Issues Magazine

Use and Abuse of Androgens in Australia

By Andrology Australia

Use, misuse and abuse of androgens are not well understood by the public, and have serious implications for young men in particular.

Recent news reports of sports stars abusing “performance-enhancing” drugs, the boom in illegal imports of synthetic androgens (“anabolic steroids”) and growth hormones and, most recently, a new trend of “steroid vacations” (where men go overseas to buy drugs not available in Australia), have all brought to light some important health issues.

Androgens and the Male Body

Androgens are male sex hormones, mainly testosterone, that play a key role in reproductive and sexual function. Testosterone is important for the physical changes that happen during male puberty such as development of the penis and testes, and for the features typical of adult men such as facial and body hair.

Testosterone acts on cells in the testes to make sperm, and it is important for overall good health. It helps the growth of bones and muscles, and it affects mood, libido and certain aspects of mental ability.

There are different forms of testosterone and synthetic androgens, commonly misnamed anabolic steroids. In Australia it is illegal to use androgens for non-medical reasons. However, illegal androgen use has become more widespread in recent years. Recreational body-builders and others increasingly use androgens with the aim of developing a lean, muscular appearance.

Medical Use of Testosterone

Men or adolescents who have a disease of the pituitary gland or testis that causes androgen deficiency (low testosterone) are prescribed testosterone by the doctor to bring their testosterone levels back to normal. Men with clinically proven androgen deficiency (diagnosed in about one in 200 men) can benefit greatly from testosterone replacement. However, because androgen deficiency has symptoms that can appear similar to other conditions, it is not easily diagnosed, so some men are not getting proper treatment with testosterone therapy.

Medical “Misuse” of Androgens

The medical misuse of androgens is the prescribing of testosterone to men who do not have proven androgen deficiency arising from reproductive system disorders.

An analysis of Australian Pharmaceutical Benefits Scheme data from 1992 to 2010 showed that spending on prescribed testosterone in Australia has increased more than ninefold in the past two decades. This is likely to be due to prescribing for conditions other than androgen deficiency: testosterone prescribed to ageing men who want to feel “healthier”, to men with infertility and to those with erectile dysfunction. Testosterone treatment has not been shown to work well or be safe in these instances.

Androgen “Abuse”

Androgen abuse involves taking massive doses of androgens, often from illegal sources, which might include androgens used by vets for animal treatment or illegally manufactured or counterfeit androgens with unknown ingredients. Large doses of androgens are often taken to improve sporting ability and to cause changes to physical appearance such as increasing muscle size and strength.

Illegal androgen users often combine the hormones with other performance-enhancing or appearance-enhancing drugs, and over-the-counter dietary supplements that may contain androgens. Using many drugs at the same time means the user may not know exactly which hormones or drugs they are taking or the quantities. The risk of using a variety of substances at the same time is that the substances can act together to produce effects that are far greater than each drug used on its own.

The use of synthetic androgens in competitive sport has been banned since 1974. However, their use in elite power sports and body-building is still happening. High doses of androgens do increase muscle size and strength, but the effects on male sporting performance are uncertain.

The World Anti-Doping Agency (WADA) standardises sports doping tests. WADA has been able to reduce androgen abuse in competitive sport and has developed tests for “designer androgens” designed specifically to escape testing methods. In Australia, the Australian Sports Anti-Doping Authority (ASADA) is the government body overseeing the implementation of the World Anti-Doping Code.

Who Is Abusing Androgens?

As well as in elite athletes and body-builders, androgen abuse is now more commonly seen amongst recreational weight-lifters and those wanting to improve their appearance.

Increasing numbers of teenage boys appear to be using androgens to try to improve sporting ability and/or physical appearance. Recent research, particularly from the USA, shows that most androgen abuse is now by non-athletes, teenagers and young men, in the desire for improved appearance such as more developed muscles and leaner bodies. A study of Australian secondary-school students reported about 3% of 12–17-year-old boys had used androgens and they were more likely than their peers to have used additional substances. This suggests that steroid use might be part of drug experimentation in adolescence.

It is now recognised that some males suffer from a condition called muscle dysmorphia, which is sometimes described as the opposite of anorexia nervosa – “bigorexia”. Muscle dysmorphia is a psychological condition mostly affecting young males, where the boy or man believes he is not muscular enough, leading to an eating disorder and extreme exercise to increase muscularity. In some cases they may also use illegal drugs in the pursuit of their idea of the “ideal” body shape. This is a condition that needs specialist psychological treatment.

Side-effects of Androgen Abuse

The side-effects of abusing androgens include acne, weight gain, mood changes (especially aggressive behaviour), decreased testes size and low sperm counts leading to infertility. Some men take chemically modified forms of testosterone, which puts them at risk of liver disease.

Because androgen abuse is a relatively recent phenomenon, the long-term effects are only now becoming better understood. The long-term effects of androgen abuse may include prostate disease (including cancer) as testosterone can increase prostate cell growth, infertility and liver damage. Evidence for links with heart disease is getting stronger, and recent research suggests effects on kidney and brain function, although more studies are needed.

There is now a focus on investigating androgen-dependence syndrome, which may be caused by the interaction of psychological factors, the negative effects on the body of androgen withdrawal, and the pleasurable effects of androgens.

Androgens: Too Little or Too Much

The story of androgens is complex. There is under-diagnosis of androgen deficiency in young men who have a reproductive system disease and will definitely benefit from testosterone therapy, and there is misuse and abuse of androgens in other contexts.

It is important to understand that androgens can be used safely and work for some medical conditions, as opposed to the unproven use of androgens and the risky use of androgens for enhancement of athletic ability or appearance.

This article was developed by Andrology Australia, the centre for male reproductive health, which is funded by the Australian Government Department of Health and administered by Monash University (www.andrologyaustralia.org).