Bayer Schering Pharma
Andrology
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Synopsis
Testosterone. It makes a bloke love footy, drink beer, chase chicks and brag to the fellas.
But what happens when he doesn’t have enough and neither he, nor his doctor, knows it?
This paper tells how Bayer Schering Pharma connected doctors with testosterone deficient
patients, educating them about an insidious male condition; demonstrating the value of insight,
creativity and local strategy in pharmaceutical marketing.
What sort of value?
A spend increase of $247,000 delivered incremental revenue of $1.96million; $2.2million projected
incremental revenue and $3.05 direct incremental profit for every dollar spent.
Now that’s something worth bragging about to the fellas.
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“Most men don’t have a life. Instead, we have just learned to pretend.
Much of what men do is an outer show, kept up for protection.”
Steve Biddulph
Manhood.
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What is testosterone?
Testosterone is the principal male hormone. Secreted by the testes and adrenal glands, it plays a
key role in male health, well-being and sexual function. It exists in both the female and male
body; however men produce forty to sixty times more than women 1. It’s classified as an anabolic
steroid; a group of hormones characterised by their ability to stimulate muscle growth, bone
density, maturation of sex organs, growth of body hair and deepening of the voice.
Testosterone is the building block of masculinity.
What is testosterone deficiency?
Testosterone deficiency (TD) is a condition where the male body doesn’t produce enough
testosterone to adequately maintain male characteristics. It presents either as a rare genetic
disorder during puberty, known as ‘Classical’ TD, or the more prevalent ‘Late Onset’ condition that
can strike men in middle age.
An insidious condition
TD is extremely difficult to detect as its symptoms are wide ranging and subtle. The overly tall
gangly teenager; small testes; a wispiness of the beard and loss of body hair; gynaecomastia (or
‘man boobs’); low sperm count; poor concentration; lack of motivation; sleep disturbance and
depression; all of these, or a combination of a few, can signal TD at any age 2.
Over 430,000 Australian men suffer from TD but with diagnosis rates as low as 4% 3, the majority
continue to endure the symptoms unaware that the very foundation of their manhood is slowly
rusting away.
Diagnosis...or the lack of
General Practitioners (GPs) are best positioned to manage TD. However their awareness of the
condition, and confidence to diagnose and treat, is low. Misdiagnosis is common, with men ending
up on an anti-depressive or erectile-dysfunction medication rather than therapeutic testosterone.
The symptoms get treated rather than the cause.
Diagnosis is complicated. It requires a thorough medical history, an uncomfortable and
embarrassing physical examination, and a laboratory assessment of blood samples from two
different mornings4.
It’s well known that men are their own worst enemy, trapped by an engrained concept of what is
believed to be masculine. They suffer in silence, only interacting with doctors when it’s absolutely
necessary and giving away the bare minimum information required to fix a specific problem.
1
2
3
4
Wikipedia
Swerdloff RS et al. J Clin Endocrinol Metab 2006;91(6): 1995-2010
Araujo AB et al. J Clin Endocrinol Metab 2007;92(11):4241-7.
Testogel approved Product Information
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“When psychological or physical symptoms occur, many men have learned not to acknowledge
them and tough-it-out alone. This isolates them from information, interventions, and support.”
What does it mean to be a man?
Denis E Boyd & Associates. Psychologists & Counsellors.
If you were a GP, with little confidence in your ability to detect and diagnose an insidious,
practically invisible condition that strikes at the very heart of masculinity, would you be putting TD
at the top of your ‘to do’ list when a bloke begrudgingly walks through your door?
The answer for the majority is an unequivocal, ‘No’.
Ineffective treatment
Treatment is just as problematic with men undergoing painful implants or weekly injections which
lack precision in their stabilisation of testosterone levels, causing erratic mood swings, loss of
libido and depression.
For many men, the repercussions from ineffectual treatment are worse than the symptoms, forcing
them to discontinue therapy, disconnect from the life they once had and struggle on alone.
“I don’t do anything I used to. I rarely see the people I used to; I don’t go to bars,
I spend a lot of time in my lounge room alone.”
Unsuccessfully treated TD sufferer
Controversy
As an anabolic steroid, abuse of therapeutic testosterone is well known. The Tour de France has
been plagued by testosterone cheats, and illicit use has beset sporting fraternities from
weightlifting to rugby.
Likewise, as small decreases in testosterone are part aging, there is ongoing debate over the
treatment of TD and at what degree of severity men should become eligible for therapy.
This has created a volatile, emotionally charged, political environment that makes the small
number of GPs with the confidence to treat, incredibly wary of prescribing and the marketing of
testosterone highly problematic.
State of play
Bayer Schering Pharma (BSP) market two testosterone brands; Testogel (a daily gel) and
Reandron 1000 (a three-monthly injection). Combined they dominate the market and both are far
superior to competitors in their ability to deliver consistent testosterone levels.
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Market $ Share (MAT)
Dec-07
Testosterone
Implants
8%
Sustanon
12%
Androderm
9%
Bayer Andrology
55%
Andriol
11%
Primoteston
3%
Figure 1 - Market dominance (IMS)
Since 2005 BSP has had great success in switching patients from older, less effective, competitors;
with an impressive 48% growth5 in 2007 thanks to the vast improvements offered by its products.
This clear product advantage had meant that the complexities of the local market, primarily low
awareness and diagnosis, had not needed to be addressed.
The task of driving market share had been relatively simple, utilising a global, product focussed,
campaign to promote individual brand switch.
Figure 2 - Global campaigns (05-07)
However by the end of 2007 BSP had all but exhausted the switch market, eroding share for the
weekly injectable Sustanon, and sending implants into a downward spiral.
5
IMS MAT Jan vs Dec 07
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Market Share
05 - 07
70%
Andriol
60%
Androderm
50%
Proviron
40%
Androfem
30%
Andromen
20%
Testosterone Implants
10%
Sustanon
Nov-07
Aug-07
May-07
Feb-07
Nov-06
Aug-06
May-06
Feb-06
Nov-05
Aug-05
May-05
0%
Primoteston
Bayer Andrology
Figure 3 - A depleted switch market (IMS)
With the $11.5 million market slowing to 3% growth6 and low diagnosis rates, BSP could not
assume continued high growth by relying on switch business; especially as the only company
investing in marketing. They would need to look beyond product battles and develop strategies to
grow the overall patient pool.
The dilemma
You would think that being the sole marketer looking to implement a growth strategy in a
profitable and underdeveloped market would be a licence to print money.
Wrong.
With the controversy surrounding TD, marketing testosterone is extremely problematic. Any
company seen to be stimulating prescribing for sheer financial gain will quickly feel the wrath of
organisations monitoring appropriate promotion.
To draw a parallel, the media commentary surrounding the illegal use of pseudoephedrine in the
production of amphetamines has dramatically changed the marketing landscape for any company
wanting to promote legitimate therapeutic goods containing the product.
For BSP and their agency, navigating the minefield that is the TD market would not be an easy
task. Finding a common thread to appease stakeholders, and using it to drive the market, would
be even harder.
The key principles
The environment BSP was operating in was defined by its instability:
6

