Although testosterone replacement therapy (TRT) use in the US has increased dramatically over the past decade, trends in TRT use among reproductive-aged men have not been investigated. We assessed changes in TRT use and practice patterns among 18-45-year-old US men from 2003-2013, and compared them to older men.
This is a retrospective, cross-sectional analysis of men ages 18-45 and 56-64 enrolled in the Truven Health MarketScan Commercial Claims Databases throughout each given calendar year from 2003-2013 (n=5,094,868 in 2013). Trends in the yearly rates of TRT use were calculated using Poisson regression. Among TRT users, Cochran-Armitage tests were used to assess temporal trends in age, formulation type, and semen analysis and serum testosterone level testing during the 12 months preceding documented use of TRT.
Between 2003 and 2013, there was a 4-fold increase in the rate of testosterone use among 18-45-year-old men from 29.2 per 10,000 person-years to 118.1 per 10,000 person-years (p<.0001). Among TRT users, topical gel formulations were initially used most. Injection use then doubled between 2009 (23.5%) and 2012 (46.2%), and surpassed topical gel use in 2013. Men 56-64 saw a statistically significant 3-fold increase in TRT use (p<.0001), which was significantly smaller than the 4-fold increase seen in younger men (p<.0001).
In 2003-2013, TRT use increased 4-fold in men 18-45, compared to 3-fold in older men. This younger age group should be a focus for future studies due to effects on fertility and unknown long-term sequelae.
The Journal of urology. 2016 Oct 24 [Epub ahead of print]
Pravin Kumar Rao, Sheree L Boulet, Akanksha Mehta, James Hotaling, Michael L Eisenberg, Stanton C Honig, Lee Warner, Dmitry M Kissin, Ajay K Nangia, Lawrence S Ross
Mid Atlantic Permanente Medical Group, Baltimore., Centers for Disease Control and Prevention, Atlanta., Department of Urology, Emory University, Atlanta., Division of Urology, University of Utah, Salt Lake City., Department of Urology, Stanford University, Palo Alto., Department of Urology, Yale University, New Haven., Department of Urology, University of Kansas, Kansas City., Department of Urology, University of Illinois, Chicago. Electronic address: .