Cross-sectional analysis of national testosterone prescribing through prescription drug monitoring programs, 2018–2022

Abstract

Background For two decades preceding the COVID-19 pandemic, testosterone therapy (TT) became more prevalent in the US. Given the forced shift in practice patterns and healthcare accessibility during the pandemic, it was unclear how TT utilization would change. Objective To assess the change in testosterone prescriptions nationally. Design Cross-sectional study. Data sources State prescription drug monitoring program data between 2018 and 2022. Participants All individuals filling testosterone prescriptions in participating states. Measurements Unique people filling testosterone prescriptions annually, demographic information on gender and age as available. Results In 2022 there was a 27% relative increase of subjects treated with TT (+439,659 cases compared with 2018). The increase was more evident in the pandemic period with a rise in prevalence most notable for people 45–54 (114,114 people, 35% increase) and 35–44 (97,263 people, 58% increase). All regions except the Midwest increased the total population treated, led by the South (52%) followed by the West (28%) and Northeast (23%). Available data indicated men accounted for most patients treated in all age groups except under 24 years. Limitations Study population limited to those in participating states with no diagnostic information and limited demographics available. Conclusion Between 2018 and 2022, and primarily after the start of the pandemic in 2020, nationally there was a substantial increase in the number of people using TT. The largest increases occurred in a younger demographic, primarily men, than have previously been reported or studied. These results echo other findings showing increased use of controlled substances during the pandemic period and warrant further study regarding the factors behind this rise.