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Assessment of public interest and current trends in testosterone replacement therapy

International Journal of Impotence Research volume 34, pages 753–756 (2022)Cite this article

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Testosterone deficiency can result in hypogonadism in men and is associated with a myriad of physical, psychological, and sexual symptoms [1, 2]. Testosterone replacement therapy (TRT) was developed over 75 years ago, with treatment able to reach physiologic serum levels since the 1990s [3, 4]. All methods of TRT differ in dosing, administration intervals, formulations, and safety profiles, but the pharmacokinetic goal for all TRT is to replace testosterone to physiologic levels with minimal serum fluctuation [5]. In the United States (US), the available routes of testosterone delivery include buccal, nasal, subdermal, transdermal, intramuscular, and oral (pill) [6].

Over the last two decades, testing and prescriptions for testosterone have increased fourfold in the US [7]. With this dramatic increase in testosterone prescriptions, there have been notable changes in prescribing patterns over time. For example, the gel formulation was previously the most commonly prescribed form of TRT, and its use as the initial form of treatment increased from 24.5% in 2000 to 60.8% in 2008. In 2013, TRT injections surpassed gels as the most commonly prescribed form of TRT [8]. Most recently, the FDA approved an oral TRT, testosterone undecanoate, which became available in 2019 and offers a new option for men undergoing testosterone treatment [9]. What is currently unknown is how public interest in TRT aligns with these prescribing patterns.

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Fig. 1: Google search interest for TRT in the USA.
Fig. 2: A linear regression of search frequency.

References

  1. Wu F, Tajar A, Beyon J, Pye SR, Silman AJ, Finn JD, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N. Eng J Med. 2010;363:123–35.

    Article  CAS  Google Scholar 

  2. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endorcinol Metab. 2010;95:2536–59.

    Article  CAS  Google Scholar 

  3. Hamilton J. Treatment of sexual underdevelopment with synthetic male hormone substance. Endocrinology. 1937;21:649–54.

    Article  Google Scholar 

  4. Nieschlag E. Current topics in testosterone replacement of hypogonadal men. Best Pr Res Clin Endocrinol Metab. 2015;29:77–90.

    Article  CAS  Google Scholar 

  5. Barbonetti A, D’Andrea S, Francavilla S. Testosterone replacement therapy. Andrology. 2020;8:1551–66.

    Article  CAS  Google Scholar 

  6. Shoskes JJ, Wilson MK, Spinner ML. Pharmacology of testosterone replacement therapy preparations. Transl Androl Urol. 2016;5:834–43.

    Article  Google Scholar 

  7. Layton JB, Li D, Meier CR, Sharpless JL, Stürmer T, Jick SS, et al. Testosterone lab testing initiation in the United Kingdom and the United States, 2000 to 2011. J Clin Endocrinol Metab. 2014;99:835–42.

    Article  CAS  Google Scholar 

  8. Layton JB, Kim Y, Alexander GC, Emery SL. Association between direct-to-consumer advertising and testosterone testing in initiation in the United States, 2009–2013. J Am Med Assoc. 2017;317:1159–66.

    Article  Google Scholar 

  9. Swerdloff RS, Wang C, White WB, Kaminetsky J, Gittelman MC, Longstreth JA, et al. A new oral testosterone undecanoate formulation restores testosterone to normal concentrations in hypogonadal men. J Clin Endocrinol Metab. 2020;105:2515–31.

    Article  Google Scholar 

  10. Handelsman DJ. Global trends in testosterone prescribing, 2000-11: expanding the spectrum of prescription drug misuse. Med J Aust. 2013;199:548–51.

    Article  Google Scholar 

  11. Chen YY, Li CM, Liang JC, Tsai CC, et al. Health information obtained from the internet and changes in medical decision making: questionnaire development and cross-sectional survey. J Med Internet Res. 2018;20:47.

    Article  Google Scholar 

  12. Cacciamani GE, Bassi S, Sebben M, Marcer A, Russo GI, Cocci A, et al. Consulting “Dr. Google” for prostate cancer treatment options: a contemporary worldwide trend analysis. Eur Urol Oncol. 2019;2019:481–88.

    Google Scholar 

  13. Dreher PC, Tong C, Ghiraldi E, Friedlander JI. Use of google trends to track online behavior and interest in kidney stone surgery. Urology. 2018;121:74–78.

    Article  Google Scholar 

  14. Russo GI, Di Mauro M, Cooci A, Cacciamani G, Cimino S, Serefoglu EC, et al. Consulting “Dr. Google” for sexual dysfunction: a contemporary worldwide trend analysis. Int J Impot Res. 2020;32:455–61.

    Article  CAS  Google Scholar 

  15. Merheb S, Want N, Weinberg J, Wang DS, Wason SEL. Online interest in surgical treatment for benign prostatic hyperplasia using Google trends. World J Urol. 2020. Online ahead of print.

  16. Houman JJ, Eleswarapu SV, Mills JN. Current and future trends in men’s health clinics. Transl Androl Urol. 2020;9:S116–22.

    Article  Google Scholar 

  17. Shahinyan R, Amighi A, Carey A, Yoffe DA, Hodge DC, Pollard ME, et al. Direct-to-consumer internet prescription platforms overlook crucial pathology found during traditional office evaluation of young men with erectile dysfunction. Urology. 2020;143:165–72.

    Article  Google Scholar 

  18. Nguyen C, Hirsch M, Money D, Kaul S, Mohamoud M, Joffe HVTestosterone. and “Age-Related Hypogonadism” – FDA concerns. N. Eng J Med. 2015;373:689–91.

    Article  Google Scholar 

  19. Stewart KD, Johnston JA, Matza LS, Curtis SE, Havel HA, Sweetana SA, et al. Preference for pharmaceutical formulation and treatment process attributes. Patient Prefer Adherence. 2016;10:1385–99.

    Article  Google Scholar 

  20. Rao PK, Boulet SL, Mehta A, Hotaling J, Eisenberg ML, Honig SC, et al. Trends in testosterone replacement therapy use from 2003-13 among reproductive- age men in the United States. J Urol. 2017;197:1121–26.

    Article  CAS  Google Scholar 

  21. Kansal J, Deitrich P, Doolittle J. Online marketing practices and characteristics of stand-alone men’s health clinics. J Urol. 2020;203:e671.

    Google Scholar 

  22. McKinlay JB, Trachtenberg F, Marceau LD, Katz JN, Fischer MA. Effects of patient medication requests on physician prescribing behavior: results of a factorial experiment. Med Care. 2014;52:294–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Wade Muncey, Danly Omil-Lima, Erin Jesse, Karishma Gupta, Ahmed ElShafei, Aram Loeb & Nannan Thirumavalavan

  2. University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Wade Muncey, Danly Omil-Lima, Erin Jesse, Karishma Gupta, Ahmed ElShafei, Aram Loeb & Nannan Thirumavalavan

  3. Elson S. Floyd College of Medicine, Spokane, WA, USA

    Chad Heflick

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Muncey, W., Omil-Lima, D., Jesse, E. et al. Assessment of public interest and current trends in testosterone replacement therapy. Int J Impot Res 34, 753–756 (2022). https://doi.org/10.1038/s41443-021-00445-4

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