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Clinical Use of Anabolics and Hormones
Clinical Use of Anabolics and Hormones
TESTOSTERONE AND ANABOLICS MISUSE AND ABUSE
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<blockquote data-quote="madman" data-source="post: 194575" data-attributes="member: 13851"><p><strong>Box 1 – Avoiding Androgen (Testosterone) Misuse</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Avoiding Testosterone Misuse </strong></p><p><strong></strong></p><p><strong><em> Testosterone is highly susceptible to wishful thinking, marketing, and promotion leading to its use as an anti-aging or sexual dysfunction tonic and for cyberchondria </em></strong></p><p></p><p><em><strong> Hypogonadism is a clinical diagnosis with a pathological basis, confirmed by hormone assays – not the other way around </strong></em></p><p><em><strong></strong></em></p><p><em><strong> Testosterone misuse is prescribing for wrong reasons: harmful, invalid, or unproven off-label indications, most often for inappropriate or unproven clinical context </strong></em></p><p><em><strong></strong></em></p><p><em><strong> The invented condition is known variously as “Andropause”, “LowT”, “Late-onset hypogonadism” or “age-related or functional hypogonadism” is a fiction in search of a definition </strong></em></p><p><em><strong></strong></em></p><p><em><strong> Functional hypogonadism is not a disease and testosterone treatment is not justified without sound evidence of efficacy and safety from placebo-controlled clinical trials </strong></em></p><p><em><strong></strong></em></p><p><em><strong> Take care to distinguish pathological from functional hypogonadism </strong></em></p><p><em><strong></strong></em></p><p><em><strong> Beware of disease mongering: watch the objective evidence and beware of indications stretched beyond valid evidence </strong></em></p><p><em><strong></strong></em></p><p><em><strong> Be prepared to say you do not know when you do not </strong></em></p><p></p><p><strong><em> Avoid testosterone prescribing solely because another doctor might do so or that underlying non-reproductive causes of low testosterone might seem irremediable</em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Mismeasure leads to Misuse </strong></p><p></p><p><em><strong> There is no basis for population screening for low testosterone </strong></em></p><p></p><p><strong><em> Avoid “case-finding” in men with non-specific clinical features without evidence of pathologic hypogonadism</em></strong></p><p><strong><em></em></strong></p><p><strong><em> Without likely underlying reproductive pathology, there is no reason to measure serum testosterone </em></strong></p><p><strong><em></em></strong></p><p><strong><em> To measure serum testosterone, the testes should be examined, and underlying reproductive pathology suspected </em></strong></p><p><strong><em></em></strong></p><p><strong><em> Always measure serum LH, FSH, and SHBG with testosterone for interpretation and obtain multiple samples </em></strong></p><p><strong><em></em></strong></p><p><strong><em> Encourage pathologists to provide accurate serum testosterone by LCMS – steroid immunoassay the era of the 20th century is ending </em></strong></p><p><strong><em></em></strong></p><p><strong><em> Imaginary derived fractions of testosterone (“free”, “bioavailable”) are a numerical artefact signifying nothing and provide no reliable clinical guidance on androgen status</em></strong></p><p><strong><em></em></strong></p><p><strong><em> Androgens are potent drugs requiring a prescription for valid medical indications but are also misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit non-medical application for performance or image enhancement. </em></strong></p><p><strong><em></em></strong></p><p><strong><em> Testosterone 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. </em></strong></p><p><strong><em></em></strong></p><p><strong><em> Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation which have over recent decades 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. </em></strong></p><p><strong><em></em></strong></p><p><strong><em> 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 aiming to create a hypermasculine body physique and image.</em></strong></p></blockquote><p></p>
[QUOTE="madman, post: 194575, member: 13851"] [B]Box 1 – Avoiding Androgen (Testosterone) Misuse Avoiding Testosterone Misuse [I] Testosterone is highly susceptible to wishful thinking, marketing, and promotion leading to its use as an anti-aging or sexual dysfunction tonic and for cyberchondria [/I][/B] [I][B] Hypogonadism is a clinical diagnosis with a pathological basis, confirmed by hormone assays – not the other way around Testosterone misuse is prescribing for wrong reasons: harmful, invalid, or unproven off-label indications, most often for inappropriate or unproven clinical context The invented condition is known variously as “Andropause”, “LowT”, “Late-onset hypogonadism” or “age-related or functional hypogonadism” is a fiction in search of a definition Functional hypogonadism is not a disease and testosterone treatment is not justified without sound evidence of efficacy and safety from placebo-controlled clinical trials Take care to distinguish pathological from functional hypogonadism Beware of disease mongering: watch the objective evidence and beware of indications stretched beyond valid evidence Be prepared to say you do not know when you do not [/B][/I] [B][I] Avoid testosterone prescribing solely because another doctor might do so or that underlying non-reproductive causes of low testosterone might seem irremediable[/I] Mismeasure leads to Misuse [/B] [I][B] There is no basis for population screening for low testosterone [/B][/I] [B][I] Avoid “case-finding” in men with non-specific clinical features without evidence of pathologic hypogonadism Without likely underlying reproductive pathology, there is no reason to measure serum testosterone To measure serum testosterone, the testes should be examined, and underlying reproductive pathology suspected Always measure serum LH, FSH, and SHBG with testosterone for interpretation and obtain multiple samples Encourage pathologists to provide accurate serum testosterone by LCMS – steroid immunoassay the era of the 20th century is ending Imaginary derived fractions of testosterone (“free”, “bioavailable”) are a numerical artefact signifying nothing and provide no reliable clinical guidance on androgen status Androgens are potent drugs requiring a prescription for valid medical indications but are also misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit non-medical application for performance or image enhancement. Testosterone 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 which have over recent decades 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 aiming to create a hypermasculine body physique and image.[/I][/B] [/QUOTE]
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Clinical Use of Anabolics and Hormones
Clinical Use of Anabolics and Hormones
TESTOSTERONE AND ANABOLICS MISUSE AND ABUSE
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