Trends and Patterns of Testosterone Therapy among U.S. Male Medicare Beneficiaries, 1999 to 2014

Abstract

Purpose: We explored the Medicare database (1999–2014) to provide a comprehensive assessment of testosterone therapy (TT) patterns in the older US male population. Materials and Methods: We estimated annual age-standardized incidence (new users) and prevalence (existing users) of TT according to demographic characteristics, comorbidities, and potential indications. Results: There were 392,698 incident TT users during 88 million person-years. TT users were predominantly younger, white non-Hispanic, and located in South and West US Census regions. On average, TT dramatically increased during 2007–2014 (average annual percent change=15.5%), despite a decrease in 2014. In 2014, the most common recorded potential indications for any TT were hypogonadism (48%), fatigue (18%), erectile dysfunction (15%), depression (4%), and psychosexual dysfunction (1%). Laboratory tests to measure circulating testosterone concentrations for TT were infrequent with 35% having had at least one testosterone test in the 120 days preceding TT, 4% the recommended two pre-TT tests, and 16% at least one pre-TT test and at least one post-TT test. Conclusions: TT remains common in the older US male population, despite a recent decrease. Although TT prescriptions are predominantly for hypogonadism, a substantial proportion appear to be for less specific conditions. Testosterone tests amongst men prescribed TT appear to be infrequent.