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Drugs in Search of a Disease-Men’s Edition

The views expressed are those of the author and are not necessarily those of Scientific American.


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Got Low T?

In one sense, it is refreshing to see men being the target of pharma, after all these years of women being the focus of relentless—and misleading—advertising. On the other, we’re seeing the start of yet another pharma campaign to dupe the public by the unnecessary medicalization of symptoms to create new drug markets. I used to be a fairly enthusiastic pharma fan, but over recent years have become increasingly disillusioned. The hype over testosterone is the latest example of why. With so many pressing problems in the world, I wish pharma would focus their attention on doing something more useful with their energies.

I thought it started with drugs for “hot flashes,” but Karen Roush set me straight about hormone therapy, reporting that “It all started with men in ancient civilizations eating the penis and testicles of animals as a cure for impotence.” (And to think that Maryn McKenna just warned us of the dangers of kissing cats! This early hormone therapy sounds a bit dicier.) In the 1940s, estrogen was able to be extracted from horse urine in large quantities, enabling a supply for treating women “suffering from estrogen deficiency.” Dr. Robert Wilson, a prominent New York gynecologist, founded a private trust in 1963 to promote estrogen use. Pharmaceutical companies provided $1.3 million to this “trust;” they, of course, stood to profit handsomely from their investment in Wilson’s endeavor. Wilson is described as being “evangelical” in his crusade to save women from the “decay” of menopause. He was quite successful, with his 1966 book, Feminine Forever, selling 100,000 copies in the first seven months alone. His theme, “A Plea for the Maintenance of Adequate Estrogen from Puberty to Grave,” expounded in a mainstream medical journal, was adopted both by the medical profession and by the popular press.

The Horror of Menopause

The estrogen replacement crusade was successful as new indications for estrogen therapy were found. Premarin (estrogen) was a blockbuster drug for Wyeth (now part of Pfizer); “by 1975, it was the second most widely prescribed drug on the market.” The magic evaporated when estrogen was linked to increases in uterine cancers. This risk was supposedly resolved with the addition of progesterone. This new “hormone replacement therapy” of estrogen in combination with progesterone, was touted to not only provide symptomatic relief of menopausal symptoms, but to prevent heart disease, osteoporosis, and cancer. By 2000, Premarin was a darling of the pharmaceutical industry, with over $1 billion in sales.

The bottom dropped out of Premarin with the unexpected finding in 2002 that, rather than being protective for women, hormone replacement therapy (HRT) actually increased risks of breast cancer, heart attacks, and blood clots. The pendulum swings back and forth, but the most recent studies again strongly suggest that HRT significantly increases the risk of breast cancer. But this latest bad news for HRT has not stopped its use. As Matthew Perrone notes, “Bladder problems, brittle bones and hot flashes have followed a similar path: from inconvenient facts of life, to ailments that can be treated with drugs.” We’ve seen the same, with drugs marketed for every sniffle, headache, or minor symptom that would better be treated with tincture of time. So women continue to take HRT, seeking symptomatic relief, if not the fountain of youth, believing cleverly targeted advertising.

And men are no wiser, if the current marketing blitz over testosterone supplements is any indication. According to Bloomberg, prescriptions for testosterone have been rapidly rising, now to 5.6 million, and sales are projected to triple over the next 5 years to $5 billion. (By comparison, Viagra’s sales were $1.98 billion in 2011 and Cialis’ were 1.88 billion). Men, too, want to reclaim their youth and are seeking the drugs to avoid a natural decline in libido and muscularity.

And the drug companies know just how to target the tragedy of “Low T.” Millions of dollars are spent on ads asking men if they are “feeling like a shadow of your former self?” or have “lost their appetite for romance.” The Daily Beast notes that, with the ads, “the company goes after male anxiety about the four horsemen of aging: less energy, a fatter gut, a fouler mood and sexual incompetence. Ads show a paunchy everyman haunted by the shadow of his former self.” They suggest porn might be a much less costly alternative to medication, but temper that, noting porn “doesn’t have the allure of youth in a bottle. And make no mistake, that’s what the testosterone manufacturers are selling. The FDA-approved Web site for AndroGel reads like the solution to every possible age-related anxiety a weakened warrior might have: “improvement in energy, sexual desire, sexual function, and mood within 1 month,” as well as “more muscle mass and decreased body fat within 3 months.” Too bad that there is only anecdotal mention of efficacy. A 2008 trial in the Netherlands—the largest to date—found no improvement in strength, thinking, bone density, or quality of life. According to Dr. Sergei Romashkan, of the National Institute on Aging, “we don’t have any evidence that prescribing testosterone to older men with relatively low testosterone levels does any good.” An 800-man NIH study is underway and scheduled for completion in 2014. And little mention is given to potentially life-threatening side effects of testosterone therapy, including prostate cancer and serious heart disease.

Baby boomers—myself included—are often reluctant to accept the realities of normal aging. We can’t do what we did 20 years ago and want time to stop. We want doctors to wave a magic wand and fix whatever frailties have developed. And until we grow up, pharma will continue to successfully seduce us with promises of the fountain of youth.

Credits:

Testosterone-Horsepower image -eschipul/Flickr
Screaming Woman image – marsmet525/Flickr
Molecules to Medicine banner © Michelle Banks

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Judy Stone About the Author: Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website. Follow on Twitter @drjudystone.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. rshoff 6:31 pm 09/13/2012

    I dunno. Is aging really ‘supposed’ to feel this bad? I would think not. What’s the difference between acceptance of aging and acceptance of illness? Not much. It would be a more productive perspective to rely on men focusing on lifestyle (such as diet and exercise) first. However, don’t cast a wand to ban pharmaceuticals for those that still need help after first putting good efforts in naturally managing their illnesses of aging. Don’t encourage doctors to write men off just because they are getting up in years. Maybe when you feel like a painful, tired, nauseated, pile of garbage you will think differently too.

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  2. 2. VivaLaEvolucion 5:22 pm 09/14/2012

    I believe older men should first look to increasing testosterone levels in their body by improving their diet lifestyle, and exercise, before turning to drugs. Nevertheless, I am still in support of drug research on the issue. VivaLaEvolucion.com

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  3. 3. Judy Stone in reply to Judy Stone 6:26 pm 09/14/2012

    I did not mean to suggest that drugs are never appropriate. Believe me, I don’t like a lot of what aging is bringing me either. I’m rather suggesting that the pharma advertising is excessive and often misleading, and that people–both men and women–try to control their health and symptoms by living more healthily, exercising, yoga, etc. Hope that clarifies.

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