News

06-04-2015

The PBS changed the prescribing guidelines for testosterone supplementation on the 1st April. GPs must first consult with a urologist, endocrinologist or member of the Australasian Chapter of Sexual Health Medicine before starting to prescribe testosterone supplementation for patients. Existing prescriptions will remain valid until 12 months from the date of prescribing or until the repeats have been used. The threshold serum testosterone level to establish PBS eligibility has been reduced from 8nmol/L to 6nmol/l  , with  a higher level of the hormone LH to be measured also. 

The move is an attempt to reduce the  rates of " inappropriate prescribing" over the decade, with men's health experts concerned that lax guidelines have allowed testosterone to be prescribed as a sexual or energy tonic or to treat 'andropause' despite a lack of evidence for this indication.. In Australia the annual testosterone sales doubled from 9.6 to 17.9 monthly does per 1000 population from 2000 to 2011. (MJA 2013;199(8) 548-551)

Prescribing rates for testosterone have been rising significantly internationally, many Men's Health Specialists have been concerned that the exponential rise has been driven by pharmaceutical marketing and changing International Consensus Guidelines that have blurred the distinction between prescribing for men who have significant causes ( post cancer therapy, pituitary disease ) and low testosterone resulting from obesity, pre-diabetes, metabolic syndrome and sleep apnoea. Concern has also been raised regarding the marketing and prescribing of testosterone as a remedy for aging and the misuse of testosterone replacement for body building or performance enhancement in men who do not have low testosterone levels on testing.

Testosterone is the sex hormone which is the main key to development of male physical features. Testosterone levels that are low can affect mood, energy , men's sex drive, erections, increase body fat, lower muscle and bone mass and reduce sperm production. There have also been studies demonstrating a higher risk of chronic conditions such as stroke, heart disease and osteoporosis. Levels are highest between the ages of 20-30yrs. As men age , testosterone levels are said to fall between 1-2%  per year. Recently researchers suggest that a large part of the drop in testosterone may be due to accumulating chronic conditions such as obesity and diabetes. If men remain very healthy into older age, their testosterone levels may remain stable. 

Testosterone replacement therapy comes in the form of gels, injections and patches.

Too much testosterone also has significant side effects, and although linked to aggression, no research has yet confirmed this. Two recent studies have suggested that testosterone replacement therapy increases the risk of heart attack , stroke and death very significantly and within a short time of commencing the therapy. ( JAMA 2013;online) These conflict with previous studies suggesting that testosterone replacement therapy may lower heart disease risk.

Side effects can also be acne, breast swelling, high red cell count, swelling of the feet and ankles , infertility and smaller testicles. Historically, high testosterone levels were believed to be a risk for prostate cancer, however, most recent studies show that low, not high testosterone were associated with worrisome prostate cancer features.It can take months for these effects to settle after ceasing the supplement.

Many of the symptoms of low testosterone can be the result of other health problems, and these need to be addressed for the most likely improvement to overall health, wellbeing and lowest risk of heart disease , death and stroke. Serum testosterone may be a barometer of general health for older men and addressing the overall problems makes most sense currently in view of all the conflicting advice and information regarding the various risks.

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