Skip to main content
SpringerLink
Log in
Book cover

Endocrinology of the Testis and Male Reproduction pp 1–35Cite as

Use, Misuse, and Abuse of Androgens

  • Living reference work entry
  • First Online:

Part of the book series: Endocrinology ((ENDOCR))

Abstract

Androgens are potent pharmacological drugs requiring legal prescription for valid medical indications but are also misused for invalid or unproven off-label medical reasons as well as used illicitly as a form of drug abuse. Understanding these distinctions and applications requires a knowledge of androgen physiology, pharmacology, and toxicology which is discussed in historical as well as present clinical practice terms. The present epidemic of testosterone misuse mainly involves using testosterone as an antiaging and/or sexual dysfunction tonic for middle-aged or older men for which the efficacy and safety are unproven, and there is concern that such treatment may be unsafe. Androgen abuse originated during the Cold War as an epidemic among elite athletes as ergogenic agents but in the 1980s transitioned to become an endemic in most communities with sufficient affluence to support an illicit drug industry geared toward body sculpting of hypermasculine body image for occupational or recreational reasons.

This is a preview of subscription content, log in via an institution.

Notes

  1. 1.

    An ancient magical talisman consisting of a five-pointed star believed to summon energy.

  2. 2.

    The term androgen abuse is used exclusively herein when referring to abuse of testosterone and/or its synthetic analog derivatives. This is more accurate terminology for steroids which are still often misnamed as “anabolic steroids” or “androgenic-anabolic steroids” elsewhere. For more detailed explanation see Handelsman (2011a).

References

  • Abbate V, Kicman AT, Evans-Brown M, McVeigh J, Cowan DA, Wilson C, et al. Anabolic steroids detected in bodybuilding dietary supplements – a significant risk to public health. Drug Test Anal. 2014;7:609.

    Article  PubMed  CAS  Google Scholar 

  • Akram ON, Bursill C, Desai R, Heather AK, Kazlauskas R, Handelsman DJ, et al. Evaluation of androgenic activity of nutraceutical-derived steroids using mammalian and yeast in vitro androgen bioassays. Anal Chem. 2011;83:2065–74.

    Article  CAS  PubMed  Google Scholar 

  • Allender S, Scarborough P, O’Flaherty M, Capewell S. Patterns of coronary heart disease mortality over the 20th century in England and Wales: possible plateaus in the rate of decline. BMC Public Health. 2008;8:148.

    Article  PubMed  PubMed Central  Google Scholar 

  • Altschule MD, Tillotson KJ. The use of testosterone in the treatment of depressions. N Engl J Med. 1948;239:1036–8.

    Article  CAS  PubMed  Google Scholar 

  • Amiaz R, Seidman SN. Testosterone and depression in men. Curr Opin Endocrinol Diabetes Obes. 2008;15:278–83.

    Article  CAS  PubMed  Google Scholar 

  • Aminorroaya A, Kelleher S, Conway AJ, Ly LP, Handelsman DJ. Adequacy of androgen replacement influences bone density response to testosterone in androgen-deficient men. Eur J Endocrinol. 2005;152:881–6.

    Article  CAS  PubMed  Google Scholar 

  • Anonymous. The pentacle of rejuvenescence. Br Med J. 1889;1:1416.

    Google Scholar 

  • Anonymous. Dr Brown-Sequard’s “Elixir of Life”. Lancet. 1890;135:57–8.

    Google Scholar 

  • Araujo AB, O’Donnell AB, Brambilla DJ, Simpson WB, Longcope C, Matsumoto AM, et al. Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts male aging study. J Clin Endocrinol Metab. 2004;89:5920–6.

    Article  CAS  PubMed  Google Scholar 

  • Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173:1465–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363:109–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bhasin S, Jasuja R. Selective androgen receptor modulators as function promoting therapies. Curr Opin Clin Nutr Metab Care. 2009;12:232–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bhasin S, Singh AB, Mac RP, Carter B, Lee MI, Cunningham GR. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl. 2003;24:299–311.

    Article  PubMed  Google Scholar 

  • Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995–2010.

    Article  CAS  PubMed  Google Scholar 

  • Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536–59.

    Article  CAS  PubMed  Google Scholar 

  • Bojesen A, Juul S, Gravholt CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab. 2003;88:622–6.

