Is Testosterone the Next Viagra?

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Q: Is testosterone replacement therapy replacing Viagra as the next big lifestyle drug?

A: You must have seen the Bloomberg report in early May exclaiming that testosterone “may become one of the most sought-after sex enhancement treatments since the introduction of Viagra 14 years ago” (bloomberg.com/news/2012-05-02/testosterone-chases-viagra-in-libido-race-as-doctors-fret.html). It’s hard to miss the advertising campaigns for AndroGel^® and various other testosterone gels, patches and products. The “Is it Low T?” commercials from Abbott Labs flood the nightly TV airwaves, asking whether low testosterone levels are “making you feel like a shadow of your former self.” The makers of Testim^® boast improvements in “muscle mass, sexual desire, bone mineral density, and sexual performance” and suggest that better health may be “just a tube-a-day away.” To the average American Joe, testosterone may sound enticingly like Cialis^®on Steroids. According to Bloomberg, prescriptions have more than doubled since 2006 to 5.6 million. Last year’s booming $1.6 billion market is expected to triple to $5 billion by 2017. After all, what red-blooded dude doesn’t want to be his best in the bedroom?

Although the virtues of testosterone have been extolled within the hardcore bodybuilding community for many decades, the big pharmaceutical companies have jumped on the bandwagon only in the past few years. Why? Building big muscles doesn’t have nearly the mass appeal of great sex. And cynics might say Big Pharma’s change of heart has less to do with recent research than with dollars and cents. Traditional testosterone ester products like cypionate and enanthate have been off-patent for ages, so there’s little moolah to be made with them (plus, injectable drugs have less mainstream acceptability). Big dollars in testosterone come from new patents – creating unique ways to administer the “He Hormone,” such as via an underarm roll-on or a tablet-like product that adheres to the gum surface in your mouth.

But even as testosterone’s popularity among mature men soars, warnings from critics escalate. The Bloomberg article led off by referencing the “deadly side effects” of “overuse” and threatened serious health consequences like increased growth of prostate tumors, blood clots, infertility and liver damage. Of course, almost every doctor will caution against excessive dosages of any drug, including testosterone. But nationally recognized testosterone experts like Harvard Medical School’s Abraham Morgentaler, MD, are debunking many of the myths surrounding the drug. Morgentaler is staunchly in the camp that sees testosterone replacement therapy as a safe and effective treatment for the millions of men whose lives are negatively affected by low levels of the hormone.

Nevertheless, conservative members of the medical establishment have always pooh-poohed testosterone wherever possible; one Cleveland urologist interviewed by Bloomberg even labeled medically prescribed replacement testosterone “a highly addictive drug.” AndroGel^®?! Come on, seriously, nobody’s robbing liquor stores for testosterone gel! Dr. Jack Darkes, Associate Professor of Clinical Psychology at the University of South Florida who has written extensively about testosterone, cites animal research showing that even injecting testosterone directly into the veins “is more like caffeine than so-called ‘highly addictive’ drugs like heroin or cocaine. So, a testosterone gel at medical replacement doses, with slow absorption and steady release, should put such overstated concerns to rest.”

Still, government agencies are also pushing back against the surge in testosterone prescriptions. Compounding pharmacies that make bioidentical testosterone products, and the associated hormone replacement clinics that prescribe or dispense them, have been prosecuted for distributing testosterone and other anabolic steroids without legitimate medical reasons. I’ve recently seen several “anti-aging” physicians targeted by state prosecutors or federal bureaus for improper testosterone prescribing practices. In some cases, the probes are justified; in others, it smells like witch-hunting. Expect these governmental control efforts to increase as society’s gatekeepers struggle to contain the trend. It may be that, as Belgian poet, playwright, and essayist Maurice Maeterlinck said, “Each progressive spirit is opposed by a thousand mediocre minds appointed to guard the past.”

So, is testosterone really the next Viagra? Not if the bureaucratic and law enforcement containment efforts succeed, as we’d likely then see doctors shy away from prescribing testosterone even where patients’ symptoms clearly demand it. But the millions of men currently reporting better sex and enhanced quality of life on the drug may help spur a “tipping point” at which societal acceptance of testosterone therapy finally overcomes the resistance of the gatekeepers. Only time will tell.