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Testosterone Misuse and Abuse

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Testosterone

Abstract

Beyond prescribing testosterone for its only valid indication, testosterone replacement therapy for pathological hypogonadism, there increasing prevalence of testosterone misuse and abuse in most countries. Testosterone misuse is when testosterone is prescribed for non-valid medical indications such as male infertility, sexual dysfunction (in men without pathological hypogonadism), but most commonly for anti-aging. Androgen abuse is the non-prescription use of testosterone or a synthetic androgen unrelated to medical indications but rather for doping, body building, or other recreational, cosmetic, or occupational reasons.

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References

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

    CAS  PubMed Central  Google Scholar 

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

    CAS  Google Scholar 

  3. 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.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  6. 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.

    Google Scholar 

  7. 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 Physiologische Chemie. 1935;233:281–2.

    CAS  Google Scholar 

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

    Google Scholar 

  9. 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.

    CAS  Google Scholar 

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

    Google Scholar 

  11. 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.

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  13. Brambilla DJ, O’Donnell AB, Matsumoto AM, McKinlay JB. Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clin Endocrinol (Oxf). 2007;67:853–62.

    CAS  Google Scholar 

  14. Nieschlag E, Nieschlag S, Behre HM. Lifespan and testosterone. Nature. 1993;366:215.

    CAS  Google Scholar 

  15. 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; 2011. p. 372–407.

    Google Scholar 

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

    Google Scholar 

  17. 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.

    PubMed Central  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  20. 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.

    Google Scholar 

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

    Google Scholar 

  22. Gan EH, Pattman S, Pearce S, Quinton R. Many men are receiving unnecessary testosterone prescriptions. BMJ. 2012;345:e5469.

    Google Scholar 

  23. 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;19:835.

    Google Scholar 

  24. 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.

    CAS  Google Scholar 

  25. 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.

    CAS  Google Scholar 

  26. 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.

    CAS  Google Scholar 

  27. 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.

    Google Scholar 

  28. Fennell C, Sartorius G, Ly LP, Turner L, Liu PY, Conway AJ, et al. Randomized cross-over clinical trial of injectable vs. implantable depot testosterone for maintenance of testosterone replacement therapy in androgen deficient men. Clin Endocrinol (Oxf). 2010;73:102–9.

    CAS  Google Scholar 

  29. Perls T, Handelsman DJ. Disease mongering of age-associated declines in testosterone and growth hormone levels. J Am Geriatr Soc. 2015;63:809–11.

    Google Scholar 

  30. Handelsman DJ, Sikaris K, Ly LP. Estimating age-specific trends in circulating testosterone and sex hormone-binding globulin in males and females across the lifespan. Ann Clin Biochem. 2016;53:377.

    CAS  Google Scholar 

  31. Handelsman DJ, Yeap B, Flicker L, Martin S, Wittert GA, Ly LP. Age-specific population centiles for androgen status in Australian men. Eur J Endocrinol. 2015;173:809.

    CAS  Google Scholar 

  32. Kaufman JM, Vermeulen A. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev. 2005;26:833–76.

    CAS  Google Scholar 

  33. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86:724–31.

    CAS  Google Scholar 

  34. Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002;87:589–98.

    CAS  Google Scholar 

  35. Camacho EM, Huhtaniemi IT, O’Neill TW, Finn JD, Pye SR, Lee DM, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur J Endocrinol. 2013;168:445–55.

    CAS  Google Scholar 

  36. Sartorius G, Spasevska S, Idan A, Turner L, Forbes E, Zamojska A, et al. Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self-reporting very good health: the healthy man study. Clin Endocrinol (Oxf). 2012;77:755–63.

    CAS  Google Scholar 

  37. Ng KK, Donat R, Chan L, Lalak A, Di Pierro I, Handelsman DJ. Sperm output of older men. Hum Reprod. 2004;19:1811–5.

    CAS  Google Scholar 

  38. Sartorius GA, Nieschlag E. Paternal age and reproduction. Hum Reprod Update. 2010;16:65–79.

    Google Scholar 

  39. Travison TG, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007;92:549–55.

    CAS  Google Scholar 

  40. Shi Z, Araujo AB, Martin S, O’Loughlin P, Wittert GA. Longitudinal changes in testosterone over five years in community-dwelling men. J Clin Endocrinol Metab. 2013;98:3289–97.