    Article  CAS  PubMed  Google Scholar 

  • Bojesen A, Juul S, Birkebaek N, Gravholt CH. Increased mortality in Klinefelter syndrome. J Clin Endocrinol Metab. 2004;89:3830–4.

    Article  CAS  PubMed  Google Scholar 

  • Borell M. Brown-Sequard’s organotherapy and its appearance in America at the end of the nineteenth century. Bull Hist Med. 1976a;50:309–20.

    CAS  PubMed  Google Scholar 

  • Borell M. Organotherapy, British physiology, and discovery of the internal secretions. J Hist Biol. 1976b;9:235–68.

    Article  CAS  PubMed  Google Scholar 

  • Borst SE, Shuster JJ, Zou B, Ye F, Jia H, Wokhlu A, et al. Cardiovascular risks and elevation of serum DHT vary by route of testosterone administration: a systematic review and meta-analysis. BMC Med. 2014;12:211.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Boyle P, Koechlin A, Bota M, d'Onofrio A, Zaridze DG, Perrin P, et al. Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate specific antigen (PSA): a meta-analysis. BJU Int. 2016;118:731.

    Article  CAS  PubMed  Google Scholar 

  • Braun SR. Promoting “Low T”: a medical writer’s perspective. JAMA Intern Med. 2013;173:1458–60.

    Article  PubMed  Google Scholar 

  • Bremner WJ. Testosterone deficiency and replacement in older men. N Engl J Med. 2010;363:189–91.

    Article  CAS  PubMed  Google Scholar 

  • Butenandt A, Hanisch G. Uber die Umwandlung des Dehydroandrosterons in Androstenol-(17)-one-(3) (Testosterone); Umweg zur darstellung des testosterons aus Cholsterin (vorlauf mitteilung). Z Physiol Chem. 1935;237:89–97.

    Article  CAS  Google Scholar 

  • Carosa E, Martini P, Brandetti F, Di Stasi SM, Lombardo F, Lenzi A, et al. Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels. Clin Endocrinol. 2004;61:382–6.

    Article  CAS  Google Scholar 

  • Catlin DH, Ahrens BD, Kucherova Y. Detection of norbolethone, an anabolic steroid never marketed, in athletes’ urine. Rapid Commun Mass Spectrom. 2002;16:1273–5.

    Article  CAS  PubMed  Google Scholar 

  • Catlin DH, Sekera MH, Ahrens BD, Starcevic B, Chang YC, Hatton CK. Tetrahydrogestrinone: discovery, synthesis, and detection. Rapid Commun Mass Spectrom. 2004;18:1245–9.

    Article  CAS  PubMed  Google Scholar 

  • Conway AJ, Handelsman DJ, Lording DW, Stuckey B, Zajac JD. Use, misuse and abuse of androgens: the Endocrine Society of Australia consensus guidelines for androgen prescribing. Med J Aust. 2000;172:220–4.

    CAS  PubMed  Google Scholar 

  • Cordaro FG, Lombardo S, Cosentino M. Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the Internet. Scand J Med Sci Sports. 2011;21:e247–59.

    Article  CAS  PubMed  Google Scholar 

  • Corona G, Maseroli E, Rastrelli G, Isidori AM, Sforza A, Mannucci E, et al. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf. 2014;13:1327–51.

    Article  CAS  PubMed  Google Scholar 

  • Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014;17:132–43.

    Article  CAS  PubMed  Google Scholar 

  • Cussons AJ, Bhagat CI, Fletcher SJ, Walsh JP. Brown-Sequard revisited: a lesson from history on the placebo effect of androgen treatment. Med J Aust. 2002;177:678–9.

    PubMed  Google Scholar 

  • Dalton JT, Mukherjee A, Zhu Z, Kirkovsky L, Miller DD. Discovery of nonsteroidal androgens. Biochem Biophys Res Commun. 1998;244:1–4.

    Article  CAS  PubMed  Google Scholar 

  • Dalton JT, Taylor RP, Mohler ML, Steiner MS. Selective androgen receptor modulators for the prevention and treatment of muscle wasting associated with cancer. Curr Opin Support Palliat Care. 2013;7:345–51.

    Article  PubMed  Google Scholar 

  • Darke S, Torok M, Duflou J. Sudden or unnatural deaths involving anabolic-androgenic steroids. J Forensic Sci. 2014;59:1025–8.

