Pharma libido

It’s tough persuading men to take drugs for a flagging sex drive

 

DRUG BUST by Alan Cassels

There’s a granite barrier separating a man and a woman lying in bed. “Lack of Energy, Low Sex Drive” is etched into it in big letters. It’s a striking photo that sends a signal swiftly and precisely: a marriage is on the rocks.

She’s gazing at him over the barrier; he’s staring into space. The tagline tells it all: “Has He Lost That Loving Feeling?”

This ad, which is currently running in the lifestyle section of a major Canadian newspaper, is part of a bold, new campaign to get you – and your physician – to think differently about being male and getting old. It used to be that slowing down, taking naps and losing interest in sex were common for a guy approaching 50, but if you’re a pharmaceutical manufacturer keen on tapping the gargantuan market of boomer decrepitude, you find disease in the most mundane of places. Yet getting men to consider their flagging sex drive as a disease and then marketing testosterone to treat it poses one wee problem: convincing men there is a problem.

It’s not as easy as it looks. The method employed in this case to sow the seeds of diagnosis is a clever self-screening questionnaire, quizzing men to see if they too may be losing that “Loving Feeling” because they lack testosterone. The ad’s website, www.lowt.ca, hosts a 10-question “Low-T Quiz,” including such sample questions as:

“Do you have a decrease in libido (sex drive)? Do you have a lack of energy? Are you sad and/or grumpy? Are you falling asleep after dinner? Have you noticed a recent deterioration in your ability to play sports?” And so on.

As a sometimes grumpy, frequently napping and not-as-good-at-sports-anymore kind of guy, I can only say one thing: “I resemble those remarks.”

But seriously, though. One has to admire the audacity and opacity of this marketing campaign. The name of the product isn’t even mentioned; nor is the name of the drug firm behind the Low-T quiz. Technically speaking, prescription drug advertising is not permitted in Canada. Oh, those pesky little Viagra or Celebrex ads running on Canadian television? They’re not “real” ads, just “reminder ads” that apparently conform to the letter of the law and are Health-Canada sanctioned.

To be fair, the drug maker here is not selling a product as much as a condition. Most peri-boomer men my age (the 45-64 cohort) would answer yes to at least three of these 10 questions, after which they’d book a trip to the doctor to discuss the benefits of some of that Low-T sex juice. It’s that simple.

While a conscientious doctor won’t whip out the prescription pad right away on the basis of a drug-company quiz that questions your manhood, the company isn’t banking on conscientious doctors. It only needs to convince some of the estimated 1.7 million Canadian male boomers (with a cluster of certain symptoms) that they might have Low T, while hoping those men have the gonads to ask their doctor for some testosterone-based libido enhancement.

At least that’s how it’s supposed to work. Yet according to a survey a decade ago of 1,000 people, only about 50 percent of men said they would actually consult the doctor if they had signs of low testosterone. Clearly, there’s a whole group of guys that need to be convinced they’ve got something medically wrong with them. Interestingly, only a third of the women polled thought men would seek medical treatment for Low-T.

Geriatrician and endocrinologist Dr. John Morley works in geriatric research at the St. Louis Veterans Affairs Medical Center. He led the team that designed the first simple screening questionnaire for androgen deficiency in aging males (ADAM). He says he created the ADAM questionnaire – which is the one the advertisement is directing men to – while sitting on the toilet. He chuckles when he adds, “It is a really crappy questionnaire.”

And not everyone likes it. “It irritated a lot of academics,” he says. “It is fairly good at picking up people who have low testosterone. It doesn’t miss people. The problem is it also picks up a lot of people who don’t have low testosterone. For example, half the people who have low libido have normal testosterone.”

Barbara Mintzes agrees. She’s an epidemiologist and a professor at UBC and an expert in drug advertising. She recent saw the ad for the Low T test running in the paper and was so put off she wrote a letter to Health Canada complaining about the ad. What angers her is partly the fact that hypogonadism, for which testosterone gel is approved to treat, is a relatively uncommon condition, yet, as she notes, “getting older is very common.”

“As a normal part of ageing, men’s testosterone levels gradually go down by about one percent per year,” she adds by way of explanation. “There’s a lot of normal variation around this range. This drug has not been tested as a treatment for getting older. It’s been tested for serious testosterone deficiency.”

One big issue for her is when you start testing every man that has some symptoms of low testosterone, “the likelihood of false positives – tests that would seem to show a problem when there isn’t one – is also very high.”

Are there many downsides to giving men testosterone when they don’t actually need it? Of course, testosterone tests cost money as do extra doctor visits and drug prescriptions can add up. Then there are the side effects, which also can be costly. The drugs themselves are not benign and testosterone replacement therapy can cause a range of side effects such as frequent or persistent erections, nausea, vomiting or jaundice. They should be avoided by men at high risk for prostate cancer or those with heart, liver or kidney problems. Last year, a study of testosterone replacement found that older men who were given testosterone gel were more likely to develop heart disease than men on a ‘placebo’ or sugar pill and the study was stopped early as a result.

One of the weirdest things about testosterone gel is the possibility of virilization of the people you touch. Whazzat, you say? Well, let’s put it this way; if you rub testosterone gel on your chest or arms and then decide to hug your lover, pets or your children when you’re not wearing a shirt, they could develop masculine traits.

Don’t believe me? Then believe the US FDA, which has issued a “Black Box” warning –the sternest drug safety warning going – that says two types of testosterone gel caused these things in children: “inappropriate enlargement of the genitalia, premature development of pubic hair, advanced bone age, increased libido and aggressive behaviour.”

Yikes. That is taking the “We all pay for side effects” axiom to a new level. This parable reminds us once again of the inherent dangers in treating aging as a disease. The roller coaster of physiological changes that occur as we age is all part of life’s ride, to be tolerated, embraced and even enjoyed, if possible. No amount of drugs will allow a man facing the far side of 40 to ever behave in the sack again like he did when he was 20. Oh, if it were only otherwise.

Then there’s that other thing. Perhaps men today have too much testosterone already. Maybe if we augment testosterone levels in today’s males we would have even less of “That Loving Feeling.” If more men took prescription testosterone, would we see more wars? More fights? More spousal abuse? More hockey brawls? More obnoxious driving from guys with large trucks? Maybe the world needs less testosterone, not more.

Just a thought, as I head off for my daily nap.

Alan Cassels is a drug policy researcher at the University of Victoria and is currently working on a book on medical screening. Have you been screened for something and have a story to tell? Let him know at cassels@uvic.ca. Read his other writings at www.alancassels.com

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