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 Legal Muscle The-State-of-Testosterone-Replacement

 

 

 

The State of Testosterone Replacement

 

By Rick Collins, Esq.

 

Q: How have the bad headlines on testosterone affected patients and physicians?

           

A: According to a study that looked at insurance prescription data on more than 10 million men, testosterone (“T”) use in the United States tripled in the decade between 2001 and 2011, as men suffering from “low T” flocked to their doctors.1 But when the same researchers looked at the data a few years later, they reported that the trend had reversed: T prescriptions for U.S. men aged 30 and older decreased by nearly half between 2013 and 2016.2

 

What changed? In 2014, the FDA issued a public safety alert about “the risk of stroke, heart attack, and death” in men on testosterone replacement therapy (“TRT”).3 The mainstream media sounded an alarm that T was dangerous – highlighting (and often exaggerating) the cardiac risks for certain candidates while ignoring the cardiac benefits for others. Plaintiff class action lawyers filed nearly 8,000 lawsuits against drug makers on behalf of men who suffered cardiovascular injuries supposedly as a result of TRT.

 

Certainly, the toxic atmosphere has scared patients. I’m sure some men with no medical need who wanted a T script purely for cosmetic or performance reasons chose not to pursue it. But on the other hand, some men with legitimate hypogonadism (low T) who would have been good candidates for TRT will likely never seek treatment due to unwarranted fears.

 

The atmosphere has also frightened physicians. Primary care physicians typically receive limited training in TRT, and their knowledge of the science may be outdated. It’s absurd to think that the cardiac warnings and many T lawsuits don’t scream “steer clear” to doctors. Would a primary care doctor faced with a patient with symptoms of low T be afraid to write a prescription, even if warranted? Probably. Will a referral to an endocrinologist solve the problem? Maybe, although some endocrinologists may be more experienced in handling thyroid or women’s estrogen problems than TRT, and they also may be influenced by what they see in the media. Further, endocrinological orthodoxy takes the position that doctors are over-prescribing T, and that only a fraction of the men who are currently on the drug should be on it.

 

Then there’s the issue of insurance. Insurance carriers follow the strict ideology of orthodox endocrinology. Many of my clients say they were “turned down” for TRT by their carriers, while others were wrapped in endless red tape. Maybe insurance companies are simply looking for excuses to avoid paying, but the end result is that fewer T prescriptions now go through insurance, as confirmed in the new study.

 

But that may not be the whole story. Many guys tell me that when their coverage was rejected or their carrier drove them crazy (e.g., forcing them to constantly refill single 1 cc amps instead of getting a 10 cc vial), they gave up on insurance and simply paid out of pocket. Injectable testosterone esters, long off-patent, are typically reasonably priced. The reduction suggested in the study doesn’t account for these prescriptions.

 

While endocrinologists have one ideology, there is a growing field of “age management” medicine with a markedly different perspective. Most of these practitioners are not endocrinologists and are not indoctrinated with that view. Disillusioned with the traditional approach of the U.S. hospital and health care system, they come to the field in search of a simple and direct-pay business model. Most age management doctors are favorably inclined toward TRT. I was recently invited to speak to physicians at an age management conference on the subject and found that the leaders in this field have a better understanding of TRT than most endocrinologists I’ve spoken with.

 

There is a broad spectrum of physician choices for hypogonadal men. Troublingly, I’ve seen “clinics” that are the hormonal equivalent to narcotic “pill mills” – pseudo-medical outfits that ship steroids on demand to “patients” who call toll-free numbers and speak with hormone “specialists” who are little more than salesmen. Even if lab tests are required, the results are then reviewed by a down-on-his-luck in-house physician whose only job is to keep churning out T scripts. But there are also some caring, knowledgeable doctors out there who will do the proper screening for candidacy and contraindications and focus on appropriate dosing and monitoring based on the current science. For men who need TRT, the bad headlines simply make it harder to get treated.

 

Rick Collins, Esq., CSCS [https://rickcollins.com/] is the lawyer who members of the bodybuilding community and dietary supplement industry turn to when they need legal help or representation. [© Rick Collins, 2022. All rights reserved. For informational purposes only, not to be construed as legal or medical advice.]

 

References:

 

1. Baillargeon J et al. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med 2013;173(15):1465-1466. doi:10.1001/jamainternmed.2013.6895

 

2. Baillargeon J et al. Testosterone Prescribing in the United States, 2002-2016. JAMA 2018;320(2):200-202. https://jamanetwork.com/journals/jama/fullarticle/2687344

 

3. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM383909.pdf

 

  

 

 

 

 

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