title: Trends in Testosterone Replacement Therapy Use from 2003 to 2013 among Reproductive-Age Men in the United States.
abstract: Although testosterone replacement therapy use in the United States has increased dramatically in the last decade, to our knowledge trends in testosterone replacement therapy use among reproductive-age men have not been investigated. We assessed changes in testosterone replacement therapy use and practice patterns among 18 to 45-year-old American men from 2003 to 2013 and compared them to older men.
  
  
  
  This is a retrospective, cross-sectional analysis of men 18 to 45 and 56 to 64 years old who were enrolled in the Truven Health MarketScan® Commercial Claims Databases throughout each given calendar year from 2003 to 2013, including 5,094,868 men in 2013. Trends in the yearly rates of testosterone replacement therapy use were calculated using Poisson regression. Among testosterone replacement therapy users, the Cochran-Armitage test was used to assess temporal trends in age, formulation type, semen analysis and serum testosterone level testing during the 12 months preceding the documented use of testosterone replacement therapy.
  
  
  
  Between 2003 and 2013, there was a fourfold increase in the rate of testosterone use among 18 to 45-year-old men from 29.2/10,000 person-years to 118.1/10,000 person-years (p <0.0001). Among testosterone replacement therapy users, topical gel formulations were initially most used. Injection use then doubled between 2009 and 2012 (23.5% and 46.2%, respectively) and surpassed topical gel use in 2013. In men 56 to 64 years old there was a statistically significant threefold increase in testosterone replacement therapy use (p <0.0001), which was significantly smaller than the fourfold increase in younger men (p <0.0001).
  
  
  
  In 2003 to 2013, testosterone replacement therapy use increased fourfold in men 18 to 45 years old compared to threefold in older men. This younger age group should be a focus for future studies due to effects on fertility and unknown long-term sequelae.
authors: Mid Atlantic Permanente Medical Group, Baltimore, Maryland.
authors: Pravin Kumar
authors: PK
authors: Rao
authors: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Sheree L
authors: SL
authors: Boulet
authors: Department of Urology, Emory University, Atlanta, Georgia.
authors: Akanksha
authors: A
authors: Mehta
authors: Division of Urology, University of Utah, Salt Lake City, Utah.
authors: James
authors: J
authors: Hotaling
authors: Department of Urology, Stanford University, Palo Alto, California.
authors: Michael L
authors: ML
authors: Eisenberg
authors: Department of Urology, Yale University, New Haven, Connecticut.
authors: Stanton C
authors: SC
authors: Honig
authors: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Lee
authors: L
authors: Warner
authors: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Dmitry M
authors: DM
authors: Kissin
authors: Department of Urology, University of Kansas, Kansas City, Kansas.
authors: Ajay K
authors: AK
authors: Nangia
authors: Department of Urology, University of Illinois, Chicago, Illinois. Electronic address: lsross51941@gmail.com.
authors: Lawrence S
authors: LS
authors: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D020249:Hormone Replacement Therapy / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013739:Testosterone / Q000627:therapeutic use*; D013997:Time Factors; D014481:United States; D014572:Urology; D055815:Young Adult
chemical_list: D013739:Testosterone
keywords: age groups; hypogonadism; infertility; male; testis; testosterone