(068) UTILIZATION PATTERNS OF TESTOSTERONE SUPPLEMENTATION AND REPLACEMENT IN YOUNG ADULT MEN
Authors: Aguiar J , Greenberg D , Halpern J , Brannigan R , Dubin J 
Published: December 2024

Abstract

Introduction
The expansion of direct-to-consumer health platforms has coincided with a significant increase in the accessibility of pharmacologic treatments for hypogonadism. However, the impact of this accessibility has been poorly defined among young adult men.

Objective
We sought to assess demographic, socioeconomic, and health factors associated with androgenic medication use among men aged 18-40 years.

Methods
We designed a survey assessing prior androgenic medication use, means of acquisition, and patient counseling received. The survey was disseminated to a convenience sample of males aged 18-40 through Research March, an NIH-funded database of research participants. Demographic features including age, race, ethnicity, education level, insurance status, sexual orientation, and relationship status were collected. Descriptive statistics were performed using t-test, chi-squared test, and univariable and multivariable logistic regression with significance defined as p &lt; 0.05.

Results
Among 401 respondents, 160 (39.9%) reported considering taking testosterone boosting supplements or medications, and 54 (13.5%) indicated prior use of medications to supplement or boost their testosterone. Among these 54 individuals, the most reported medications were testosterone replacement (72.2%), anastrozole (51.9%), clomiphene (50.0%), HCG (50.0%), SARMs (42.6%), and anabolic steroids (42.6%). Self-identified Black or African American race was associated with higher rates of utilization on univariable analysis (OR = 7.30, 95% CI: 3.78-14.12, p &lt; 0.001). Similarly, Medicare or Medicaid insurance status (OR = 2.52, 95% CI: 1.26-5.02, p = 0.01) and self-pay or uninsured status (OR = 3.95, 95% CI: 1.59-9.86, p = 0.003) were associated with increased utilization. On multivariable regression, Black or African American race (OR = 4.40, p &lt; 0.001) and prior sexual health visit (OR = 10.13, p &lt; 0.001) were independently associated with higher utilization. There were no statistically significant differences among usage patterns with respect to age, education level, relationship status, or sexual orientation. Fatigue (45.3%), low libido (45.3%), apathy (32.1%), poor endurance (30.2%), and erectile dysfunction (30.2%) were the most frequently cited reasons prompting initial use. Urologists were the most frequent source of initial procurement (28.3%), followed by primary care physicians (22.6%) and other medical providers or physicians (18.9%). Patients reported their preferred sources of procurement as PCPs (30.2%), Urologists (26.4%), and direct to consumer platforms (24.5%). Safety (56.6%), privacy (49.1%), cost (45.3%), and convenience (39.6%) were the most important considerations in medication procurement. 77.3% of medication utilizers reported receiving counseling on potential risks and side effects associated with androgenic medications. Medication utilizers were able to correctly identify commonly associated risks with greater accuracy than individuals without prior medication use including infertility (75.5% vs 45.8%), cardiovascular risk (79.3% vs 69.5%), erythrocytosis (81.1% vs 50.7%), sleep apnea (62.3% vs 32.3%), increased prostate cancer development risk (69.8% vs 60.8%), and testosterone dependency (73.6% vs 57.1%).

Conclusions
Our study highlights notable differences in usage patterns observed across racial and insurance status groups. We observed concerning popularity of potentially harmful substances (ie, anabolic steroids and SARMs) in young men. Despite high rates of reported counseling on potential risks, users cited safety, privacy, cost, and convenience as critical factors influencing medication procurement. These insights underscore the need for targeted educational efforts and equitable access to androgenic treatments within this population.

Disclosure
No.