title: The 20-year public health impact and direct cost of testosterone deficiency in U.S. men.
abstract: BACKGROUND
  Testosterone deficiency (TD) imposes a substantial public health burden in the U.S. We modeled the costs associated with TD-related sequelae including cardiovascular disease (CVD), diabetes mellitus (DM), and osteoporosis-related fractures (ORFs).
  
  
  OBJECTIVE
  To quantify the incremental cost burden imposed by TD's cardiometabolic sequelae.
  
  
  METHODS
  Incidence, prevalence, and mortality of these conditions were collected for men ages 45-74 from six national databases and large cross-sectional studies. Relative risk (RR) rates were determined for these sequelae in patients with T < 300 ng/dL. The prevalence of TD was determined for this cohort of men.
  
  
  METHODS
  Adjusted incidence and prevalence were determined. Annual costs for the three TD-related sequelae were inflated at a real rate of 3% for 20 years.
  
  
  RESULTS
  Actual and adjusted (normalized for T deficiency) rates of CVD, DM, and ORFs in U.S. men aged 45-74 assuming a TD prevalence of 13.4% were calculated. We determined that, over a 20-year period, T deficiency is projected to be involved in the development of approximately 1.3 million new cases of CVD, 1.1 million new cases of DM, and over 600,000 ORFs. In year 1, the attributed cost burden of these diseases was approximately $8.4 billion. Over the entire 20-year period, T deficiency may be directly responsible for approximately $190-$525 billion in inflation-adjusted U.S. health care expenditures.
  
  
  CONCLUSIONS
  TD may be a significant contributor to adverse public health. Further study is needed to definitively describe the whether TD is a modifiable risk factor for CVD, DM, and ORFs. This may represent an opportunity for nationwide public health initiatives aimed at preventive care.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA. mkhera@bcm.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Moskovic
authors.forename: Andre B
authors.initials: AB
authors.lastname: Araujo
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
authors.forename: Mohit
authors.initials: M
authors.lastname: Khera
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D011634:Public Health / Q000191:economics*; D012306:Risk; D016019:Survival Analysis; D013739:Testosterone / Q000172:deficiency*; D014481:United States
chemical_list: D013739:Testosterone