madman
Super Moderator
Testing the boundaries: Self-medicated testosterone replacement and why it is practiced
ABSTRACT
Background: Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as ‘enhancement’ or ‘doping’, and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance-enhancing drugs (IPEDs) but never systematically explored.
Approach: This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as ‘testosterone replacement therapy’ (TRT). In particular, it focuses on 26 (84%) of these individuals who self-medicated TRT. Data were analyzed thematically (using NVivo) in order to answer the question: ‘how and why is testosterone self-medicated?’. Using Bacchi’s (2016) problematization approach to policy analysis, this paper also asks, ‘what happens to the ‘problem’ of non-prescribed testosterone use if such use is therapeutic?’.
Findings: Self-medicated TRT was found to be very similar to TRT as practiced in medical contexts. Self-medication was often practiced because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use.
Conclusion: By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualizations of all illicit testosterone use as ‘abuse’, and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment.
Background
Testosterone is the primary sex hormone in males and is produced in the gonads (and in the ovaries of females). It is responsible for the development of the male reproductive tissues as well as increased muscle growth and masculinizing characteristics such as facial hair growth. Synthetic testosterone is also produced in the pharmaceutical industry, as well as in illicit laboratories, and is used therapeutically and for enhancement purposes. Testosterone use entails numerous risks. All use of testosterone results in anabolic-androgenic steroid-induced hypogonadism which is ‘the functional incompetence of the testes with subnormal or impaired production of testosterone and/or spermatozoa due to administration of androgens or anabolic steroids’ (Tan & Scally, 2009:723). Anabolic-androgenic steroid (henceforth, ‘steroid’) use is now the most common cause of hypogonadism (Coward Robert et al., 2013). Other risks of testosterone include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea, and/or severe heart failure (Bassil, Alkaade & Morley, 2009).
When the risks of testosterone use are deemed by policymakers to be outweighed by its benefits, testosterone use is sanctioned by law. At this point in history, testosterone use is only legal in many countries if it is prescribed by a medical practitioner. Medical practitioners base decisions to prescribe testosterone on what they consider a therapeutic need, a need for healing or restoration of health. Therapeutic uses include the treatment of those with symptoms of testosterone deficiency, such as the loss of muscle and bone mass, depressed mood, and a decreased libido (Barbonetti, D’Andrea & Francavilla, 2020). There is good evidence to suggest that as men age, their serum testosterone levels decrease, and there is general agreement that testosterone replacement therapy (TRT) can have beneficial health outcomes, including preventing conditions related to low levels of testosterone such as osteoporosis (Corona, Torres & Maggi, 2020).
Testosterone is also used for enhancement purposes. That is, testosterone can be used ‘to improve human form or functioning beyond what is necessary to sustain or restore good health’ (Juengst, 1998:29). Testosterone is used as an enhancement by those who desire an increase in strength, muscularity, and the ability of the body to recover from exercise. The use of testosterone without a medical prescription is prohibited mainly in competitive sport, but also in some recreational sport (van de Ven & Mulrooney, 2017a) because of the advantage it confers. When testosterone is used for enhancement purposes it is usually grouped together with other similar compounds and termed ‘anabolic-androgenic steroid (AAS) abuse’, or ‘doping’.
Non-prescribed use of testosterone is illegal in most Western countries, presumably because policymakers deem: (1) the benefits of testosterone use to be outweighed by the risks if there is not a therapeutic need; and/or (2) that enhancement use poses a risk to society e.g. in terms of ‘cheating’. Bacchi (2016) proposes a Foucault-influenced ‘What’s the Problem Represented to be? (WPR) approach’ to policy analysis. In accordance with Michel Foucault’s idea of biopolitics, where state apparatuses have the power and responsibility to control the very principles of life and physical embodiment, she suggests that problems do not sit outside of policy processes waiting to be solved, but rather are constituted (i.e. brought into existence through practice) within policies (Bacchi, 2016). This is what Foucault would have called a ‘technology of the self’; a means of constructing an individual body and self in a world controlled by biopower (Gutman, Hutton, Foucault, & Martin, 1988). Taking this approach, we can see that within testosterone policy nonprescribed testosterone use is constituted as a problem. This paper asks what becomes of this problem if non-prescribed use is therapeutic, that is, if testosterone is self-medicated?
*Self-medication
*Approach
*Findings
What is self-medicated TRT?
Why self-medicate?
-Failure to get testosterone prescribed
-Self-medication is the preferred option
*Testosterone replacement and testosterone enhancement
Discussion
What is self-medicated TRT?
Why self-medicate TRT?
*Testosterone: therapy and enhancement
As Brennan, Wells, and Van Hout (2018), p.49) note, ‘the potential for lay performance of medical procedures on the self in a space where people assume autonomy over their knowledge and understanding of the body and engage in self-medication and self-experimentation warrants further investigation’. Self-medication can empower individuals but can increase the risks of drug use significantly. Therefore, we need to understand the motivations for, and the practices of, self-medication in order to reduce the harms of these practices. Such investigations can reveal not only the nature of both enhancement and repair, and the shortcomings of this distinction, but also the shortcomings of the medical system as currently practiced. Using Bacchi’s (2016) WPR approach we can see that policy may constitute non-prescribed testosterone use as a problem, but when individuals with verifiable health problems are denied treatment by health practitioners desiring to give treatment, it appears the problem is actually the policies that prevent access to medical treatment or the biopolitics of the situation.
