Misuse of androgensThe medical misuse of androgens is the prescribing of testosterone to men who do not have androgen deficiency. This may happen in such settings as:
Testosterone replacement therapy has been proven safe and effective over decades, for treatment of men with recognised problems of the pituitary or testis that cause androgen deficiency. Testosterone treatment has not been proven safe and effective for older men without any recognised disorders of the pituitary or testis. Until further evidence is available, testosterone treatment of such older men can not be recommended.
In the wider community, abuse of androgens in sport is also an important issue with some elite athletes and body builders using massive doses of androgens. For athletes this breaks the rules against sports doping and for all androgen abusers, the long-term affects on the body particularly for prostate (prostate cancer, BPH) and cardiovascular diseases (heart attack, stroke) remain of great concern.
 Related link: Use, misuse and abuse of androgens
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Medical misuse of androgensAndrogens are sometimes prescribed without a well established medical reason. Some common examples of medical misuse of androgens when androgen deficiency has not been diagnosed include:
Male infertility
There is no reason for prescribing androgens for male infertility. The only effect likely to happen is a negative effect and sperm production may stop. If testosterone or other androgens are prescribed, the body’s detection system recognises that the levels of testosterone are too high. The body then shuts down the factory (Leydig cells) by stopping the production of LH and FSH. These hormone changes in turn stop sperm production.
These actions are the basis of clinical trials that are being undertaken in Australia in which testosterone is given as a male contraceptive.
Erectile dysfunction or impotence
Androgen deficiency is an uncommon (< 5%) cause of men presenting with erectile dysfunction. However, all men presenting with erectile dysfunction should be tested for androgen deficiency as it can be easily treated. In the unusual event that androgen deficiency is diagnosed with erectile dysfunction, the underlying cause of the androgen deficiency needs to be further investigated.
‘Male menopause’ or ‘andropause’
Ageing men who have symptoms that have been associated with androgen deficiency are sometimes described in the media as having "male menopause" or "andropause". Terms such as these are misleading and have little place in meaningful medical or scientific discussion.
Menopause refers to the stopping of menstrual cycle (periods) which can only be applied to women. Andropause is a misleading term as it suggests a false analogy with menopause.
In fact, testosterone levels in men do not stop suddenly but slowly decline with age. The risks and benefits of testosterone replacement for older men with lower testosterone levels than their younger male counterparts are being researched. Back to top
Treatment of non-specific symptomsThere is no basis for testosterone replacement therapy based on symptoms in the absence of established androgen deficiency. In addition to the unproven safety and efficacy, the placebo effect of androgen injections may be confusing to both doctor and patient. When placebo effects decrease, further confusion and dissatisfaction with treatment may be expected. Back to top
Abuse of androgensAndrogens may be misused and abused to improve sporting ability and to cause changes to physical appearance such as increasing muscle size and strength.
The use of androgens in competitive sport has been banned since 1974. However, their use in elite sports continues and anonymous questionnaires also suggest large usage in certain non-competitive sports like bodybuilding. Increasing numbers of teenage males appear to be using androgens to try to improve sporting ability and/or physical appearance.
High doses of androgens do increase muscle size and strength, but the effects on sporting performance are unknown. Testing for the presence of androgens is done with urine samples and is extremely sensitive so that doping can be detected even months after the last androgens were administered.
The side effects of androgens include acne, weight gain, mood changes (especially aggressive behaviour), decreased testes size and low sperm counts leading to infertility. Some men take chemically modified forms of testosterone, for example 17-α alkylated androgens, and put themselves at risk of liver disease.
Some men are seeking androgens from illegal sources and are taking doses that are far more than those used for normal replacement treatment. The purity of the materials from such sources may not be known; some androgens are only approved for veterinary use and others may be toxic to the liver.
Published in part from the Endocrine Society of Australia consensus guidelines for androgen prescribing.
Conway A, Handelsman DJ, Lording DW, Stuckey B, Zajac JD (2000) Use, misuse and abuse of androgens. Medical Journal of Australia; 172: 220-224. Publication in full available at http://www.mja.com.au/public/issues/172_05_060300/conway/conway.html Back to top
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Testosterone Misuse and Abuse