    Article  CAS  PubMed  Google Scholar 

  • David K, Dingemanse E, Freud J, Laqueur E. Uber krystallinisches mannliches Hormon aus Hoden (Testosteron), wirksamer als aus Harn oder aus Cholestrin bereitetes Androsteron. Hoppe Seylers Zeischrift Physiol Chemie. 1935;233:281–2.

    Article  CAS  Google Scholar 

  • de Souza GL, Hallak J. Anabolic steroids and male infertility: a comprehensive review. BJU Int. 2011;108:1860–5.

    Article  PubMed  CAS  Google Scholar 

  • Death AK, McGrath KC, Kazlauskas R, Handelsman DJ. Tetrahydrogestrinone is a potent androgen and progestin. J Clin Endocrinol Metab. 2004;89:2498–500.

    Article  CAS  PubMed  Google Scholar 

  • Dobs AS, Boccia RV, Croot CC, Gabrail NY, Dalton JT, Hancock ML, et al. Effects of enobosarm on muscle wasting and physical function in patients with cancer: a double-blind, randomised controlled phase 2 trial. Lancet Oncol. 2013;14:335–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dunn M. The non-medical use of steroids in Australia: results from a general population survey. Aust N Z J Public Health. 2010;34:531–2.

    Article  PubMed  Google Scholar 

  • Dunn M, White V. The epidemiology of anabolic-androgenic steroid use among Australian secondary school students. J Sci Med Sport. 2011;14:10–4.

    Google Scholar 

  • Dwyer AA, Raivio T, Pitteloud N. Gonadotrophin replacement for induction of fertility in hypogonadal men. Best Pract Res Clin Endocrinol Metab. 2015;29:91–103.

    Article  CAS  PubMed  Google Scholar 

  • Edwards P, Ekins R. The “Pardridge” hypotheses relating to the role of hormone binding proteins in hormone delivery: a critique. Steroids. 1988;52:367–8.

    Article  CAS  PubMed  Google Scholar 

  • Ekins R. Measurement of free hormones in blood. Endocr Rev. 1990;11:5–46.

    Article  CAS  PubMed  Google Scholar 

  • Food and Drug Administration (FDA) Center for Drug Evaluation and Research. Minutes of the Joint Meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee and the Drug Safety and Risk Management advisory committee, 2014. 2014. Available from: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM418144.pdf.

  • Food and Drug Administration (FDA) Center for Drug Evaluation and Research. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. 2015. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm436259.htm.

  • Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.

    Article  CAS  PubMed  Google Scholar 

  • Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem. 1997;43:1262–79.

    CAS  PubMed  Google Scholar 

  • Gabrielsen JS, Najari BB, Alukal JP, Eisenberg ML. Trends in testosterone prescription and public health concerns. Urol Clin North Am. 2016;43:261–71.

    Article  PubMed  Google Scholar 

  • Gan EH, Pattman S, HSP S, Quinton R. A UK epidemic of testosterone prescribing, 2001–2010. Clin Endocrinol. 2013;79:564–70.

    Article  Google Scholar 

  • Geyer H, Parr MK, Mareck U, Reinhart U, Schrader Y, Schanzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids – results of an international study. Int J Sports Med. 2004;25:124–9.

    Article  CAS  PubMed  Google Scholar 

  • Grata E, Perrenoud L, Saugy M, Baume N. SARM-S4 and metabolites detection in sports drug testing: a case report. Forensic Sci Int. 2011;213:104–8.

    Article  CAS  PubMed  Google Scholar 

  • Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med. 2000;133:933–41.

    Article  CAS  PubMed  Google Scholar 

  • Groth KA, Skakkebaek A, Host C, Gravholt CH, Bojesen A. Clinical review: Klinefelter syndrome – a clinical update. J Clin Endocrinol Metab. 2013;98:20–30.

    Article  CAS  PubMed  Google Scholar 

  • Haber C. Life extension and history: the continual search for the fountain of youth. J Gerontol A Biol Sci Med Sci. 2004;59:B515–22.

    Article  PubMed  Google Scholar 

  • Hall RC, Hall RC, Chapman MJ. Psychiatric complications of anabolic steroid abuse. Psychosomatics. 2005;46:285–90.

    Article  PubMed  Google Scholar 

  • Hall SA, Ranganathan G, Tinsley LJ, Lund JL, Kupelian V, Wittert GA, et al. Population-based patterns of prescription androgen use, 1976–2008. Pharmacoepidemiol Drug Saf. 2014;23:498–506.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hamilton JB. Treatment of sexual underdevelopment with synthetic male hormone substance. Endocrinology. 1937;21:649–54.

