Between 2001 and 2011, androgen use among American men aged 40 and over more than tripled — from 0.81% to 2.91%.[1] That is the number usually quoted when people describe a testosterone boom. The more interesting findings in the same analysis are the ones about how those prescriptions were being written.
What the claims data measured
Baillargeon and colleagues examined a commercial insurance claims database covering male enrollees aged 40 and older, and calculated the prevalence of androgen replacement therapy — the share of covered men who filled at least one androgen prescription in a given year.[1]
The rise was not confined to one group. It appeared across every age band examined. By 2011:
2.29% of men in their 40s and 3.75% of men in their 60s were taking some form of androgen replacement therapy.[1]
Of the four formulations examined, topical gel showed both the highest overall use and the fastest growth — more than a five-fold increase.[1] The delivery method that took the market is the same one covered in how gels came to dominate.
The finding that should have got more attention
A prescription trend on its own says nothing about whether the prescribing was appropriate. The same paper looked at that directly, and the answer was uncomfortable.
Among all new androgen users between 2001 and 2011, only 74.72% had had their testosterone level measured in the prior 12 months.[1]
Roughly one in four men started testosterone therapy without a documented testosterone measurement in the year beforehand.
The diagnosis data points the same way. Common diagnoses recorded in the year before starting therapy were hypogonadism (50.58%), fatigue (34.49%), erectile dysfunction (31.88%) and psycho-sexual dysfunction (11.75%).[1] Half of new users had a hypogonadism diagnosis on record. Half did not.
The authors' own conclusion is measured and worth quoting rather than paraphrasing: their findings that almost 20% of new users received treatment for 30 days or less, and that most men did not have clear evidence of a potential indication, suggest that the clinical reasons for initiating therapy are complex.[1]
It was also geographically lopsided
Prescribing prevalence varied by more than a factor of two across US Census regions. For all men aged 40 and over in 2010:[1]
| Region | Prevalence |
|---|---|
| South | 3.77% |
| West | 2.61% |
| Midwest | 1.78% |
| Northeast | 1.60% |
Biology does not vary by census region. Practice patterns do.
And a lot of it did not stick
The median number of days covered by androgen prescriptions in the 12 months after starting treatment, for men beginning in 2010, was 150 — well under half a year. Approximately 18.63% of new users filled only one prescription and received a maximum of 30 days of coverage.[1]
That pattern is consistent with what later adherence work found for topical therapy specifically, and it matters for anyone reading trend lines: a prevalence figure counts men who filled a prescription, not men who stayed on treatment.
What happened next
The same research group extended the analysis of US testosterone prescribing through 2016.[2] The decade after 2011 is not a simple continuation of the decade before it, because the regulatory environment changed in the middle of it.
The sequence that reshaped prescribing is covered in the controversy years: a trial stopped early in 2010, an observational analysis in 2013, and a class-wide FDA labeling action in 2015 that put a cardiovascular warning on every testosterone product. That warning stood until the FDA's 2025 class-wide labeling change, which followed the TRAVERSE trial.
Bottom line
The testosterone boom of the 2000s was real and large. The claims data that documented it also documented its weakest point: a substantial share of men started therapy without a recent testosterone measurement, half had no hypogonadism diagnosis on record, and the median new user was covered for about five months.
None of that says testosterone therapy does not work. It says that a market growing three-fold in a decade is not by itself evidence that the right men were being treated — which is precisely why confirming the diagnosis before starting is the part of the process worth being strict about.
References
2 sources
- Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173(15):1465–1466. doi:10.1001/jamainternmed.2013.6895 · PMID 23939517
- Baillargeon J, Kuo YF, Westra JR, Urban RJ, Goodwin JS. Testosterone Prescribing in the United States, 2002-2016. JAMA. 2018;320(2):200–202. doi:10.1001/jama.2018.7999 · PMID 29998328
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