“In Italy there are 17 million men over 40 years of age: of these, 6-8% have a serious lack of testosterone in the blood, in practice 1-1.5 million men over 40 suffer from hypogonadism, pathology often diagnosed late because the more specific symptoms, including those affecting the sexual sphere, are not reported spontaneously by the patient, out of shame or ignorance “, says Andrea Isidori, full professor of Endocrinology at the Umberto I University Hospital in Rome and current president of the Italian Society of Andrology and Medicine of Sexuality (Siams).
“Some responsibility also belongs to doctors who do not investigate it – admits Isidori – forgetting to ask patients ‘how is your sex life?’. Just as with cholesterol, or PSA, levels should be checked of testosterone in every man who has problems with obesity, diabetes, anemia or osteoporosis.Unfortunately, male hypogonadism is often under-diagnosed and, even when identified, suffers from a ‘social stigma’ which makes it difficult to identify”. The most common symptoms are: erection difficulties, decreased desire, weight gain, tiredness, loss of motivation.
“Many men in the prime of their working, sexual and social relationships – explains the endocrinologist – blame age or stress, and do not associate those signals with real alarm bells of a condition which, if not adequately treated, it causes osteoporosis, anemia, obesity, diabetes mellitus, increased cardiovascular risk and mood disorders”. Among the causes, the “malfunctioning of the testicle or of the gland (pituitary) which controls the production of testosterone – underlines Isidori – the drugs taken for infections (anti-fungal) or other chronic pathologies (painkillers, antiepileptics, opioids), and the excess alcohol, all interfere with the production of testosterone. In addition, there are many patients who have recovered from cancer. In fact, chemotherapy or radiotherapy can cause a drop in testosterone levels in the blood that can last forever “.
The therapies available today are effective, and can correct all the consequences of hypogonadism, but “therapeutic continuity is fundamental” – warns Isidori -. We have various methods of administration available, mainly via cutaneous gels or intramuscular injections. However, the pharmaceutical companies invest little in these products.Result?There are times when therapies are scarce and the lack of testosterone leads to interruptions of treatment.This way patients are denied a right enshrined in the constitution and there is a risk that even that small percentage of hypogonadal who manages to receive a diagnosis and start substitution therapy, ends up sinking into the limbo of those who do not get treatment”.
Hence the appeal to the Italian Medicines Agency, which recognized the reimbursement by the National Health Service and the Regional Health Service of testosterone in people with male hypogonadism, “to make all testosterone-based preparations reimbursable, including those in range C, which otherwise cost the patient up to 60 euros a month”. Since this therapy is prescribed “only by specialists – concludes Isidori – and therefore the number of people who need it is known, Aifa can force pharmaceutical companies to guarantee in Italy the quantity necessary for the patients’ needs. Only in this way can they guarantee therapeutic continuity”.