Position Statements

Use and Misuse of Androgens

• Introduction
• Key Messages
• Table 1 - Use, Misuse and Abuse of Androgens
• Table 2 - Bichemical Evaluation of the Diagnosis of Androgen Deficiency in Men with Climical Features Consistent with Hypogonadism

Androgens are hormones based on the structure of testosterone, the major male sex hormone. The main medical use of androgens is for androgen replacement therapy in patients with established androgen deficiency. Androgen deficiency occurs in 5 out of 1000 men and is caused by either testicular or hypothalamic-pituitary disease. The diagnosis may easily be missed, denying patients simple and effective medical treatment. The diagnosis of androgen deficiency involves recognising appropriate clinical features with confirmation by hormonal measurements (FSH, LH and testosterone.). In men with features suggestive of androgen deficiency this diagnosis is unlikely with testis volume > 20 ml without atrophy, and with a plasma testosterone consistently > 18 nmol/L. In men presenting with erectile dysfunction and no clinical evidence of hypogonadism the diagnosis of androgen deficiency is very unlikely if the plasma testosterone is consistently > 8 nmol/L. When the diagnosis is not clear, referral to an experienced clinical endocrinologist is recommended.

Extension of the indication for testosterone therapy to partial androgen deficiency remains to be fully evaluated for safety and efficacy. These potential indications include ageing in men, apparent androgen deficiency secondary to chronic disease. These areas remain suitable for carefully monitored clinical research.

Absolute contra-indications to androgen therapy are prostate and breast cancer. Screening of men on androgen replacement therapy for cardiovascular and prostate disease should be comparable to that of men of similar age.

Misuse of androgens (no acceptable medical indication) includes male infertility, male impotence without proven androgen deficiency, and "male menopause." There is no evidence at present that the modest decrease of circulating blood testosterone commencing in mid-life has any clinical significance. The risks and benefits of androgen therapy in this setting is being evaluated but no firm conclusions are yet available. Promotion of androgen therapy for ‘male menopause" is based on inadequate evidence and is inappropriate.

The ESA endorses the source document for this position statement, "Use, misuse and abuse of androgens, Conway et al. (Submitted for publication).

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