Highly regulated and hotly debated

History of ineffective therapies
IMS, G03B market MAT Dec 07
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
Uncertain prescribers lacking confidence and adequate knowledge

Unwilling patients detached from their condition
An unstable
environment
Figure 4 - Instability
With such volatility it was important to seek out the constants; the pockets of stability; and make
them central to the marketing strategy. That constant was the governing body Andrology
Australia, and its charter:
“Andrology Australia seeks to increase awareness and understanding of androgen (testosterone)
deficiency, to improve accurate diagnosis and to encourage appropriate treatment and follow-up.”
www.andrologyaustralia.org
In defining a new direction, Andrology Australia’s key principles were put at the heart of the
thinking to ensure the ensuing campaign would avoid controversy:
o
Increase awareness and understanding
o
Improve accurate diagnosis
o
Encourage appropriate treatment
The objective
To stimulate market growth by increasing awareness and diagnosis of TD, ensuring BSP Andrology
capitalises on subsequent treatment decisions.
There were two key metrics to measure the campaign’s success:
1. Market metric:
Increase total patients in the market by 15%
2. Business metric:
Directly convert this patient influx (15% BSP dollar growth)
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Strategy
It was clear that product led communication would not stimulate growth beyond the switch
business already achieved. As such, a deeper connection would need to be made to the condition,
the men who unknowingly suffer from it, and the GPs who should be diagnosing them.
The grip of masculinity
For generations society has dictated to men how they should act. What their role should be as a
family provider, household leader and contributor to the workforce and community.
“Masculinity relates to the socially constructed ideas about qualities and
characteristics that are appropriate for men.”
Andrology Australia
For a forty plus baby boomer at risk of TD, these idealistic characteristics are all they know. They
haven’t progressed to the liberal views of gen-X, and the metro-sexualism of gen-Y is truly
another world. They still look up to a 1950s fatherly ideal rooted in stoicism and emotional denial.
In a bid to protect these ideals, men do more damage than good. They’re irregular visitors to GPs
and when they do, they aren’t forthcoming with information. There’s a vast chasm between
acknowledgement of a problem and action.
“If I mention it and there’s nothing wrong, I’ll look stupid”
Co-morbidity sufferer, un-tested testosterone
Men are often flying blind. Unlike women, who tend to have a much deeper self-connection. It’s
often not through stubbornness that men don’t take action; instead they just don’t seem to
register there’s a problem.
“Men just go into their cave”
“We suffer from get-around-to-it-itis”
Co-morbidity sufferers, un-tested testosterone
When it comes to the subtle, intangible and often deeply personal symptoms of TD, it’s safer to
shrug them off as part of ageing and adhere to the masculine life you knew before.
The problem is, with the system fuelling your masculinity low on petrol, you can’t ignore the
changes occurring and the effect they’re having on you and the people around you.
The gimmicks
These guys may have been unknowingly living with TD for some time. As such, they’ve become
amazingly adept at creating disguises; covering up their symptoms to ensure they’re conforming
to what is socially acceptable as ‘masculine’.
Everyone has heard of the ‘mid-life crisis’ male who buys himself a convertible to hang on to his
youth. Men suffering from TD can latch on to the same gimmicks, but for much more deep-seated
and complex reasons.
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The connection
Testosterone deficient men don’t believe they physically or emotionally live up to society’s
standards and hide behind veiled attempts of masculinity in the hope their falsities aren’t exposed.
Properly diagnosed and treated, these men don’t have to live the lie. Testosterone therapy can
restore their masculinity and rebuild the foundations of their manhood.
