The 20-year public health impact and direct cost of testosterone deficiency in U.S. men

J Sex Med. 2013 Feb;10(2):562-9. doi: 10.1111/j.1743-6109.2012.02944.x. Epub 2012 Oct 4.


Introduction: Testosterone deficiency (TD) imposes a substantial public health burden in the U.S. We modeled the costs associated with TD-related sequelae including cardiovascular disease (CVD), diabetes mellitus (DM), and osteoporosis-related fractures (ORFs).

Aim: To quantify the incremental cost burden imposed by TD's cardiometabolic sequelae.

Method: Incidence, prevalence, and mortality of these conditions were collected for men ages 45-74 from six national databases and large cross-sectional studies. Relative risk (RR) rates were determined for these sequelae in patients with T < 300 ng/dL. The prevalence of TD was determined for this cohort of men.

Main outcome measures: Adjusted incidence and prevalence were determined. Annual costs for the three TD-related sequelae were inflated at a real rate of 3% for 20 years.

Results: Actual and adjusted (normalized for T deficiency) rates of CVD, DM, and ORFs in U.S. men aged 45-74 assuming a TD prevalence of 13.4% were calculated. We determined that, over a 20-year period, T deficiency is projected to be involved in the development of approximately 1.3 million new cases of CVD, 1.1 million new cases of DM, and over 600,000 ORFs. In year 1, the attributed cost burden of these diseases was approximately $8.4 billion. Over the entire 20-year period, T deficiency may be directly responsible for approximately $190-$525 billion in inflation-adjusted U.S. health care expenditures.

Conclusion: TD may be a significant contributor to adverse public health. Further study is needed to definitively describe the whether TD is a modifiable risk factor for CVD, DM, and ORFs. This may represent an opportunity for nationwide public health initiatives aimed at preventive care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cardiovascular Diseases / economics*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / mortality
  • Cause of Death
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / mortality
  • Health Care Costs*
  • Health Expenditures / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Osteoporotic Fractures / economics*
  • Osteoporotic Fractures / epidemiology*
  • Osteoporotic Fractures / mortality
  • Public Health / economics*
  • Risk
  • Survival Analysis
  • Testosterone / deficiency*
  • United States


  • Testosterone