    CAS  Google Scholar 

  41. Grossmann M. Low testosterone in men with type 2 diabetes: significance and treatment. J Clin Endocrinol Metab. 2011;96:2341–53.

    CAS  Google Scholar 

  42. Rastrelli G, Carter EL, Ahern T, Finn JD, Antonio L, O’Neill TW, et al. Development of and recovery from secondary hypogonadism in aging men: prospective results from the EMAS. J Clin Endocrinol Metab. 2015;100:3172–82.

    CAS  Google Scholar 

  43. 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  Google Scholar 

  44. Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: a randomized controlled trial. J Clin Endocrinol Metab. 2015;100:2956–62.

    CAS  Google Scholar 

  45. Gianatti EJ, Dupuis P, Hoermann R, Zajac JD, Grossmann M. Effect of testosterone treatment on constitutional and sexual symptoms in men with type 2 diabetes in a randomized, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2014;99:3821–8.

    CAS  Google Scholar 

  46. Basaria S, Travison TG, Alford D, Knapp PE, Teeter K, Cahalan C, et al. Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial. Pain. 2015;156:280–8.

    CAS  PubMed Central  Google Scholar 

  47. Bhasin S, Woodhouse L, Casaburi R, Singh AB, Mac RP, Lee M, et al. Older men are as responsive as young men to the anabolic effects of graded doses of testosterone on the skeletal muscle. J Clin Endocrinol Metab. 2005;90:678–88.

    CAS  Google Scholar 

  48. Bhasin S, Storer TW, Berman N, Yarasheski KE, Clevenger B, Phillips J, et al. Testosterone replacement increases fat-free mass and muscle size in hypogonadal men. J Clin Endocrinol Metab. 1997;82:407–13.

    CAS  Google Scholar 

  49. Finkelstein JS, Lee H, Burnett-Bowie SA, Pallais JC, Yu EW, Borges LF, et al. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013;369:1011–22.

    CAS  PubMed Central  Google Scholar 

  50. Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med. 1996;335:1–7.

    CAS  Google Scholar 

  51. Snyder PJ, Peachey H, Hannoush P, Berlin JA, Loh L, Lenrow DA, et al. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab. 1999;84:2647–53.

    CAS  Google Scholar 

  52. Page ST, Amory JK, Bowman FD, Anawalt BD, Matsumoto AM, Bremner WJ, et al. Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. 2005;90:1502–10.

    CAS  Google Scholar 

  53. Snyder PJ, Peachey H, Hannoush P, Berlin JA, Loh L, Holmes JH, et al. Effect of testosterone treatment on bone mineral density in men over 65 years of age. J Clin Endocrinol Metab. 1999;84:1966–72.

    CAS  Google Scholar 

  54. Amory JK, Watts NB, Easley KA, Sutton PR, Anawalt BD, Matsumoto AM, et al. Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. J Clin Endocrinol Metab. 2004;89:503–10.

    CAS  Google Scholar 

  55. Tracz MJ, Sideras K, Bolona ER, Haddad RM, Kennedy CC, Uraga MV, et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab. 2006;91:2011–6.

    CAS  Google Scholar 

  56. Buvat J, Lemaire A. Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy. J Urol. 1997;158:1764–7.

    CAS  Google Scholar 

  57. Corona G, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014;11:1577–92.

    CAS  Google Scholar 

  58. Bolona ER, Uraga MV, Haddad RM, Tracz MJ, Sideras K, Kennedy CC, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82:20–8.

    CAS  Google Scholar 

  59. 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.

    CAS  Google Scholar 

  60. 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 (Oxf). 2004;61:382–6.

    CAS  Google Scholar 

  61. 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.

    Google Scholar 

  62. 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.

    CAS  Google Scholar 

  63. Basaria S, Harman SM, Travison TG, Hodis H, Tsitouras P, Budoff M, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial. JAMA. 2015;314:570–81.