    Article  Google Scholar 

  • Hamilton D. The monkey gland affair. London: Chatto & Windus; 1986. p. 155.

    Google Scholar 

  • Handelsman DJ. Trends and regional differences in testosterone prescribing in Australia, 1991–2001. Med J Aust. 2004;181:419–22.

    PubMed  Google Scholar 

  • Handelsman DJ. Update in andrology. J Clin Endocrinol Metab. 2007;92:4505–11.

    Article  CAS  PubMed  Google Scholar 

  • Handelsman DJ. Androgen physiology, pharmacology and abuse. In: DeGroot LJ, Jameson JL, editors. Endocrinology. 6th ed. Philadelphia: Elsevier Saunders; 2010. p. 2469–98.

    Google Scholar 

  • Handelsman DJ. Commentary: androgens and “anabolic steroids”: the one-headed Janus. Endocrinology. 2011a;152:1752–4.

    Article  CAS  PubMed  Google Scholar 

  • Handelsman DJ. Androgen therapy in non-gonadal disease. In: Nieschlag E, Behre HM, editors. Testosterone: action, deficiency and substitution. 4th ed. Cambridge: Cambridge University Press; 2011b. p. 372–407.

    Google Scholar 

  • Handelsman DJ. An old emperor finds new clothing: rejuvenation in our time. Asian J Androl. 2011c;13:125–9.

    Article  PubMed  Google Scholar 

  • Handelsman DJ. Pharmacoepidemiology of testosterone prescribing in Australia, 1992–2010. Med J Aust. 2012;196:642–5.

    Article  PubMed  Google Scholar 

  • Handelsman DJ. Global trends in testosterone prescribing, 2000–2011: expanding the spectrum of prescription drug misuse. Med J Aust. 2013;199:548–51.

    Article  PubMed  Google Scholar 

  • Handelsman DJ. Androgen physiology, pharmacology and abuse. In: DeGroot LJ, Jameson JL, editors. Endocrinology. 7th ed. Philadelphia: Elsevier Saunders; 2015a. p. 2368–93.

    Google Scholar 

  • Handelsman DJ. Irrational exuberance in testosterone prescribing: when will the bubble burst? Med Care. 2015b;53:743–5.

    Article  PubMed  Google Scholar 

  • Handelsman DJ. Performance enhancing hormones in sports doping. In: DeGroot LJ, Jameson JL, editors. Endocrinology. 7th ed. Philadelphia: Elsevier Saunders; 2015c. p. 441–54.

    Google Scholar 

  • Handelsman DJ, Gupta L. Prevalence and risk factors for anabolic-androgenic steroid abuse in Australian secondary school students. Int J Androl. 1997;20:159–64.

    Article  CAS  PubMed  Google Scholar 

  • Handelsman DJ, Heather A. Androgen abuse in sports. Asian J Androl. 2008;10:403–15.

    Article  CAS  PubMed  Google Scholar 

  • Haring R, Ittermann T, Volzke H, Krebs A, Zygmunt M, Felix SB, et al. Prevalence, incidence and risk factors of testosterone deficiency in a population-based cohort of men: results from the study of health in Pomerania. Aging Male. 2010;13:247–57.

    Article  CAS  PubMed  Google Scholar 

  • Herlihy AS, McLachlan RI. Screening for Klinefelter syndrome. Curr Opin Endocrinol Diabetes Obes. 2015;22:224–9.

    Article  CAS  PubMed  Google Scholar 

  • Hoffman JR, Kraemer WJ, Bhasin S, Storer T, Ratamess NA, Haff GG, et al. Position stand on androgen and human growth hormone use. J Strength Cond Res/National Strength Cond Assoc. 2009;23:S1–S59.

    Article  Google Scholar 

  • Hsu B, Cumming RG, Blyth FM, Naganathan V, Le Couteur DG, Seibel MJ, et al. The longitudinal relationship of sexual function and androgen status in older men: the Concord Health and Ageing in Men Project. J Clin Endocrinol Metab. 2015;100:1350–8.

    Article  CAS  PubMed  Google Scholar 

  • Huo S, Scialli AR, McGarvey S, Hill E, Tugertimur B, Hogenmiller A, et al. Treatment of men for “Low Testosterone”: a systematic review. PLoS One. 2016;11:e0162480.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy. 2011;31:757–66.