The proposition
For such a complex and difficult to navigate issue, the solution and springboard to a highly
engaging campaign came down to just one word:
Restoration.
Bring to life the restorative effects testosterone therapy can have on the day-to-day life of
testosterone deficient men.
Empowering the GP
By investing in their awareness, diagnosis and treatment of TD, BSP can empower doctors to make
significant changes to their patients’ lives by restoring them to their former masculine self.
Creativity and engagement
Testosterone is a small and relatively unsupported market. Communication for testosterone brands
therefore needs to work hard to break through the clutter created by the big spenders like antihypertensives.
The creative would need to take ownership of the most commercial of three principles defined in
the objectives to ensure a return on investment:

Encourage appropriate treatment
The resulting concept brought to life, via arresting and differentiating visuals, the liberating benefit
TD treatment offers men, by restoring their masculinity and allowing them to cast aside the
‘gimmicks’ used to mask their deficiency.
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Figure 5 - Bike execution
Figure 6 - Trophy execution
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Figure 7 - Toupée execution
As a market growth strategy the campaign was dual-branded, as opposed to the previous product
specific global executions. This also offered greater media and production efficiencies.
Implementation
It was crucial that implementation addressed the final two principles:

Increase awareness and understanding

Improve accurate diagnosis
This was achieved via an integrated roll out spanning the following communications plan:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
31 7 14 21 28 4 11 18 25 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 1 8 15 22 29 6 13 20 27 3 10 17 24 1 8 15 22
Australian Family Physician (FPC)
Medicine Today (FPC)
Medical Observer (Fireplace)
Medical Observer (FPC)
Australian Doctor (Fireplace)
Australian Doctor (FPC)
Conference stand
Sales Aids
Leave Behinds
Direct Mail
Website
Webdrivers
Clinical Paper Folders
Screening programme
Figure 8 - 2008 Communications plan
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Figure 9 - Conference invite
Figure 10 - Sales materials
The campaign theme was pulled through branded elements and a fifteen second rich media film
was used as a bridge to an educative, unbranded website.
Figure 11 - Toupée rich media
The interactive, password protected website was designed solely to up-skill; taking GPs through
the diagnostic steps – from symptom identification to clinical examinations and blood tests.
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Loading
Landing page
Registration
Symptoms
Quality of life
Diagnosis
Patient case study
Screening tools
Figure 9 - GP website
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Results
The campaign far surpassed the two key metrics:
1. Market metric:
Market actual:
Increase total patients by 15%
Increased total patients by 23%
2. Business metric:
BSP dollar growth of 15%
Business actual:
BSP dollar growth of 28%
The impact on the market was substantial; best demonstrated via market growth.
Total Market MAT % growth
15%
16%
14%
12%
10%
8%
6%
4%
3%
2%
0%
07 growth
08 growth
Figure 13 - Market stimulation (IMS)
BSP was the sole driver of market growth, contributing incremental revenue of $1.9 million
(representing 15% of total market value); the combined competitor set delivered negative growth.
Market $ contribution
$2,200,000
$2,000,000
$1,800,000
$1,600,000
$1,400,000
$1,200,000
$1,000,000
$800,000
$600,000
$400,000
$200,000
$-$200,000
$1,957,324
-$18,113
07 vs 08 Total competitor
contribution
2007 vs 2008 Total Bayer Schering
contribution
Figure 14 - Incremental revenue (IMS)
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The amplified market activity was highlighted via the dominant prescribing intention of ‘new’ and
‘trial’ users of the BSP brands.
Figure 15 - Growth in new & trial prescribers (GP Monitor)
Return on investment
To demonstrate return on investment, two calculations have been made:


