Editor's Correspondence |

Men, Androgen Deficiency, and Pharmaceutical Promotion—Reply

Susan A. Hall, PhD; Andre B. Araujo, PhD; Thomas G. Travison, PhD; Gretchen R. Esche, MS; John B. McKinlay, PhD; Richard V. Clark, MD, PhD; Rachel E. Williams, PhD
Arch Intern Med. 2009;169(1):87-89. doi:10.1001/archinternmed.2008.539.
Text Size: A A A
Published online


In reply

Dr Finucane suggests that symptomatic androgen deficiency was arbitrarily defined in the Boston Area Community Health (BACH) study1 and seems to imply that the study was a “disease creation” effort related to pharmaceutical marketing. This study was sponsored by the National Institutes of Health, with additional financial support from GlaxoSmithKline for these analyses, as we disclosed in our article. Our disease definition was not arbitrary but based on published clinical practice guidelines from the Endocrine Society, the medical authority on this topic.2 We used a combination of low total testosterone level + low free testosterone + the presence of symptoms (both specific [eg, low libido, osteoporosis, and erectile dysfunction] and nonspecific symptoms). We recognize that there is significant debate over what threshold constitutes low testosterone level. In our publication examining the prevalence of symptomatic androgen deficiency in this study population, our cut points of lower than 300 ng/dL for total testosterone and lower than 5 ng/dL for free testosterone level were empirically superior to others tested insofar as they best corresponded with the prevalence of low libido, which is considered the hallmark symptom of a low testosterone level.3 We chose to consistently define symptomatic androgen deficiency when turning to estimate treatment patterns. In our “Comment” section, we specifically noted that we do not know whether it would have been clinically appropriate to give testosterone to the untreated men but that it is important to monitor treatment patterns in the general population for change, given the marked increase in sales of prescription testosterone in the United States.4

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics