title: Population-based patterns of prescription androgen use, 1976-2008.
abstract: OBJECTIVE
  Prescription testosterone (T) has limited approved medical indications and is a controlled substance in Canada. Utilization studies in other Westernized countries have revealed sharp increases in T use in recent years. We examined medical use of androgens, including T, over a ≥30-year period among adult (18+) men in a population-based study set in a Canadian juridisdiction of universal health care.
  
  
  METHODS
  Analyses were based on data from electronic records of dispensed prescriptions during 1976-2008 in Saskatchewan, Canada. All formulations of androgens listed in the provincial formulary (oral and injectable) were included. We examined demographics of users, androgen types used, switching patterns, and trends in the annual rate of use over time.
  
  
  RESULTS
  There were 11 521 androgen users who were followed for an average of 11.8 years. Overall, 11 types of androgens were used, and there were 86 812 dispensing events. The mean age at first use was 56.4 years (median: 58). Men had 7.5 prescription dispensing events on average (median: 2). The most commonly used formulations were methyl-T (36.2% of users) followed by T-enanthate (32.5%), T-cypionate (22.3%), and T-undecanoate (20.0%). Most users (82%) did not switch among androgen types. The annual rate of use varied substantially over time, with a marked increase observed from 1994 to 1999 and a decrease from 2000 to 2008.
  
  
  CONCLUSIONS
  Androgen users were largely middle aged and had relatively few dispensings. We hypothesize that observed secular trends in androgen use may align with drug treatment pattern changes for erectile dysfunction, including the advent of phosphodiesterase type 5 inhibitors.
authors: Department of Epidemiology, New England Research Institutes, Watertown, MA, USA.
authors: Susan A
authors: SA
authors: Hall
authors: Gayatri
authors: G
authors: Ranganathan
authors: Liane J
authors: LJ
authors: Tinsley
authors: Jennifer L
authors: JL
authors: Lund
authors: Varant
authors: V
authors: Kupelian
authors: Gary A
authors: GA
authors: Wittert
authors: Philip W
authors: PW
authors: Kantoff
authors: Alvaro
authors: A
authors: Morales
authors: Andre B
authors: AB
authors: Araujo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000728:Androgens / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D015331:Cohort Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D012525:Saskatchewan; D013739:Testosterone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000728:Androgens; D013739:Testosterone
keywords: androgens; drug utilization; hypogonadism; pharmacoepidemiology; testosterone