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Pharma's Reputation Flagging Due To Low Testosterone

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I often bristle at Big Pharma critics who claim that the industry invents diseases. As I have discussed previously, you can’t invent a disease unless there’s a large conspiracy of Big Pharma, the FDA, physicians, and payers. Actually, a great example of these groups working together for the good of patients is the story of the development of Pfizer’s Lyrica for the treatment of fibromyalgia, a devastating pain condition.

But sometimes the dividing line between medicine and lifestyle gets blurred, as has recently arisen around testosterone. As men age, testosterone levels drop on the order of 1% per year. Over time, this can result in fatigue and a decrease in bone density. There is a natural human desire to ward off the aging process and one way to do this is try to restore, or at least slow, the decline of one’s testosterone levels. Not surprisingly, companies like AbbVie (AndroGel) and Lilly (Axiron) have developed products designed to elevate testosterone levels. I have no doubt that there are people with very low testosterone who can benefit from these products.

However, in their zeal to maximize sales, these companies have utilized a large marketing campaign and, in doing so, have promoted a condition coined “Low–T”. Unfortunately, this has resulted in “Low-T” being used as an example of Pharma’s penchant for turning something as simple as aging into a disease. A New York Times op-ed by John La Puma, called “Don’t Ask Your Doctor About ‘Low-T’”, hammers this point home.

“But ‘low T’, as the condition has been labeled, isn’t nearly as common as the drug ads for prescription testosterone would have you believe. Pharmaceutical companies have seized on the decline in testosterone levels as pathological and applicable to every man.”

Ordinarily, one might respond that it is a man's right to take any compound, be it a dietary supplement, herbal remedy, or even testosterone, if he feels it might benefit him. That’s all well and good. However, the FDA has recently announced that it is investigating the possible increased risk of stroke, heart attack and death in men who are taking testosterone-boosting products.  Suddenly, these testosterone preparations may not be so benign.

Ironically, these drugs might be able to be avoided if men took better care of themselves. La Puma points out that obese men who lost an average of 17 pounds saw their testosterone levels increase by 15%. One might hope that physicians would try a diet and exercise regimen before prescribing AndroGel or Axiron. But then, physicians may be a part of the problem. La Puma reports that many doctors are writing prescriptions without even measuring a patient’s testosterone levels. In fact, up to 25% of these prescriptions are dispensed without any blood test. Physicians, who can act as a check in this process, are not doing so.

At a time when restoring its image is a major challenge, “Low-T” isn’t helping matters. The use of TV ads, which I have stated contributes to Pharma’s problem , reinforces critics in their claim that the industry medicalizes normal conditions. There is a role for this drug in the treatment of patients. But not everyone over 65 should be viewed as a potential consumer for AndroGel. If Pharma wants to reclaim its one-time highly respected status, it needs to use less testosterone in promoting it products.