    CAS  Google Scholar 

  64. Cherrier MM, Asthana S, Plymate S, Baker L, Matsumoto AM, Peskind E, et al. Testosterone supplementation improves spatial and verbal memory in healthy older men. Neurology. 2001;57:80–8.

    CAS  Google Scholar 

  65. Cherrier MM, Anderson K, Shofer J, Millard S, Matsumoto AM. Testosterone treatment of men with mild cognitive impairment and low testosterone levels. Am J Alzheimers Dis Other Demen. 2015;30:421–30.

    CAS  Google Scholar 

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

    Google Scholar 

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

    CAS  Google Scholar 

  68. 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  Google Scholar 

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

    CAS  Google Scholar 

  70. 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.

    CAS  Google Scholar 

  71. Pound RW, McLaren RH, Robertson J. The independent commission report #12015. 09/11/15; 2015. Available from: https://wada-main-prod.s3.amazonaws.com/resources/files/wada_independent_commission_report_1_en.pdf.

    Google Scholar 

  72. Ryan AJ. Anabolic steroids are fool’s gold. Fed Proc. 1981;40:2682–8.

    CAS  Google Scholar 

  73. Elashoff JD, Jacknow AD, Shain SG, Braunstein GD. Effects of anabolic-androgenic steroids on muscular strength. Ann Intern Med. 1991;115:387–93.

    CAS  Google Scholar 

  74. 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.

    CAS  Google Scholar 

  75. 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.

    CAS  Google Scholar 

  76. 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.

    CAS  Google Scholar 

  77. 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. 2015;7:609.

    CAS  Google Scholar 

  78. 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.

    Google Scholar 

  79. 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.

    CAS  Google Scholar 

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

    CAS  PubMed Central  Google Scholar 

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

    CAS  Google Scholar 

  82. Kazlauskas R. Designer steroids. Handb Exp Pharmacol. 2010; (195):155–85.

    Google Scholar 

  83. 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.

    CAS  Google Scholar 

  84. 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.

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  86. 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.

    CAS  Google Scholar 

  87. 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.

    CAS  Google Scholar 

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

    CAS  PubMed Central  Google Scholar 

  89. 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.

    Google Scholar 

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

    CAS  Google Scholar 

  91. 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.

    CAS  PubMed Central  Google Scholar 

  92. 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.

    CAS  Google Scholar 

  93. WADA. Anti-doping testing figures - laboratory report. Montreal, QC: WADA; 2014.

    Google Scholar 

  94. Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. Subst Abuse Treat Prev Policy. 2014;9:27.

    PubMed Central  Google Scholar 

  95. 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.

    Google Scholar 

  96. 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.

    CAS  Google Scholar 

  97. Kanayama G, Boynes M, Hudson JI, Field AE, Pope Jr HG. Anabolic steroid abuse among teenage girls: an illusory problem? Drug Alcohol Depend. 2007;88:156–62.

    Google Scholar 

  98. Buckley WE, Yesalis CE, Freidl KE, Anderson WA, Streit AL, Wright JE. Estimated prevalence of anabolic steroid use among male high school students. JAMA. 1988;260:3441–5.

    CAS  Google Scholar 

  99. Johnston LD, O’Malley P, Bachman JG, Schulenberg J, Miech R. Monitoring the future national survey results on drug use, 1975–2013. Ann Arbor, MI: Institute for Social Research, University of Michigan; 2014.

    Google Scholar 

  100. 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. 2009;23:S1–59.

    Google Scholar 

  101. Bolding G, Sherr L, Maguire M, Elford J. HIV risk behaviours among gay men who use anabolic steroids. Addiction. 1999;94:1829–35.

    CAS  Google Scholar 

  102. Blashill AJ, Safren SA. Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys. Pediatrics. 2014;133:469–75.

    PubMed Central  Google Scholar 

  103. Handelsman DJ. Clinical review: the rationale for banning human chorionic gonadotropin and estrogen blockers in sport. J Clin Endocrinol Metab. 2006;91:1646–53.

