Use, Misuse, and Abuse of Androgens

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.