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Grumpy Old Men: Maybe It’s A Question of Testosterone

Rating

2 Star

Grumpy Old Men: Maybe It’s A Question of Testosterone

Our Review Summary

This story failed to provide good information about testosterone treatment.  

  • It didn’t discuss costs.
  • We believe that it committed disease-mongering (see criterion above.)
  • It talked about "accumulating evidence" without quantifying what that evidence was, but only giving anecdotes.
  • It gave an incomplete description of potential harms. 

After reading this piece, a person was not much better informed about what testosterone treatment could and could not do.  The story failed to provide insight that would enable a person to weigh the risks and benefits of this intervention.

There are many differences between older and younger individuals.   While the story attempted to dampen enthusiasm for testosterone replacement therapy as a fountain of youth for older men, it did not adequately balance the quotes from experts to achieve this objective.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story supplied no information about the costs of treatment.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story did not provide any quantification of the benefits of treatment.  

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story mentioned the ongoing discussion about the association between levels of testosterone and prostate cancer.  It should have distinguished between what is known about testosterone levels and prostate cancer in general and how that compares with what is known about the use of testosterone replacement therapy and prostate cancer.

There are also other potential harms of testosterone replacement therapy including fluid retention, liver toxicity, polycythemia, etc.  Given these are older men, likely with comorbid illness and multiple medications already, the addition of another medication, especially a hormone with possible severe side effects, should not be taken lightly.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story did not actually present much in the way of evidence about the benefits of testosterone replacement therapy.  Although linking low levels of testosterone with a number of common complaints, it did not describe what is known (or not known) about whether or to what extent these resolve in a population treated with testosterone.

The story quoted one expert who wondered why testosterone wasn’t used to treat testosterone deficiency in old men when it is used for this purpose in young men.  The story should have included some balance with a quote from someone who might have insight into reasons why old men and young men differ.

In addition, the story stated that ‘…evidence is accumulating’ without providing additional information about the nature of the clinical evidence.  Instead, it is followed by anecdotal tales which is really the antithesis of what characterizes good ‘evidence’. 

Does the story commit disease-mongering?

Not Satisfactory

The story mentioned a wide range of complaints that aren’t specific to testosterone deficiency.  It failed to clearly explain that while these complaints (lack of energy, sexual dysfunction, mood changes, etc) may be associated with low testosterone levels, there are a number of other potential causes.

This story is, however, to be commended for not falling into the rabbit hole of using the term ‘andropause’ which was apparently popular at the meeting discussed.  

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story provided interview quotes from a number of people who attended the 6th Annual World Congress on the Aging Male, and mentioned that they all had ties to pharmaceutical firms marketing testosterone. However, it could have sought out someone to provide balance and talk about what is not known about the efficacy of the treatment and the harms that may accompany its use.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

While mentioning a laundry list of symptoms that aren’t specific to testosterone deficiency, the story failed to mention that there are interventions for management of these besides testosterone.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story talked about testosterone replacement therapy being available by prescription.  It mentioned that it is currently available in an injectable form, a topical gel and in a transdermal patch.  This was very clear and well done.

However the story also included discussion about pharmaceutical companies working on the development of an oral form which would deliver the benefits without the potential harms without sufficient framing to indicate that outstanding questions remain both as to whether an oral mode of delivery would be effective and if it were, whether the potential harms would really be diminished.

Does the story establish the true novelty of the approach?

Satisfactory

The story was clear that it was not about a new therapy.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a press release.

Total Score: 4 of 10 Satisfactory

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