    CAS  Google Scholar 

  104. Handelsman DJ, Goebel C, Idan A, Jimenez M, Trout G, Kazlauskas R. Effects of recombinant human LH and hCG on serum and urine LH and androgens in men. Clin Endocrinol (Oxf). 2009;71:417–28.

    CAS  Google Scholar 

  105. Goebel C, Howe CJ, Ho KK, Nelson A, Kazlauskas R, Trout GJ. Screening for testosterone abuse in male athletes using the measurement of urinary LH, a revision of the paradigm. Drug Test Anal. 2009;1:511–7.

    CAS  Google Scholar 

  106. Healy DL, Evans J. Creutzfeldt-Jakob disease after pituitary gonadotrophins. Br Med J. 1993;307:517–8.

    CAS  Google Scholar 

  107. Handelsman DJ, Idan A, Grainger J, Goebel C, Turner L, Conway AJ. Detection and effects on serum and urine steroid and LH of repeated GnRH analog (leuprolide) stimulation. J Steroid Biochem Mol Biol. 2014;141:113–20.

    CAS  Google Scholar 

  108. Santen RJ, Brodie H, Simpson ER, Siiteri PK, Brodie A. History of aromatase: saga of an important biological mediator and therapeutic target. Endocr Rev. 2009;30:343–75.

    CAS  Google Scholar 

  109. Maximov PY, Lee TM, Jordan VC. The discovery and development of selective estrogen receptor modulators (SERMs) for clinical practice. Curr Clin Pharmacol. 2013;8:135–55.

    CAS  PubMed Central  Google Scholar 

  110. Handelsman DJ. Indirect androgen doping by oestrogen blockade in sports. Br J Pharmacol. 2008;154:598–605.

    CAS  PubMed Central  Google Scholar 

  111. Hall RC, Hall RC. Abuse of supraphysiologic doses of anabolic steroids. South Med J. 2005;98:550–5.

    Google Scholar 

  112. Ayotte C. Detecting the administration of endogenous anabolic androgenic steroids. Handb Exp Pharmacol. 2010; (195):77–98.

    Google Scholar 

  113. Xue Y, Sun D, Daly A, Yang F, Zhou X, Zhao M, et al. Adaptive evolution of UGT2B17 copy-number variation. Am J Hum Genet. 2008;83:337–46.

    CAS  PubMed Central  Google Scholar 

  114. Schulze JJ, Lundmark J, Garle M, Skilving I, Ekstrom L, Rane A. Doping test results dependent on genotype of uridine diphospho-glucuronosyl transferase 2B17, the major enzyme for testosterone glucuronidation. J Clin Endocrinol Metab. 2008;93:2500–6.

    CAS  Google Scholar 

  115. Vernec AR. The Athlete Biological Passport: an integral element of innovative strategies in antidoping. Br J Sports Med. 2014;48:817–9.

    Google Scholar 

  116. Sottas PE, Saudan C, Schweizer C, Baume N, Mangin P, Saugy M. From population- to subject-based limits of T/E ratio to detect testosterone abuse in elite sports. Forensic Sci Int. 2008;174:166–72.

    CAS  Google Scholar 

  117. Perry PJ, MacIndoe JH, Yates WR, Scott SD, Holman TL. Detection of anabolic steroid administration: ratio of urinary testosterone to epitestosterone vs the ratio of urinary testosterone to luteinizing hormone. Clin Chem. 1997;43:731–5.

    CAS  Google Scholar 

  118. Singh GK, Jimenez M, Newman R, Handelsman DJ. Immunoreactive LH in long-term frozen human urine samples. Drug Test Anal. 2014;6:336.

    CAS  Google Scholar 

  119. Cawley A, Collins M, Kazlauskas R, Handelsman DJ, Heywood R, Longworth M, et al. Stable isotope ratio profiling of testosterone preparations. Drug Test Anal. 2010;2:557–67.

    CAS  Google Scholar 

  120. Piper T, Emery C, Thomas A, Saugy M, Thevis M. Combination of carbon isotope ratio with hydrogen isotope ratio determinations in sports drug testing. Anal Bioanal Chem. 2013;405:5455–66.

