Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of
testosterone in the 1930s, commercialization of
testosterone and
synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in
therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for
testosterone remains in replacement
therapy for pathological
hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for
testosterone, mostly representing wishful thinking about
rejuvenation. Over recent decades, this created an epidemic of
testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or
obesity, where efficacy and safety remains unproven and doubtful.
Androgen abuse originated during the Cold War as an epidemic of
androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of
drug abuse in sufficiently affluent communities that support an
illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of
testosterone, defined as prescribing without valid clinical indications, and abuse of
testosterone or
synthetic androgens (
androgen abuse), defined as the illicit use of
androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.