    Article  CAS  PubMed  Google Scholar 

  • Ishak KG, Zimmerman HJ. Hepatotoxic effects of the anabolic-androgenic steroids. Semin Liver Dis. 1987;7:230–6.

    Article  CAS  PubMed  Google Scholar 

  • Jannini EA, Screponi E, Carosa E, Pepe M, Lo Giudice F, Trimarchi F, et al. Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone. Int J Androl. 1999;22:385–92.

    Article  CAS  PubMed  Google Scholar 

  • Jasuja GK, Bhasin S, Reisman JI, Berlowitz DR, Rose AJ. Ascertainment of testosterone prescribing practices in the VA. Med Care. 2015;53:746–52.

    Article  PubMed  Google Scholar 

  • Jee BC, Lee JY, Suh CS, Kim SH, Choi YM, Moon SY. Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery. Fertil Steril. 2009;91:40–5.

    Article  CAS  PubMed  Google Scholar 

  • Jenkins JS. The voice of the castrato. Lancet. 1998;351:1877–80.

    Article  CAS  PubMed  Google Scholar 

  • Junkman K. Long-acting steroids in reproduction. Recent Prog Horm Res. 1957;13:380–419.

    Google Scholar 

  • Kahn A. Regaining lost youth: the controversial and colorful beginnings of hormone replacement therapy in aging. J Gerontol A Biol Sci Med Sci. 2005;60:142–7.

    Article  PubMed  Google Scholar 

  • Kanayama G, Amiaz R, Seidman S, Pope Jr HG. Testosterone supplementation for depressed men: current research and suggested treatment guidelines. Exp Clin Psychopharmacol. 2007;15:529–38.

    Article  CAS  PubMed  Google Scholar 

  • Kanayama G, Hudson JI, Pope Jr HG. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend. 2008;98:1–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kanayama G, Brower KJ, Wood RI, Hudson JI, Pope Jr HG. Anabolic-androgenic steroid dependence: an emerging disorder. Addiction. 2009;104:1966–78.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanayama G, Hudson JI, Pope Jr HG. Illicit anabolic-androgenic steroid use. Horm Behav. 2010;58:111–21.

    Article  CAS  PubMed  Google Scholar 

  • Kanayama G, Kean J, Hudson JI, Pope Jr HG. Cognitive deficits in long-term anabolic-androgenic steroid users. Drug Alcohol Depend. 2013;130:208–14.

    Article  CAS  PubMed  Google Scholar 

  • Kazlauskas R. Designer steroids. Handb Exp Pharmacol 2010;195:155–85.

    Google Scholar 

  • Kelleher S, Conway AJ, Handelsman DJ. Blood testosterone threshold for androgen deficiency symptoms. J Clin Endocrinol Metab. 2004;89:3813–7.

    Article  CAS  PubMed  Google Scholar 

  • Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. 2008;154:502–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kilbourne EJ, Moore WJ, Freedman LP, Nagpal S. Selective androgen receptor modulators for frailty and osteoporosis. Curr Opin Investig Drugs. 2007;8:821–9.

    CAS  PubMed  Google Scholar 

  • Klotz F, Garle M, Granath F, Thiblin I. Criminality among individuals testing positive for the presence of anabolic androgenic steroids. Arch Gen Psychiatry. 2006;63:1274–9.

    Article  PubMed  Google Scholar 

  • Ko EY, Siddiqi K, Brannigan RE, Sabanegh Jr ES. Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association. J Urol. 2012;187:973–8.

    Article  PubMed  Google Scholar 

  • Kohler M, Thomas A, Geyer H, Petrou M, Schanzer W, Thevis M. Confiscated black market products and nutritional supplements with non-approved ingredients analyzed in the Cologne Doping Control Laboratory 2009. Drug Test Anal. 2010;2:533–7.

    Article  CAS  PubMed  Google Scholar 

  • Kolettis PN, Purcell ML, Parker W, Poston T, Nangia AK. Medical testosterone: an iatrogenic cause of male infertility and a growing problem. Urology. 2015;85:1068–72.

    Article  PubMed  Google Scholar 

  • Kovac JR, Scovell J, Ramasamy R, Rajanahally S, Coward RM, Smith RP, et al. Men regret anabolic steroid use due to a lack of comprehension regarding the consequences on future fertility. Andrologia. 2015;47:872–8.

