And She’ll Like it, Too (unless I have a heart attack or stroke)

After turning 50, I’ve noticed that my eyesight is getting worse, I have far less hair, I’m pudgier than I’d like, and I don’t have a ton of energy. I chalked it up to eating too many cheeseburgers, not working out enough and sitting behind a desk all day.

But, after watching numerous TV commercials, I’ve realized it’s not my fault – I must have low testosterone!

During the pandemic, the idea of telehealth took off. Because people were discouraged to go out in public, especially to doctors’ offices out of fear of contracting COVID, patients could consult with a health care provider virtually.

While telehealth, sometimes called telemedicine, is extremely convenient, the trend also saw a dramatic increase in online supplement or pharmaceutical dispensaries, many promising the ability to get a prescription for medications without having to see a doctor.

One such campaign was for testosterone, which was touted as a cure-all for men’s age-related illnesses, such as feeling lethargic or having a low libido. The condition was dubbed “male menopause” or even “manopause,” and it was caused by “low testosterone,” or low T for short. Many websites heavily advertised the treatment for low T as ‘testosterone replacement therapy,’ or TRT.

Testosterone is a lucrative business – one study showed that the market for testosterone supplements was $1.85 billion in 2023.

The companies that promote taking testosterone almost all cite one study published in 2002 by New England Research Institutes scientists who found that testosterone levels drop 1% a year in men over 40. According to Stefan Schlatt, director of the Center for Reproductive Medicine and Andrology at the University of Muenster in Germany, the data behind the statistic included older men in deteriorating health whose levels declined because of illnesses. “Healthy men do not show a drop,” he said.

Other physicians agreed, with many citing chronic medical conditions, poor diet or a sedentary lifestyle as causes for weight gain or a drop in libido. They also warn of the risk that starting to take testosterone can lead to taking it indefinitely, because taking supplements can cause the body to cease its own production of the hormone.

However, testosterone manufacturers hung their hat on the 2002 study and flooded television airways with ads to combat “low-T.” As a result, however, in 2015, the U.S. Food and Drug Administration banned such ads, accusing the pharmaceutical industry of exaggerating the low-T phenomenon to scare men into buying supplements.

The FDA has recommended that all testosterone supplements carry a warning that they may increase the risk of heart attack and stroke. In two separate jury trials, plaintiffs won a total of $290 million in damages from lawsuits against AndroGel manufacturer, AbbVie. The plaintiffs claimed use of the testosterone replacement therapy medication resulted in serious cardiovascular injuries, including heart attacks and strokes.

While the FDA does not allow off-label marketing of testosterone, it does allow such off-label prescriptions. Off-label use of testosterone replacement has become especially commonplace among veterans, as several websites target members of the military specifically. According to a report by the U.S. military, of the male service members who took testosterone supplements in 2017, fewer than half met the clinical practice guidelines for taking it.

There are, however, valid medical reasons for testosterone therapy, such as for men with hypogonadism, transitioning transgender men, and some women struggling with menopausal symptoms.

I was going to wrap up the article with a chemistry joke. I tried one out with some friends but got no reaction.

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Reg P. Wydeven

Elder Law and Estate Planning Attorney at McCarty Law LLP
Hoping to follow in his father’s footsteps from a young age, Reg’s practice primarily consists of advising individuals on estate planning, estate settlement and elder law matters. As Reg represents clients in matters like guardianship proceedings and long-term care admissions, he feels grateful to be able to offer families thorough legal help in their time of need.

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