    CAS  Google Scholar 

  121. Piper T, Thomas A, Thevis M, Saugy M. Investigations on hydrogen isotope ratios of endogenous urinary steroids: reference-population-based thresholds and proof-of-concept. Drug Test Anal. 2012;4:717–27.

    CAS  Google Scholar 

  122. Nielen MW, Bovee TF, van Engelen MC, Rutgers P, Hamers AR, van Rhijn JH, et al. Urine testing for designer steroids by liquid chromatography with androgen bioassay detection and electrospray quadrupole time-of-flight mass spectrometry identification. Anal Chem. 2006;78:424–31.

    CAS  Google Scholar 

  123. Bauer A, Rataj F, Zierau O, Anielski P, Grosse J, Parr MK, et al. Characterization of identity, metabolism and androgenic activity of 17-hydroxyandrosta-3,5-diene by GC-MS and a yeast transactivation system. Arch Toxicol. 2012;86:1873–84.

    CAS  Google Scholar 

  124. McRobb L, Handelsman DJ, Kazlauskas R, Wilkinson S, McLeod MD, Heather AK. Structure-activity relationships of synthetic progestins in a yeast-based in vitro androgen bioassay. J Steroid Biochem Mol Biol. 2008;110:39–47.

    CAS  Google Scholar 

  125. Geyer H, Schanzer W, Thevis M. Anabolic agents: recent strategies for their detection and protection from inadvertent doping. Br J Sports Med. 2014;48:820–6.

    Google Scholar 

  126. Deshmukh N, Hussain I, Barker J, Petroczi A, Naughton DP. Analysis of anabolic steroids in human hair using LC-MS/MS. Steroids. 2010;75:710–4.

    CAS  Google Scholar 

  127. Deshmukh NI, Barker J, Petroczi A, Naughton DP. Detection of testosterone and epitestosterone in human hair using liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal. 2012;67–68:154–8.

    Google Scholar 

  128. Kintz P. Testing for anabolic steroids in hair: a review. Leg Med (Tokyo). 2003;5 Suppl 1:S29–33.

    CAS  Google Scholar 

  129. Stenman UH, Hotakainen K, Alfthan H. Gonadotropins in doping: pharmacological basis and detection of illicit use. Br J Pharmacol. 2008;154:569–83.

    CAS  PubMed Central  Google Scholar 

  130. Kuuranne T, Ahola L, Pussinen C, Leinonen A. Analysis of human chorionic gonadotropin (hCG): application of routine immunological methods for initial testing and confirmation analysis in doping control. Drug Test Anal. 2013;5:614–8.

    CAS  Google Scholar 

  131. Woldemariam GA, Butch AW. Immunoextraction-tandem mass spectrometry method for measuring intact human chorionic gonadotropin, free beta-subunit, and beta-subunit core fragment in urine. Clin Chem. 2014;60:1089–97.

    CAS  PubMed Central  Google Scholar 

  132. Lund H, Snilsberg AH, Paus E, Halvorsen TG, Hemmersbach P, Reubsaet L. Sports drug testing using immuno-MS: clinical study comprising administration of human chorionic gonadotropin to males. Anal Bioanal Chem. 2013;405:1569–76.

    CAS  Google Scholar 

  133. Sandella B, Hartmann B, Berkson D, Hong E. Testicular conditions in athletes: torsion, tumors, and epididymitis. Curr Sports Med Rep. 2012;11:92–5.

    Google Scholar 

  134. United Kingdom Testicular Cancer Study Group. Aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility, and exercise. BMJ. 1994;308:1393–9.

    Google Scholar 

  135. Gallagher RP, Huchcroft S, Phillips N, Hill GB, Coldman AJ, Coppin C, et al. Physical activity, medical history, and risk of testicular cancer (Alberta and British Columbia, Canada). Cancer Causes Control. 1995;6:398–406.

    CAS  Google Scholar 

  136. Pope Jr HG, Wood R, 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.

    CAS  Google Scholar 

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

    Google Scholar 

  138. Handelsman DJ. Androgen misuse and abuse. Best Pract Res Clin Endocrinol Metab. 2011;25:377–89.

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  140. Bachman E, Feng R, Travison T, Li M, Olbina G, Ostland V, et al. Testosterone suppresses hepcidin in men: a potential mechanism for testosterone-induced erythrocytosis. J Clin Endocrinol Metab. 2010;95:4743–7.