    Article  CAS  PubMed  Google Scholar 

  • Krug O, Thomas A, Walpurgis K, Piper T, Sigmund G, Schanzer W, et al. Identification of black market products and potential doping agents in Germany 2010–2013. Eur J Clin Pharmacol. 2014;70:1303–11.

    Article  PubMed  Google Scholar 

  • Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, Capewell S. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. Am J Epidemiol. 2005;162:764–73.

    Article  PubMed  Google Scholar 

  • Layton JB, Li D, Meier CR, Sharpless J, Sturmer T, Jick SS, et al. Testosterone lab testing and initiation in the United Kingdom and the United States, 2000–2011. J Clin Endocrinol Metab. 2014;99:835–842.

    Google Scholar 

  • Liu PY, Baker HW, Jayadev V, Zacharin M, Conway AJ, Handelsman DJ. Induction of spermatogenesis and fertility during gonadotropin treatment of gonadotropin-deficient infertile men: predictors of fertility outcome. J Clin Endocrinol Metab. 2009;94:801–8.

    Article  CAS  PubMed  Google Scholar 

  • Liverman CT, Blazer DG (Eds). Testosterone and aging: clinical research directions. Washington, DC: Institute of Medicine: The National Academies Press; 2004.

    Google Scholar 

  • Lundholm L, Kall K, Wallin S, Thiblin I. Use of anabolic androgenic steroids in substance abusers arrested for crime. Drug Alcohol Depend. 2010;111:222–6.

    Article  PubMed  Google Scholar 

  • Lundholm L, Frisell T, Lichtenstein P, Langstrom N. Anabolic androgenic steroids and violent offending: confounding by polysubstance abuse among 10,365 general population men. Addiction. 2015;110:100–8.

    Article  PubMed  Google Scholar 

  • Lunenfeld B, Mskhalaya G, Zitzmann M, Arver S, Kalinchenko S, Tishova Y, et al. Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male. 2015;18:5–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ly LP, Handelsman DJ. Empirical estimation of free testosterone from testosterone and sex hormone-binding globulin immunoassays. Eur J Endocrinol. 2005;152:471–8.

    Article  CAS  PubMed  Google Scholar 

  • Ly LP, Sartorius G, Hull L, Leung A, Swerdloff RS, Wang C, et al. Accuracy of calculated free testosterone formulae in men. Clin Endocrinol. 2010;73:382–8.

    Article  CAS  Google Scholar 

  • Medvei VC. A history of endocrinology. Lancaster: MTP Press; 1982.

    Book  Google Scholar 

  • Mendel CM. The free hormone hypothesis: a physiologically based mathematical model. Endocr Rev. 1989;10:232–74.

    Article  CAS  PubMed  Google Scholar 

  • Millar AC, Lau AN, Tomlinson G, Kraguljac A, Simel DL, Detsky AS, et al. Predicting low testosterone in aging men: a systematic review. CMAJ. 2016;188:E321–30.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller NL, Fulmer BR. Injection, ligation and transplantation: the search for the glandular fountain of youth. J Urol. 2007;177:2000–5.

    Article  PubMed  Google Scholar 

  • Mohler ML, Bohl CE, Jones A, Coss CC, Narayanan R, He Y, et al. Nonsteroidal selective androgen receptor modulators (SARMs): dissociating the anabolic and androgenic activities of the androgen receptor for therapeutic benefit. J Med Chem. 2009;52:3597–617.

    Article  CAS  PubMed  Google Scholar 

  • Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60:762–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nakhoul G, Simon JF. Anemia of chronic kidney disease: treat it, but not too aggressively. Cleve Clin J Med. 2016;83:613–24.

    Article  PubMed  Google Scholar 

  • Nieschlag E, Nieschlag S. Testosterone deficiency: a historical perspective. Asian J Androl. 2014;16:161–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nieschlag E, Vorona E. mechanisms in endocrinology: medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol. 2015;173:R47–58.

    Article  CAS  PubMed  Google Scholar 

  • Nieschlag E, Swerdloff R, Behre HM, Gooren LJ, Kaufman JM, Legros JJ, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. Int J Androl. 2005;28:125–7.

    Article  CAS  PubMed  Google Scholar 

  • Nigro N, Christ-Crain M. Testosterone treatment in the aging male: myth or reality? Swiss Med Wkly. 2012;142:w13539.

    PubMed  Google Scholar 

  • Orwoll ES. Establishing a framework – does testosterone supplementation help older men? N Engl J Med. 2016;374:682–3.

