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Androgens and testosterone replacement therapy

Aug. 30, 2019

The link between hormonal disorders and the abused of anabolic steroids and testosterone is proved by a number of scientific studies. [1, 2, 5]. In men, the body’s hormone production decreases. By contrast, the amount of testosterone in women rises higher than the inherent level. This induces an increase in masculine features: for example, decreased breast size, the deepening of the voice, and the increased growth of body hair. In men, the end or reduction of hormone production typically leads to sexual and gender issues, mood issues, blood glucose disorders, and thyroid dysfunctions. [6]

Testosterone replacement therapy mainly consists of pharmacological treatments administered for the replacement of testosterone production decreasing with age. In men, the level of serum total testosterone provides a reliable picture of testosterone production dysfunctions.  In young, adult men, the serum testosterone reference value is 10–35 nmol/l. In elderly men, the minimum reference limit is slightly lower. Low levels (less than 8 nmol/l) combined with clinical symptoms indicate testosterone deficiency. [7]. Clinical symptoms include weakened libido and virility, erectile dysfunction, decreased muscle mass and strength, increased body fat content, deterioration of bone density, as well as psychological symptoms like depression [7].

Is it replacement therapy or self-imposed treatment?

Testosterone treatment experimentation should be preceded by appropriate diagnostic analyses, ruling out any diseases. The serum testosterone should be determined reliably, for example, through liquid chromatography-mass spectrometry. The recommendation is that this test should be repeated on several morning samples [7]. Testosterone replacement therapy is not without risks. It can increase the risk of cardiovascular diseases, halt the body’s testosterone production or delay the treatment of an actual organic disease if the cause of the low testosterone is not identified. However, these risks do not apply to men who are appropriately found to have low testosterone [4].

Self-imposed replacement treatment may occur in conjunction with fitness doping. Typically, the reason for the treatment is the body’s failure to produce testosterone. Both the testosterone and the necessary instruments are often ordered illegally online or acquired through some other illegal channel.  Illegally acquired substances may contain impurities and replacement therapy without the supervision of a medical practitioner is never without risks. Medical treatment always takes into account any heart, kidney or liver diseases, as well as any other conditions that may affect the safety of the replacement therapy. Self-imposed replacement treatment is linked to the risks of injection as well. A faulty method of administering the injection or the wrong injection site can have adverse health consequences, such as infections or abscesses.  Beginning testosterone replacement therapy should always be assessed on a case-by-case basis together with a medical practitioner.

Testosterone replacement therapy numbers on the rise

According to the statistics of the Social Insurance Institution of Finland (KELA), the prescriptions of medical practitioners for testosterone replacement therapy more than doubled in number (approx. 32,000 → approx. 74,000) between 2008 and 2018 [3]. Some of the factors affecting this growth in replacement therapy may include the improved identification of low testosterone and increased knowledge about the effects of testosterone deficiency. According to Metso [4], one significant factor behind the increase in replacement therapy consists of the abstinence symptoms associated with discontinued doping substance use. Low testosterone induced by doping substance experimentation is generally restored on its own without any need for replacement therapy. In some men, however, the extended weakening of the libido, fatigue or infertility may follow.

Ville Leskinen
Master of Health Sciences (MHSc)

[1] Burger HG. Androgen production in women. Fertil Steril. 2002;77: S3–5
[2] Kadi F. Cellular and molecular mechanisms responsible for the action of testosterone on human skeletal muscle. A basis for illegal performance enhancement. Br J Pharmacol. 2008;154(3):522–528
[3] Testosteronin saajat ja reseptitiedot. 2019. Kelasto-raportti.
[4] Metso S. Testosteronikokeilujen aiheuttamat haitat ja kulut kuriin. Pääkirjoitus Lääkärilehdessä 3/2016.
[5] Perheentupa A, Rönkä R. Testosteronihoito vaarantaa siittiötuotannon. Duodecim. 2009; 125:821–3
[6] Sarikaya H, Peters C, Schulz T, Schönfelder, Michna H. 2007. Biomedical Side Effects of Doping. International Symposium Munich, Germany. “Harmonising the Knowledge About Biomedical Side Effects of Doping” -Project of the European Union
[7] Vehkavaara S. Ikääntyvien miesten testosteronikorvaushoito. Sosiaali- ja terveysministeriö.