Endocrine Abstracts

Objective: There are large regional and international differences in prescription patterns of testosterone replacement therapy (TRT) and testosterone measurements, with an increase in testosterone prescriptions reported in several countries. We investigated temporal changes in testosterone testing and reimbursed doses of TRT covered by the Belgian healthcare system.

Methods: Anonymous data on testosterone and sex hormone-binding globulin (SHBG) measurements (number of analyses and amount spent in euro) in men 17 years or older, were requested from the government (RIZIV) for 2012-2022. Data on TRT were requested from the government (Farmanet) from 1-2013 until 12-2022. This covers pharmaceutical preparations reimbursed in Belgium, prescribed by a physician and provided to the patient via public pharmacies. In Belgium, only Sustanon® is reimbursed, so this dataset does not contain data on transdermal preparations or testosterone undecanoate. Data are provided as number of delivered packages and amount spent. Since 2012, one package of Sustanon® on the Belgian market contains one dose of 250 mg testosterone esters.

Results: In 2013, total testosterone was measured 105.060 times in Belgian adult men. This increased to 149.602 in 2022 (+42% over a 10-year time period). The amount spent by the healthcare system for testosterone testing increased from C=379.394 in 2013 to C=551.759 in 2022 (+45%). SHBG was measured 48.442 times in Belgian adult men in 2013. This increased to 70.715 in 2022 (+46%). The amount spent by the healthcare system for SHBG testing increased from C=155.547 in 2013 to C=231.876 in 2022 (+49%). In 2013, 37.950 doses of Sustanon® were sold to adult men. In 2022, this increased to 76.189 doses (+101%), corresponding to a cost of C=373.330 in 2013 and C=675.042 in 2022 (+81%). To put these numbers into perspective, from 2013 till 2022, the number of Belgian adult men increased by 5.8%. Inflation was 28.5% over 10 years.

Conclusion: The number of testosterone measurements increased by 42% in Belgium between 2013 and 2022. Remarkably, the number of doses of the only reimbursed testosterone replacement therapy showed an increase of 101%, which is much larger compared to the number of testosterone measurements. These findings correspond to similar trends of prescription pattern increases reported in other European countries.