The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men


  • Dr. Araujo is supported by Award Number R01AG020727 from the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute On Aging or the National Institutes of Health.

  • Dr. Araujo is a consultant to Lilly, USA.

  • Precis: This manuscript assesses the scope of imposed by testosterone deficiency of US men in terms of disease burden and direct costs.

Daniel Moskovic, MD, MA, MBA, Mohit Khera, MD, MBA, MPH, Scott Department of Urology, Baylor College of Medicine, 6620 Main Street, Suite 1325, Houston, TX 77030, USA. Tel: 713-798-6593; Fax: 713-798-6593; E-mail:;


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. Moskovic DJ, Araujo AB, Lipshultz LI, and Khera M. The 20-year public health impact and direct cost of testosterone deficiency in U.S. men. J Sex Med **;**:**–**.