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Comment & Response
February 2014

Promotion of “Low T” and the Role of Testosterone Clinical Trials

Author Affiliations
  • 1School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
  • 2City University of New York (CUNY) School of Public Health, New York, New York
JAMA Intern Med. 2014;174(2):305-306. doi:10.1001/jamainternmed.2013.12750

To the Editor Braun1 provides a fascinating insight into the means by which vested interests have promoted a new condition of “low T” among older men and a climate of opinion where testosterone therapy is seen in a positive light, very similar to the marketing of estrogen to older women in the late 20th century. Schwartz and Woloshin2 draw attention to the current lack of evidence of meaningful, overall benefit from testosterone therapy, largely echoing the Institute of Medicine (IOM) report from 2004: “there is not clear evidence of benefit [from testosterone therapy] for any of the health outcomes examined.”3(p99) The IOM also specifically recommended only small-scale trials of testosterone therapy, where no other treatment was available.3 Schwartz and Woloshin2(p1462) now recommend a “large-scale randomized trial to demonstrate that testosterone therapy does more good than harm.” Given the current climate of opinion, genuine uncertainty in the expert medical community over whether testosterone therapy will be beneficial undoubtedly now exists. However, the evidence of harm from testosterone therapy has, since 2004, accumulated, but for the very reasons given by Braun,1 has also had less “air time.”

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