Selling Sickness 2013

hormone hoaxes for ladies and gents

It’s not just women’s problem anymore.

As a feminist, I (LT) have watched for decades the worrisome news about the safety of reproductive hormones for menopause symptomspre-menstrual complaints, and oral contraceptives. The history of the use and marketing of these powerful steroids for women takes a recurring pattern with early promotion as wonder drugs, then a rise in caution as side effects become known, and finally strong ambivalence and even withdrawn approval when scandals and dangers become publicized.

The latest episode of this story came from an exposé about compounding centers and the manufacture of “bioidentical” hormones. (This story is not to be confused with the one last year about how nonsterile conditions in compounding centers caused products to be contaminated and cause fungal meningitis.) This new exposé resulted from an undercover project by health writer Cathryn Jakobson Ramin.

Duplicate prescriptions for gonadal hormones (estrogens and progestogens) were filled at 12 different compounding pharmacies, resulting in widespread inconsistencies and shortfalls in hormone content. It is an illusion that these under-the-radar pharmacies are producing products that are safe and effective. Public health requires better regulation of all drugs and supplements and types of manufacturing facilities.

But the point today is how this is no longer just a story about women’s search for the fountain of youth. Now, a huge marketing campaign for testosterone has put men in the bullseye of overtreatment. Major stories in the Atlantic and the New York Times have examined the role of physicians with deep conflicts of interest who promote testosterone to all and sundry complaining of fatigue or sexual disappointment.  My favorite quote is from Dr. Harry Fisch, one of those enthusiastic and well-paid consultants to the testosterone industry  who recommends testosterone to his patient, Mike, 45 years old, 40 pounds overweight, with high blood pressure and diabetes. “If it gives you more energy to exercise, I’m all for it.” This appears to be the state of the art in endocrine diagnostics and treatment.

As Dr. John Morley, another consultant, says at another point in the Times article, after reviewing the history of male gonadal fads including monkey and goat testes transplants and self-injection of crushed guinea-pig testicles. “This is the hilarious history of testosterone. It may not have gotten any better.” Uh-oh. Now men can sing the sweet song of Caveat Emptor, too.

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