MJA
MJA

Trends and regional differences in testosterone prescribing in Australia, 1991–2001

Med J Aust 2004; 181 (8): 419-422.

Summary

Objectives: To analyse temporal trends and geographical variations in testosterone prescribing in Australia.

Design and setting: An analysis of testosterone prescribing over the past 11 years according to products and region, determined by Pharmaceutical Benefits Scheme (PBS) expenditure in Australian states and territories.

Main outcome measure: Patterns of monthly PBS expenditure on injectable, oral and implantable testosterone products from 1 January 1991 to 30 December 2001, classified by state or territory.

Results: There were two periods (1993–1994 and 1998–1999) of striking upsurge followed by declines in national total prescribing of testosterone. These changes were more prominent for oral than injectable testosterone products, and patterns were similar in all regions, apart from a disproportionately higher peak in Western Australia in 1998. On a per-capita basis, Western Australia showed a dramatic increase in prescribing of oral and implantable, but not injectable, testosterone coinciding with the opening of a franchised men’s sexual health clinic in Perth.

Conclusion: The two striking upsurges in testosterone prescribing despite no convincing new evidence to justify them appear to reflect promotional activity to prescribe testosterone for older men, rather than overcoming the underdiagnosis of androgen deficiency related to pituitary or testicular disease in younger men. The curtailments after the introduced restrictions to PBS prescribing for older men without overt androgen deficiency were partial and temporary, suggesting that such regulatory barriers are only partly successful in counteracting the commercial and populist pressure driving excessive testosterone prescribing. Professional and community education is needed for appropriate diagnosis of genuine androgen deficiency in younger men, while discouraging unproven testosterone treatment for ageing men.

Please login with your free MJA account to view this article in full

  • David J Handelsman

  • ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW.

Correspondence: 

Acknowledgements: 

The author thanks Paula Anderson for technical assistance, and Dr B Oddens (Organon Australia) for helpful comments and review of the manuscript. Funding support was received from Andrology Australia, the federally funded Australian Centre of Excellence in Male Reproductive Health.

Competing interests:

The author has received institutional funding to design and perform clinical studies involving testosterone or other forms of androgen therapy from the World Health Organization, National Health and Medical Research Council, World Antidoping Agency and all pharmaceutical companies marketing androgens and related products in Australia (Organon, Schering, Serono, Pharmacia-Upjohn, Besins, SciGen, Lawley).

  • 1. Australian Government Department of Health and Ageing. General Public. Pharmaceutical Benefits Scheme. About the PBS. Available at: www.health.gov.au/pbs/general/aboutus.htm (accessed Aug 2004).
  • 2. Conway AJ, Handelsman DJ, Lording DW, et al. Use, misuse and abuse of androgens. The Endocrine Society of Australia consensus guidelines for androgen prescribing. Med J Aust 2000; 172: 220-224. <MJA full text>
  • 3. Smyth CM, Bremner WJ. Klinefelter syndrome. Arch Intern Med 1998; 158: 1309-1314.
  • 4. Handelsman DJ. Androgen action and pharmacologic uses. In: DeGroot LJ, editor. Endocrinology. 4th ed. Philadelphia: W B Saunders, 2001: 2232-2242.
  • 5. Gruenewald DA, Matsumoto AM. Testosterone supplementation therapy for older men: potential benefits and risks. J Am Geriatr Soc 2003; 51: 101-115.
  • 6. Liverman CT, Blazer DG, editors. Testosterone and aging: clinical research directions. Washington, DC: Institute of Medicine, The National Academies Press, 2004.
  • 7. Bhasin S, Singh AB, Mac RP, et al. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl 2003; 24: 299-311.
  • 8. Shackleford DM, Faassen WA, Houwing N, et al. Contribution of lymphatically transported testosterone undecanoate to the systemic exposure of testosterone after oral administration of two andriol formulations in conscious lymph duct-cannulated dogs. J Pharmacol Exp Ther 2003; 306: 925-933.
  • 9. Bagchus WM, Hust R, Maris F, et al. Important effect of food on the bioavailability of oral testosterone undecanoate. Pharmacotherapy 2003; 23: 319-325.
  • 10. Conway AJ, Boylan LM, Howe C, et al. A randomised clinical trial of testosterone replacement therapy in hypogonadal men. Int J Androl 1988; 11: 247-264.
  • 11. Bojesen A, Juul S, Gravholt CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab 2003; 88: 622-626.
  • 12. Abramsky L, Chapple J. 47,XXY (Klinefelter syndrome) and 47,XYY: estimated rates of and indication for postnatal diagnosis with implications for prenatal counselling. Prenat Diagn 1997; 17: 363-368.
  • 13. Handelsman DJ, Zajac JD. Androgen deficiency and replacement therapy in men. Med J Aust 2004; 180: 529-535. <MJA full text>
  • 14. Easterday CL, Grimes DA, Riggs JA. Hysterectomy in the United States. Obstet Gynecol 1983; 62: 203-212.
  • 15. Coulter A, McPherson K, Vessey M. Do British women undergo too many or too few hysterectomies? Soc Sci Med 1988; 27: 987-994.
  • 16. MacLennan AH, MacLennan A, Wilson D. The prevalence of hysterectomy in South Australia. Med J Aust 1993; 158: 807-809.
  • 17. Cherkin DC, Deyo RA, Loeser JD, et al. An international comparison of back surgery rates. Spine 1994; 19: 1201-1206.
  • 18. Taylor R, Rushworth RL. Hysterectomy fractions in New South Wales, 1971-2006. Aust N Z J Public Health 1998; 22: 759-764.
  • 19. Oddens BJ, Boulet MJ, Lehert P, et al. A study on the use of medication for climacteric complaints in western Europe–II. Maturitas 1994; 19: 1-12.
  • 20. Boulet MJ, Oddens BJ, Lehert P, et al. Climacteric and menopause in seven South-east Asian countries. Maturitas 1994; 19: 157-176.
  • 21. Jolleys JV, Olesen F. A comparative study of prescribing of hormone replacement therapy in USA and Europe. Maturitas 1996; 23: 47-53.
  • 22. MacLennan AH, Wilson DH, Taylor AW. Hormone replacement therapy: prevalence, compliance and the “healthy women” notion. Climacteric 1998; 1: 42-49.
  • 23. Vessey MP, Villard-Mackintosh L, McPherson K, et al. The epidemiology of hysterectomy: findings in a large cohort study. Br J Obstet Gynaecol 1992; 99: 402-407.p

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article