    CAS  PubMed Central  Google Scholar 

  141. 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.

    CAS  PubMed Central  Google Scholar 

  142. Ruige JB, Ouwens DM, Kaufman JM. Beneficial and adverse effects of testosterone on the cardiovascular system in men. J Clin Endocrinol Metab. 2013;98:4300–10.

    CAS  Google Scholar 

  143. 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.

    CAS  Google Scholar 

  144. 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.

    PubMed Central  Google Scholar 

  145. Liu PY, Death AK, Handelsman DJ. Androgens and cardiovascular disease. Endocr Rev. 2003;24:313–40.

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  147. Velazquez I, Alter BP. Androgens and liver tumors: Fanconi’s anemia and non-Fanconi’s conditions. Am J Hematol. 2004;77:257–67.

    Google Scholar 

  148. Socas L, Zumbado M, Perez-Luzardo O, Ramos A, Perez C, Hernandez JR, et al. Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature. Br J Sports Med. 2005;39:e27.

    CAS  PubMed Central  Google Scholar 

  149. Sanchez-Osorio M, Duarte-Rojo A, Martinez-Benitez B, Torre A, Uribe M. Anabolic-androgenic steroids and liver injury. Liver Int. 2008;28:278–82.

    Google Scholar 

  150. 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.

    CAS  PubMed Central  Google Scholar 

  151. Corrigan B. Anabolic steroids and the mind. Med J Aust. 1996;165:222–6.

    CAS  Google Scholar 

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

    Google Scholar 

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

    PubMed Central  Google Scholar 

  154. Pagonis TA, Angelopoulos NV, Koukoulis GN, Hadjichristodoulou CS. Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. Eur Psychiatry. 2006;21:551–62.

    Google Scholar 

  155. Pope Jr HG, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: a randomized controlled trial. Arch Gen Psychiatry. 2000;57:133–40. discussion 55-6.

    CAS  Google Scholar 

  156. Pope Jr HG, Katz DL. Homicide and near-homicide by anabolic steroid users. J Clin Psychiatry. 1990;51:28–31.

    Google Scholar 

  157. Pope Jr HG, Kouri EM, Powell KF, Campbell C, Katz DL. Anabolic-androgenic steroid use among 133 prisoners. Compr Psychiatry. 1996;37:322–7.

    Google Scholar 

  158. Isacsson G, Garle M, Ljung EB, Asgard U, Bergman U. Anabolic steroids and violent crime--an epidemiological study at a jail in Stockholm. Sweden Compr Psychiatry. 1998;39:203–5.

    CAS  Google Scholar 

  159. Klotz F, Petersson A, Hoffman O, Thiblin I. The significance of anabolic androgenic steroids in a Swedish prison population. Compr Psychiatry. 2010;51:312–8.

    Google Scholar 

  160. Lood Y, Eklund A, Garle M, Ahlner J. Anabolic androgenic steroids in police cases in Sweden 1999-2009. Forensic Sci Int. 2012;219:199–204.

    CAS  Google Scholar 

  161. van Amsterdam J, Opperhuizen A, Hartgens F. Adverse health effects of anabolic-androgenic steroids. Regul Toxicol Pharmacol. 2010;57:117–23.

    Google Scholar 

  162. Goldberg L, Elliot DL, Clarke GN, MacKinnon DP, Moe E, Zoref L, et al. Effects of a multidimensional anabolic steroid prevention intervention: the Adolescents Training and Learning to Avoid Steroids (ATLAS) program. JAMA. 1996;276:1555–62.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Andrology Department, Concord Hospital, Sydney, NSW, 2139, Australia

    Rakesh Iyer

  2. ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, 2139, Australia

    David J. Handelsman

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    Alexandre Hohl

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Iyer, R., Handelsman, D.J. (2017). Testosterone Misuse and Abuse. In: Hohl, A. (eds) Testosterone. Springer, Cham. https://doi.org/10.1007/978-3-319-46086-4_19

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