    Article  CAS  PubMed  Google Scholar 

  • Orwoll E, Lambert LC, Marshall LM, Phipps K, Blank J, Barrett-Connor E, et al. Testosterone and estradiol among older men. J Clin Endocrinol Metab. 2006;91:1336–44.

    Article  CAS  PubMed  Google Scholar 

  • Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of 500 users. Med Sci Sports Exerc. 2006;38:644–51.

    Article  CAS  PubMed  Google Scholar 

  • Piszczek J, Mamdani M, Antoniou T, Juurlink DN, Gomes T. The impact of drug reimbursement policy on rates of testosterone replacement therapy among older men. PLoS One. 2014;9:e98003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pope Jr HG, Amiaz R, Brennan BP, Orr G, Weiser M, Kelly JF, et al. Parallel-group placebo-controlled trial of testosterone gel in men with major depressive disorder displaying an incomplete response to standard antidepressant treatment. J Clin Psychopharmacol. 2010;30:126–34.

    Article  CAS  PubMed  Google Scholar 

  • Pope Jr HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35:341–75.

    Article  CAS  PubMed  Google Scholar 

  • Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101:1271–9.

    Article  CAS  PubMed  Google Scholar 

  • Rahnema CD, Crosnoe LE, Kim ED. Designer steroids – over-the-counter supplements and their androgenic component: review of an increasing problem. Andrology. 2015;3:150.

    Article  CAS  PubMed  Google Scholar 

  • Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008;100:170–83.

    Article  CAS  PubMed  Google Scholar 

  • Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321–33.

    Article  CAS  PubMed  Google Scholar 

  • Ruige JB, Mahmoud AM, De Bacquer D, Kaufman JM. Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis. Heart. 2011;97:870–5.

    Article  CAS  PubMed  Google Scholar 

  • Ruzicka L, Wettstein A. Uber die krystallische Herstellung des Testikelhormons, Testosteron (androsten-3-on-17-ol). Helv Chim Acta. 1935;18:1264–75.

    Article  CAS  Google Scholar 

  • Sabharwal G, Craig T. Recombinant human C1 esterase inhibitor for the treatment of hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE). Expert Rev Clin Immunol. 2015;11:319–27.

    Article  CAS  PubMed  Google Scholar 

  • Sagoe D, Molde H, Andreassen CS, Torsheim T, Pallesen S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol. 2014;24:383–98.

    Article  PubMed  Google Scholar 

  • Samplaski MK, Loai Y, Wong K, Lo KC, Grober ED, Jarvi KA. Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters. Fertil Steril. 2014;101:64–9.

    Article  CAS  PubMed  Google Scholar 

  • Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, et al. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010;95:s1–s66.

    Article  CAS  PubMed  Google Scholar 

  • Sartorius G, Ly LP, Sikaris K, McLachlan R, Handelsman DJ. Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem. 2009;46:137–43.

    Article  CAS  PubMed  Google Scholar 

  • Sekera MH, Ahrens BD, Chang YC, Starcevic B, Georgakopoulos C, Catlin DH. Another designer steroid: discovery, synthesis, and detection of ‘madol’ in urine. Rapid Commun Mass Spectrom. 2005;19:781–4.

    Article  CAS  PubMed  Google Scholar 

  • Sengoopta C. ‘Dr Steinach coming to make old young!’: sex glands, vasectomy and the quest for rejuvenation in the roaring twenties. Endeavour. 2003;27:122–6.

    Article  PubMed  Google Scholar 

  • Shores MM, Kivlahan DR, Sadak TI, Li EJ, Matsumoto AM. A randomized, double-blind, placebo-controlled study of testosterone treatment in hypogonadal older men with subthreshold depression (dysthymia or minor depression). J Clin Psychiatry. 2009;70:1009–16.

    Article  CAS  PubMed  Google Scholar 

  • Snyder PJ, Peachey H, Berlin JA, Hannoush P, Haddad G, Dlewati A, et al. Effects of testosterone replacement in hypogonadal men. J Clin Endocrinol Metab. 2000;85:2670–7.

    CAS  PubMed  Google Scholar 

  • Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374:611–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Spitzer M, Basaria S, Travison TG, Davda MN, Paley A, Cohen B, et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: a parallel, randomized trial. Ann Intern Med. 2012;157:681–91.