Payback on incremental sales
Projected incremental revenue
1. The incremental sales of $1.9 million was achieved by a budget increase (directly associated
with the production and promotion of the new campaign) of $247,613. This figure includes
media, production and medical education costs.

Equates to a payback of 8 times the investment
2. However a truer assessment of the campaign’s performance is to look at the projected
incremental revenue from the campaign based on the following formula
Figure 16 - Projected incremental revenue formula
The figures for this calculation cannot be disclosed, but if the new patients brought to the BSP
brands in 2008 continued treatment for twelve months, the increase equates to:

$2.2 million in projected incremental revenue
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Incremental profit related to the campaign
The issue with basic ROI calculations is that they don’t take into account other key factors. The
following formula has been used to calculate the incremental profit related to the campaign:
Figure 17 - 'Incremental profit attributed to campaign' formula
Again the figures used to make this calculation cannot be disclosed, particularly due to the
confidentiality of margin and COGS percentages.
The incremental profit related to the campaign from this calculation is:

$3.05 direct incremental profit for every $1.00 spent on the campaign
Discounting other factors
What was the impact of the sales force?
The size of the sales force, just thirteen representatives nationwide, did not change in 2008.
What was the impact of competitor activity?
No other brand or competitor product was actively promoted in 2007 or 2008.
What was the impact of advertising spend?
Due to the production of the new campaign, the overall costs went up in 2008, however the
budget allocated to promote it remained the same as 2007.
What was the impact of medical education?
In 2008 a series of representative moderated ‘men’s health’ meetings were held. Although TD was
a topic, and used to drive interest, the majority of time focussed on erectile dysfunction to
promote BSP’s PDE5 inhibitor, Levitra. The cost of these meetings in 2008 was $160,000, $80,000
of which was contributed by Levitra. To ensure transparency, the full $160,000 has been included
in the calculations above.
What was the impact of sampling?
Reandron 1000 cannot be sampled by law, and the sampling of Testogel is problematic. The
amount of Testogel samples distributed did not change in 2008.
What was the impact of government legislation?
There are strict eligibility criteria for therapeutic testosterone which requires a complex submission
for each new patient. There was no change to this legislation in 2008.
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What was the impact of publicity and PR?
Terms such as ‘man-opause’ are often picked up by the media and create negative and positive
publicity. BSP are kept busy dealing with these issues on a regular basis. The level of activity did
not change in 2008.
Industry recognition
The campaign’s uniqueness was recognised within the global healthcare community at the New
York Festival Global Awards:

Global Award:
Hormone category

Finalist Certificate:
Professional film/video category
Conclusions
In an era where markets such as Australia are instructed to use global campaigns and strategies
which, although effective, fail to address specific local needs, this paper has demonstrated what
can be achieved by harnessing the power of local insight to meet local objectives.
It has also demonstrated the power of creativity to drive engagement and its ability to work hand
in hand with ethical, educative initiatives.
Last but not least, it has demonstrated that Aussie blokes don’t have to retreat to their cave when
declining testosterone loosens their grip on the socially constructed ideals of masculinity.
Through driving awareness and understanding, accurate diagnosis and appropriate treatment, BSP
are helping Australian GPs restore the masculinity of their male patients.
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