ABSTRACT
Background: Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as ‘enhancement’ or ‘doping’, and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance-enhancing drugs (IPEDs) but never systematically explored.
Approach: This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as ‘testosterone replacement therapy’ (TRT). In particular, it focuses on 26 (84%) of these individuals who self-medicated TRT. Data were analyzed thematically (using NVivo) in order to answer the question: ‘how and why is testosterone self-medicated?’. Using Bacchi’s (2016) problematization approach to policy analysis, this paper also asks, ‘what happens to the ‘problem’ of non-prescribed testosterone use if such use is therapeutic?’.
Findings: Self-medicated TRT was found to be very similar to TRT as practiced in medical contexts. Self-medication was often practiced because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use.
Conclusion: By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualizations of all illicit testosterone use as ‘abuse’, and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment.
Background
Testosterone is the primary sex hormone in males and is produced in the gonads (and in the ovaries of females). It is responsible for the development of the male reproductive tissues as well as increased muscle growth and masculinizing characteristics such as facial hair growth. Synthetic testosterone is also produced in the pharmaceutical industry, as well as in illicit laboratories, and is used therapeutically and for enhancement purposes. Testosterone use entails numerous risks. All use of testosterone results in anabolic-androgenic steroid-induced hypogonadism which is ‘the functional incompetence of the testes with subnormal or impaired production of testosterone and/or spermatozoa due to administration of androgens or anabolic steroids’ (Tan & Scally, 2009:723). Anabolic-androgenic steroid (henceforth, ‘steroid’) use is now the most common cause of hypogonadism (Coward Robert et al., 2013). Other risks of testosterone include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea, and/or severe heart failure (Bassil, Alkaade & Morley, 2009).
When the risks of testosterone use are deemed by policymakers to be outweighed by its benefits, testosterone use is sanctioned by law. At this point in history, testosterone use is only legal in many countries if it is prescribed by a medical practitioner. Medical practitioners base decisions to prescribe testosterone on what they consider a therapeutic need, a need for healing or restoration of health. Therapeutic uses include the treatment of those with symptoms of testosterone deficiency, such as the loss of muscle and bone mass, depressed mood, and a decreased libido (Barbonetti, D’Andrea & Francavilla, 2020). There is good evidence to suggest that as men age, their serum testosterone levels decrease, and there is general agreement that testosterone replacement therapy (TRT) can have beneficial health outcomes, including preventing conditions related to low levels of testosterone such as osteoporosis (Corona, Torres & Maggi, 2020).
Testosterone is also used for enhancement purposes. That is, testosterone can be used ‘to improve human form or functioning beyond what is necessary to sustain or restore good health’ (Juengst, 1998:29). Testosterone is used as an enhancement by those who desire an increase in strength, muscularity, and the ability of the body to recover from exercise. The use of testosterone without a medical prescription is prohibited mainly in competitive sport, but also in some recreational sport (van de Ven & Mulrooney, 2017a) because of the advantage it confers. When testosterone is used for enhancement purposes it is usually grouped together with other similar compounds and termed ‘anabolic-androgenic steroid (AAS) abuse’, or ‘doping’.
Non-prescribed use of testosterone is illegal in most Western countries, presumably because policymakers deem: (1) the benefits of testosterone use to be outweighed by the risks if there is not a therapeutic need; and/or (2) that enhancement use poses a risk to society e.g. in terms of ‘cheating’. Bacchi (2016) proposes a Foucault-influenced ‘What’s the Problem Represented to be? (WPR) approach’ to policy analysis. In accordance with Michel Foucault’s idea of biopolitics, where state apparatuses have the power and responsibility to control the very principles of life and physical embodiment, she suggests that problems do not sit outside of policy processes waiting to be solved, but rather are constituted (i.e. brought into existence through practice) within policies (Bacchi, 2016). This is what Foucault would have called a ‘technology of the self’; a means of constructing an individual body and self in a world controlled by biopower (Gutman, Hutton, Foucault, & Martin, 1988). Taking this approach, we can see that within testosterone policy nonprescribed testosterone use is constituted as a problem. This paper asks what becomes of this problem if non-prescribed use is therapeutic, that is, if testosterone is self-medicated?
*Self-medication
*Approach
*Findings
What is self-medicated TRT?
Why self-medicate?
-Failure to get testosterone prescribed
-Self-medication is the preferred option
*Testosterone replacement and testosterone enhancement
Discussion
What is self-medicated TRT?
Why self-medicate TRT?
*Testosterone: therapy and enhancement
As Brennan, Wells, and Van Hout (2018), p.49) note, ‘the potential for lay performance of medical procedures on the self in a space where people assume autonomy over their knowledge and understanding of the body and engage in self-medication and self-experimentation warrants further investigation’. Self-medication can empower individuals but can increase the risks of drug use significantly. Therefore, we need to understand the motivations for, and the practices of, self-medication in order to reduce the harms of these practices. Such investigations can reveal not only the nature of both enhancement and repair, and the shortcomings of this distinction, but also the shortcomings of the medical system as currently practiced. Using Bacchi’s (2016) WPR approach we can see that policy may constitute non-prescribed testosterone use as a problem, but when individuals with verifiable health problems are denied treatment by health practitioners desiring to give treatment, it appears the problem is actually the policies that prevent access to medical treatment or the biopolitics of the situation.
