a TRT is the wife. I got her set up with Defy too.

 

[CoastWatcher]

That's why the only person other than doctors that know I'm a TRT is the wife. I got her set up with Defy too.

I'm not quite that circumspect. If I feel it may help someone, I talk about my experiences with low testosterone and urge them to seek a qualified doctor. But I choose my moments.

 

[Saxon]

I feel certain that the high attrition rate is due to the fact that almost all of those men, the 80-85% who abandon TRT within a year, had terrible protocols prescribed. TRT didn't fail them, their doctors did.

Yes, this is the "My doctor prescribed me a 150mg injection of Test Cyp once every three weeks at his office" crowd.

 

[Vince]

I feel certain that the high attrition rate is due to the fact that almost all of those men, the 80-85% who abandon TRT within a year, had terrible protocols prescribed. TRT didn't fail them, their doctors did.

You really have to be your own health advocate and find a doctor willing to work with you. It does take a lot of discipline to stick to your protocol, that's why I was afraid of daily injections of T. Would I be disciplined enough to stick with it.

 

[dawatts22]

I feel certain that the high attrition rate is due to the fact that almost all of those men, the 80-85% who abandon TRT within a year, had terrible protocols prescribed. TRT didn't fail them, their doctors did.

If you read the cited studies the first one (32) is saying the low adherence was with T-Gel patients and those on short-term TR therapy, which is a 6 month cycle according to the NCBI. The second citation (33) is based on topical gel TRT users most likely dropping due to its ineffectiveness.

So yeah, you're right. These studies were indeed using horrible protocols.

 

[Ripped one]

You said, "After one year, 80–85% of men discontinue TRT."

Is this really true and accurate? Why?

 

[CoastWatcher]

You said, "After one year, 80–85% of men discontinue TRT."

Is this really true and accurate? Why?

It's a quotation from the study. I assume, appearing in a peer-reviewed journal, that it reflects the day at they gathered. I speculate that the men who quit TRT in a year haven't had a decent protocol prescribed and feel that TRT has somehow failed them when (in reality) it is their doctor who failed them.

 

[bouquetCPA]

It's a quotation from the study. I assume, appearing in a peer-reviewed journal, that it reflects the day at they gathered. I speculate that the men who quit TRT in a year haven't had a decent protocol prescribed and feel that TRT has somehow failed them when (in reality) it is their doctor who failed them.

After my ordeal with the original doctor who put me on TRT, I could see why people quit after a bad protocol. Between him crashing my estradiol and being unavailable for an appointment for 11 weeks, I would have chose to quit versus continuing this roller coaster ride if I had not found another doctor. I swear, I ended up feeling worse than before I started TRT with the totally crashed estradiol.

 

[HarryCat]

You said, "After one year, 80–85% of men discontinue TRT."

Is this really true and accurate? Why?

Many, maybe most, men who try testosterone have horrible lifestyle issues. Lousy diet, no exercise, drinking too much alcohol, etc, and then they expect TRT to "fix" them. It doesn't work that way.

 

[Saul]

You said, "After one year, 80–85% of men discontinue TRT."

Is this really true and accurate? Why?

It makes me thankful for this web site and its members.

 

[CoastWatcher]

It makes me thankful for this web site and its members.

I learn something every day here at EM.