Midlife: Drop in testosterone can affect sexual desire in men and women

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story makes no mention of costs. These treatments can be costly and may not be covered by insurance. A 30-pill box of AndroGel costs $295 on Drugstore.com.  If, as the story states, “testosterone use is very widespread but it’s misused a lot,” cost certainly seems to be an important issue to address.

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

Not Satisfactory

As with the harms, none of the benefits of testosterone are actually quantified. The story did not, by any means, hype testosterone products as a cure all, and, as noted above, spent considerable time explaining the complexities of sexual health. That said, the framing of the story was about what happens when testosterone levels drop, and this leads readers to think that more testosterone must be better. For example, in noting that there are currently no approved testosterone products for women, instead of saying that no company has been able to make a case through clinical trials that testosterone supplements in women would have any positive effect, the story says, “To fill the void, doctors sometimes resort to prescribing off-label treatments for women, such as low doses of the gels approved for men, says Sheryl Kingsberg, a clinical psychologist and chief of obstetrics/gynecology behavioral medicine at University Hospitals Case Medical Center in Cleveland.” The assumption here is that “the void” has been created by a slow or ineffective FDA and that women definitely need testosterone supplementation. If that is truly the case, the story should have provided some clear numbers to back that up.

And there’s no information given on how many men benefit – and to what level of benefit – from any of the products mentioned.

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

Not Satisfactory

The story starts to strike a bit of a cautionary tone. The very first quote in the story says, “Testosterone use is very widespread, but it’s misused a lot.” That’s Dr. Glenn Braunstein, an endocrinologist and chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles. The story goes on to say, “Inaccurate diagnoses can result simply because blood draws were done at the wrong time of day. In men, testosterone levels peak in the morning and dip in the afternoon, so if doctors rely on a single blood test done in the afternoon, they may misdiagnose the source of the problem, Braunstein says.” That’s great information.

But the story never described the potential harms from testosterone replacement. Skin rash, acne, prostate enlargement and headache are just a few of the more common side effects.

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

Not Satisfactory

The story makes several claims about the effectiveness of testosterone replacement that are unreferenced and not supported by the larger body of medical evidence. In 2004, the National Academy of Science concluded, “…no beneficial effects of administering testosterone have been well established.”

Does the story commit disease-mongering?

Not Satisfactory

Although the story does provide the reader with a bit of information on the complexities of sexual health and low libido, it treats declining testosterone levels in both men and women as something that needs to be treated. For example, the story notes, “Men’s testosterone levels decrease by about 1% per year and then drop faster as they approach older age.” At this point we don’t know if this is bad but it certainly cannot be good. In the very next line, we are provided with the answer. Not only is it not good but there is a treatment, “Testosterone treatment for men and women can help restore the hormone to a level that will push the sexual accelerator.”

Indeed, even in the first sentence, the story is framed as the “dizzying” conspiratorial assault on sexual desire in midlife.  Let’s face it: we are all likely to grow older and with age comes a host of age related changes. Levels of testosterone do decline as we age and testosterone is an important hormone in both men and women. But unlike low estrogen levels in women, the impact of falling testosterone in men is really not clearly defined. Although reduction in bone density, decreased libido, type 2 diabetes, changes in muscle mass and strength have all been associated with testosterone deficiency, replacement of the hormone has not demonstrated any consistent results. The Institute of Medicine in a published report from 2004 concluded, “…no beneficial effects of administering testosterone have been well established.” A story that focuses on libido only, provides no supporting evidence and suggests that testosterone replacement works in everyone is simply wrong.

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

Not Satisfactory

In one sense, the story makes good use of experts who give readers the broad scope of sexual health and don’t allow the story to become too narrowly focused on any one type of therapy. Typical of the comments is this one from Sheryl Kingsberg, a clinical psychologist and chief of obstetrics/gynecology behavioral medicine at University Hospitals Case Medical Center in Cleveland: “It’s important for post-menopausal women to know that the quality of a relationship has been shown to be a much better predictor of sexual health and sexual satisfaction than age and menopausal status.” But we were troubled by the fact that both experts quoted have done work for some of the companies that make these testosterone products, either taking grants directly or working on advisory boards. Both recently particiapted in a progam sponsored by a maker of a testosterone gel that was geared toward the investment community. We think that is always context that readers deserve to have.