An article in today’s Courier-Mail, “Testosterone Heart Risk Link”(p 5) is the latest in a series of media and medical journal articles I've read questioning testosterone prescription rates and benefits. I'm not sure if these issues have been raised here already, but if not, the following may be of interest.
In Australia, PBS criteria for testosterone prescribing are currently being reviewed by the Pharmaceutical Benefits Advisory Committee (PBAC). Last year the committee found that use of testosterone therapies had increased markedly over the last five years and it was thought that some use may fall outside current restrictions. A study published last year in the Medical Journal of Australia found expenditure rose ninefold to $12.7 million in the 20 years to 2010. Last year, an estimated $17 million was spent in Australia on testosterone prescriptions.
In an editorial written in The New England Journal of Medicine last month, Dr David Handelsman, an international authority on androgens and director of the ANZAC Research Institute in Sydney, said testosterone is suffering from “surging overuse from off-label prescribing for diverse unproven indications including use in older men as an anti-aging or sexual tonic and in younger men for bodybuilding or doping”. Handelsman believes that Australia’s prescription criteria for testosterone are being evaded and that there is a need to audit compliance and to tighten up the rules for PBS subsidy. In his opinion testosterone therapy remains unproven and possibly detrimental and he believes that taxpayers shouldn’t be subsidising it, just as they don’t subsidise anti-impotence drugs. Dr Handelsman has confirmed that he has contributed to the PBAC review.
Testosterone prescription rates are also under the spotlight in the United States. An article published in the New York Times last week raised similar concerns to those expressed in Australia, suggesting that the sharply rising use of testosterone “may be bad for patients as well as the United States’ $2.7 trillion annual health care bill.” The article pointed out that insurers are covering the bulk of the high-priced treatments, requiring only a small co-payment from patients while noting that Axiron sells for more than $500 a month retail. A spokesperson for Eli Lilly was quoted in the Australian Medical Observer in June as saying that the company does not promote or condone the use of Axiron outside of its indication for confirmed testosterone deficiency.
PBAC’s report on testosterone prescription in Australia is due before the end of the year.
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