Are you tired? Do you have low energy? Have you put on some weight recently?
Despite the advances of modern medicine, there is no magic pill or fountain of youth to combat aging, poor food choices or bad exercise habits.
But if you’ve been watching infomercials or flipping through a magazine lately, you may think testosterone could be a cure-all. The “low T” movement, also known as “andropause,” targets aging men for their declining testosterone levels. And over the past decade, it’s become a multibillion-dollar industry.
A new editorial in the Journal of the American Geriatrics Society makes the case that “disease mongering” created a surge in the prescribing and the use of testosterone and human growth hormone in the United States.
So what exactly is “disease mongering?” It’s the concept of selling sickness to healthy people. Many people have normal ailments that are simply a part of life. Not every symptom means that something is seriously wrong or even wrong at all. But if you can “medicalize” what may be normal signs of aging, then you can also expand the opportunities for treatments. And that, coupled with aggressive promotion, can create a lucrative industry. That’s disease mongering in a nutshell.
Thomas Perls, co-author of the editorial, practices geriatric medicine at Boston Medical Center and has become a well-known critic of the anti-aging industry. He believes the baby boomer generation has become particularly vulnerable to marketing.
“They’re a well-educated, wealthier group of people who, on a regular basis, are exposed to new cures saying, ‘We can stop or reverse your aging,’ or ‘We can make this go away,’ or ‘We can make your sex life better,’” Perls said.
The editorial cites a tenfold increase in testosterone prescriptions in the United States in the past decade. Pharmaceutical sales of testosterone increased from $324 million in 2002 to $2 billion in 2012.
The “disease mongering” claim doesn’t sit well with those on the other side of the spectrum, who claim that testosterone has valid and proven uses.
“The allegation of ‘disease mongering’ is highly disturbing,” said Abraham Morgentaler, associate clinical professor of urology at Harvard Medical School and author of “Testosterone for Life.” “This type of allegation is nearly always made by individuals with no experience treating patients with the condition.”
In the editorial, Perls and his co-author, David Handelsman, a professor of endocrinology at the ANZAC Research Institute at the University of Sydney in Australia, write that disease mongering also plays a big role in the “anti-aging” marketing for human growth hormone. The use of HGH is only medically valid for three conditions, all of which are rare.
FDA issues warning
Critics have raised concerns about safety, misleading advertising and lax guidelines for prescribing testosterone. Earlier this month, the FDA cautioned that many men are using testosterone for “no apparent reason other than aging,” and that the “benefits and safety” of such use have not been determined.
Testosterone, a male hormone and anabolic steroid, is used to treat men diagnosed with hypogonadism, a condition where the body cannot produce enough testosterone.
Mark E. Richards, a North Bethesda, Md., plastic surgeon who treats hundreds of patients with hormone therapy, said at an FDA hearing on the issue that he was disappointed that many of the committee members seemed unaware of existing medical literature on testosterone.
When it comes to the “disease mongering” argument that Perls takes, Richards said he can’t entirely disagree with that position.
“He’s half-right in that the pharmaceutical industry has hyped it beyond the scientific reality of the situation,” Richards said. “He’s wrong in that there is a legitimate medical problem that occurs with low testosterone.”