The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men

ABSTRACT

Introduction.  Testosterone deficiency (TD) imposes a substantial public health burden in the U.S. We modeled the costs associated with TD-related sequelae including cardiovascular disease (CVD), diabetes mellitus (DM), and osteoporosis-related fractures (ORFs).

Aim.  To quantify the incremental cost burden imposed by TD's cardiometabolic sequelae.

Method.  Incidence, prevalence, and mortality of these conditions were collected for men ages 45–74 from six national databases and large cross-sectional studies. Relative risk (RR) rates were determined for these sequelae in patients with T < 300 ng/dL. The prevalence of TD was determined for this cohort of men.

Main Outcome Measures.  Adjusted incidence and prevalence were determined. Annual costs for the three TD-related sequelae were inflated at a real rate of 3% for 20 years.

Results.  Actual and adjusted (normalized for T deficiency) rates of CVD, DM, and ORFs in U.S. men aged 45–74 assuming a TD prevalence of 13.4% were calculated. We determined that, over a 20-year period, T deficiency is projected to be involved in the development of approximately 1.3 million new cases of CVD, 1.1 million new cases of DM, and over 600,000 ORFs. In year 1, the attributed cost burden of these diseases was approximately $8.4 billion. Over the entire 20-year period, T deficiency may be directly responsible for approximately $190–$525 billion in inflation-adjusted U.S. health care expenditures.

Conclusion.  TD may be a significant contributor to adverse public health. Further study is needed to definitively describe the whether TD is a modifiable risk factor for CVD, DM, and ORFs. This may represent an opportunity for nationwide public health initiatives aimed at preventive care. Moskovic DJ, Araujo AB, Lipshultz LI, and Khera M. The 20-year public health impact and direct cost of testosterone deficiency in U.S. men. J Sex Med

TESTOSTERONE STUDY IN OLDER MEN STOPPED EARLY DUE WITH GREATER HEART RISK

A placebo controlled study using a 1 percent testosterone gel (Testim) in  700 older men  (aged 65 and older) was stopped early due  a higher incidence of cardiovascular events in the testosterone arm.

These findings contradict those from a previously published study performed in 2,416  men  that reported  that a 30% reduction in cardiovascular events occurred in men with higher blood levels of testosterone.

The halted study associated the higher incidence of events with higher total and free testosterone and higher estradiol blood levels. The study does not provide relative risk differences between testosterone and estradiol levels, so it is not known which factor has the highest impact on cardiovascular risks.  

Testosterone converts into estradiol, a female hormone, via aromatization in the liver and other tissues. Previous studies have shown that men with even slightly elevated estrogen levels doubled their risk of stroke and had far higher incidences of coronary artery disease. High estradiol can also cause enlargement of breast tissue, water retention and possibly erectile dysfunction in men.  However, men with low estradiol are more prone to osteoporosis and cognitive loss, so a good balance of this hormone is important for a man’s health.

Nelson Vergel, author of the best-selling book Testosterone: A Man’s Guide, said “ I am glad that the  study authors suggest that a similar study needs to be performed by providing not only testosterone supplementation but also an aromatase inhibitor to assess if any decrease in cardiovascular events is seen by decreasing testosterone conversion into estradiol. Reducing aromatase conversion of testosterone into estradiol also frees up more testosterone to do its job”.

The most popular aromatase inhibitor used in men is anastrazole (brand name: Arimidex), which is dosed in small oral doses 3 times a week. But a mixture of testosterone plus anastrazole cream has recently entered the market.

“We  are the only pharmacy that provides by prescription a testosterone cream that has been formulated with anastrazole for both  products to be absorbed through the skin”, said Jaime Rios, co-owner of APS Pharmacy , a specialty pharmacy that ships economical hormone products nationwide. "This cream makes it easy for men to control their estradiol without having to remember to take an oral medication", added Rios.

More men’s clinics are taking notice of balancing estradiol in men using testosterone. One of them is Defy Medical  .  “We monitor estradiol closely in men served by our clinic and provide treatment solutions that are affordable to any man”, said Jasen Bruce, clinic manager for Defy." We also provide the most economical testosterone and estradiol blood test to any man who wishes to have these hormones tested", added Bruce.