    Article  PubMed  Google Scholar 

  • Starcevic B, Ahrens BD, Butch AW. Detection of the selective androgen receptor modulator S-4 (Andarine) in a doping control sample. Drug Test Anal. 2013;5:377–9.

    Article  CAS  PubMed  Google Scholar 

  • Swerdlow AJ, Higgins CD, Schoemaker MJ, Wright AF, Jacobs PA. Mortality in patients with Klinefelter syndrome in Britain: a cohort study. J Clin Endocrinol Metab. 2005;90:6516–22.

    Article  CAS  PubMed  Google Scholar 

  • Taylor R, Dobson A, Mirzaei M. Contribution of changes in risk factors to the decline of coronary heart disease mortality in Australia over three decades. Eur J Cardiovasc Prev Rehabil. 2006;13:760–8.

    Article  PubMed  Google Scholar 

  • Thevis M, Geyer H, Thomas A, Schanzer W. Trafficking of drug candidates relevant for sports drug testing: detection of non-approved therapeutics categorized as anabolic and gene doping agents in products distributed via the Internet. Drug Test Anal. 2011;3:331–6.

    Article  CAS  PubMed  Google Scholar 

  • Thiblin I, Lindquist O, Rajs J. Cause and manner of death among users of anabolic androgenic steroids. J Forensic Sci. 2000;45:16–23.

    Article  CAS  PubMed  Google Scholar 

  • Thiblin I, Garmo H, Garle M, Holmberg L, Byberg L, Michaelsson K, et al. Anabolic steroids and cardiovascular risk: a national population-based cohort study. Drug Alcohol Depend. 2015;152:87–92.

    Article  CAS  PubMed  Google Scholar 

  • Travison TG, Shackelton R, Araujo AB, Hall SA, Williams RE, Clark RV, et al. The natural history of symptomatic androgen deficiency in men: onset, progression, and spontaneous remission. J Am Geriatr Soc. 2008;56:831–9.

    Article  PubMed  Google Scholar 

  • Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999;353:1547–57.

    Article  CAS  PubMed  Google Scholar 

  • Turani H, Levi J, Zevin D, Kessler E. Hepatic lesions in patients on anabolic androgenic therapy. Isr J Med Sci. 1983;19:332–7.

    CAS  PubMed  Google Scholar 

  • Vanberg P, Atar D. Androgenic anabolic steroid abuse and the cardiovascular system. Handb Exp Pharmacol. 2010;195:411–57.

    Google Scholar 

  • Voronoff S. Rejuvenation by grafting. London: George Allen & Unwin Ltd; 1925.

    Google Scholar 

  • Walsh TJ, Shores MM, Fox AE, Moore KP, Forsberg CW, Kinsey CE, et al. Recent trends in testosterone testing, low testosterone levels, and testosterone treatment among Veterans. Andrology. 2015;3:287–92.

    Article  CAS  PubMed  Google Scholar 

  • Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. J Androl. 2009;30:1–9.

    Article  PubMed  Google Scholar 

  • Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363:123–35.

    Article  CAS  PubMed  Google Scholar 

  • Wyndham D. Versemaking and lovemaking – W. B. Yeats’ “strange second puberty”: Norman Haire and the Steinach rejuvenation operation. J Hist Behav Sci. 2003;39:25–50.

    Article  PubMed  Google Scholar 

  • Xu L, Freeman G, Cowling BJ, Schooling CM. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med. 2013;11:108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zitzmann M, Faber S, Nieschlag E. Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab. 2006;91:4335–43.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ANZAC Research Institute, University of Sydney, 2139, Sydney, Australia

    David J. Handelsman

  2. Andrology Department, Concord Hospital, Sydney, Australia

    David J. Handelsman

Authors
  1. David J. Handelsman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David J. Handelsman .

Editor information

Editors and Affiliations

  1. Dept. of Biomedicine, Metabolism and Neural Sciences, University of Modena and Reggio Emilia, Modena, Modena, Italy

    Manuela Simoni

  2. Dept. of Surgery and Cancer, Imperial College London, London, United Kingdom

    Ilpo Huhtaniemi

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Her Majesty the Queen in Right of Australia

About this entry

Cite this entry

Handelsman, D.J. (2017). Use, Misuse, and Abuse of Androgens. In: Simoni, M., Huhtaniemi, I. (eds) Endocrinology of the Testis and Male Reproduction. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-29456-8_44-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29456-8_44-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29456-8

  • Online ISBN: 978-3-319-29456-8

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation