Testosterone (medication)のソースを表示

{{Short description|Medication and naturally occurring steroid hormone}}
{{About|testosterone as a medication|the natural hormone|Testosterone}}
{{Redirect|Testavan|the wine-tasting accessory|Tastevin}}
{{Use mdy dates|date=March 2025}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Drugbox
| Watchedfields = changed
| verifiedrevid = 649778658
| drug_name = Testosterone
| image = Testosteron.svg
| image_class = skin-invert-image
| width = 225
| alt = 
| image2 = Testosterone molecule ball.png
| width2 = 225
| alt2 = 
| caption = <!-- Clinical data -->
| pronounce = {{IPAc-en|t|ɛ|ˈ|s|t|ɒ|s|t|ə|r|oʊ|n}} {{respell|teh|STOS|tə|rohn}}<ref>[https://web.archive.org/web/20171201080834/https://en.oxforddictionaries.com/definition/testosterone Testosterone]. [[Oxford Dictionaries (website)|Oxford Dictionaries]].</ref>
| tradename = AndroGel, Testim, TestoGel, [[#Brand names|others]]
| Drugs.com = {{drugs.com|monograph|testosterone}}
| MedlinePlus = a619028
| DailyMedID = Testosterone
| pregnancy_AU = D
| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Testosterone Use During Pregnancy | website=Drugs.com | date=August 20, 2019 | url=https://www.drugs.com/pregnancy/testosterone.html | access-date=January 8, 2020 | archive-date=February 1, 2014 | archive-url=https://web.archive.org/web/20140201201902/http://www.drugs.com/pregnancy/testosterone.html | url-status=live }}</ref>
| pregnancy_category = [[Contraindication|Contraindicated]] due to [[teratogen]]ic effects
| addiction_liability = Moderate <ref name="d982">{{cite web | title=Anabolic steroid misuse | website=nhs.uk | date=November 4, 2022 | url=https://www.nhs.uk/conditions/anabolic-steroid-misuse/ | access-date=July 12, 2024}}</ref>
| routes_of_administration = [[buccal administration|buccal]], [[intranasal administration|intranasal]], [[subcutaneous implant]], [[transdermal administration|transdermal]] ([[gel]], [[cream]], [[transdermal patch|patch]]).
| class = [[Androgen]], [[anabolic steroid]]
| ATC_prefix = G03
| ATC_suffix = BA03
| ATC_supplemental = <!-- Legal status -->
| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled-->{{Citation needed|date=August 2023}}
| legal_AU_comment = 
| legal_BR = C5
| legal_BR_comment = <ref>{{Cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=March 31, 2023 |title=RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |url-status=live |archive-url=https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |archive-date=August 3, 2023 |access-date=August 15, 2023 |publisher=[[Diário Oficial da União]] |language=pt-BR |publication-date=April 4, 2023}}</ref>
| legal_CA = Schedule IV{{citation needed|date=August 2023}}
| legal_CA_comment = 
| legal_DE = <!-- Anlage I, II, III or Unscheduled-->{{citation needed|date=August 2023}}
| legal_DE_comment = 
| legal_NZ = <!-- Class A, B, C -->{{citation needed|date=August 2023}}
| legal_NZ_comment = 
| legal_UK = Class C{{citation needed|date=August 2023}}
| legal_UK_comment = 
| legal_US = Schedule III{{citation needed|date=August 2023}}
| legal_US_comment = 
| legal_EU = Rx-only
| legal_EU_comment = <ref>{{cite web | author = Human Medicines Evaluation Division | title = Active substance: testosterone (all formulations apart from topical use) | url = https://www.ema.europa.eu/documents/psusa/testosterone-all-formulations-apart-topical-use-list-nationally-authorised-medicinal-products-psusa/00010631/202112_en.pdf | work= List of nationally authorised medicinal products | publisher = European Medicines Agency | date = September 1, 2022 | access-date = September 6, 2022 | archive-date = September 6, 2022 | archive-url = https://web.archive.org/web/20220906054434/https://www.ema.europa.eu/en/documents/psusa/testosterone-all-formulations-apart-topical-use-list-nationally-authorised-medicinal-products-psusa/00010631/202112_en.pdf | url-status = live }}</ref><ref>{{cite web | author = Human Medicines Evaluation Division | title = Active substance: testosterone (topical use) | url = https://www.ema.europa.eu/documents/psusa/testosterone-topical-use-list-nationally-authorised-medicinal-products-psusa/00002908/202112_en.pdf | work= List of nationally authorised medicinal products | publisher = European Medicines Agency | date = September 1, 2022 | access-date = September 6, 2022 | archive-date = September 6, 2022 | archive-url = https://web.archive.org/web/20220906054434/https://www.ema.europa.eu/en/documents/psusa/testosterone-topical-use-list-nationally-authorised-medicinal-products-psusa/00002908/202112_en.pdf | url-status = live }}</ref>
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV-->{{citation needed|date=August 2023}}
| legal_UN_comment = 
| legal_status = Rx-only

<!-- Pharmacokinetic data -->| dependency_liability = Moderate <ref name="d982">{{cite web | title=Anabolic steroid misuse | website=nhs.uk | date=November 4, 2022 | url=https://www.nhs.uk/conditions/anabolic-steroid-misuse/ | access-date=July 12, 2024}}</ref>
| bioavailability = Oral: very low (due to extensive [[first pass effect|first pass metabolism]])
| protein_bound = 97.0–99.5% (to {{abbrlink|SHBG|sex hormone-binding globulin}} and [[human serum albumin|albumin]])<ref name="MelmedPolonsky2015">{{cite book|vauthors=Melmed S, Polonsky KS, Larsen PR|title=Williams Textbook of Endocrinology|url=https://books.google.com/books?id=iPIACwAAQBAJ&pg=PA709|date=November 11, 2015|publisher=Elsevier Health Sciences|isbn=978-0-323-34157-8|pages=709, 711, 765|access-date=November 18, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414214954/https://books.google.com/books?id=iPIACwAAQBAJ&pg=PA709|url-status=live}}</ref>
| metabolism = [[Liver]] (mainly [[redox|reduction]] and [[conjugation (biochemistry)|conjugation]])
| metabolites = 
| onset = 
| elimination_half-life = 2–4&nbsp;hours{{Citation needed|date=October 2016}}
| duration_of_action = 
| excretion = [[Urine]] (90%), [[feces]] (6%)

<!-- Identifiers -->| CAS_number_Ref = {{cascite|correct|CAS}}
| CAS_number = 58-22-0
| CAS_supplemental = <br />{{CAS|57-85-2}} ([[propionate]])<!-- Also CAS verified --><br />{{CAS|315-37-7}} ([[enanthate]])<br />{{CAS|58-20-8}} ([[cypionate]])<br />{{CAS|5949-44-0}} ([[undecanoate]])
| PubChem = 6013
| IUPHAR_ligand = 2858
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00624
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 5791
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 3XMK78S47O
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00075
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 17347
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 386630
| NIAID_ChemDB = 
| PDB_ligand = 
| synonyms = Androst-4-en-17β-ol-3-one

<!-- Chemical and physical data -->| IUPAC_name = (8''R'',9''S'',10''R'',13''S'',14''S'',17''S'')-17-hydroxy-10,13-dimethyl-1,2,6,7,8,9,11,12,14,15,16,17-dodecahydrocyclopenta[''a'']phenanthren-3-one
| C = 19
| H = 28
| O = 2
| SMILES = O=C4\C=C2/[C@]([C@H]1CC[C@@]3([C@@H](O)CC[C@H]3[C@@H]1CC2)C)(C)CC4
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C19H28O2/c1-18-9-7-13(20)11-12(18)3-4-14-15-5-6-17(21)19(15,2)10-8-16(14)18/h11,14-17,21H,3-10H2,1-2H3/t14-,15-,16-,17-,18-,19-/m0/s1
| StdInChI_comment = 
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = MUMGGOZAMZWBJJ-DYKIIFRCSA-N
| density = 
| density_notes = 
| melting_point = 155
| melting_high = 
| melting_notes = 
| boiling_point = 
| boiling_notes = 
| solubility = 
| sol_units = 
| specific_rotation = +110.2°
}}

<!-- Definition and medical uses -->
'''Testosterone''' is a [[medication]] and naturally occurring [[testosterone|steroid hormone]].<ref name=AHFS2016/> It is used to treat [[male hypogonadism]], [[gender dysphoria]], and certain types of [[breast cancer]].<ref name=AHFS2016/><ref>{{cite web |title=List of Gender Dysphoria Medications (6 Compared) |url=https://www.drugs.com/condition/gender-dysphoria.html |website=Drugs.com |access-date=May 6, 2020 |language=en |archive-date=April 26, 2020 |archive-url=https://web.archive.org/web/20200426180544/https://www.drugs.com/condition/gender-dysphoria.html |url-status=live }}</ref> It may also be used to increase [[athletic ability]] in the form of [[doping in sport|doping]].<ref name=AHFS2016/> It is unclear if the use of testosterone for [[andropause|low levels due to aging]] is beneficial or harmful.<ref name=FDA2015>{{cite web |author=Staff |title=Testosterone Products: Drug Safety Communication – FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm436280.htm |date=March 3, 2015 |work=[[FDA]] |access-date=March 5, 2015 |url-status=live |archive-url=https://web.archive.org/web/20150305015556/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm436280.htm |archive-date=March 5, 2015}}</ref> Testosterone can be administered through several different routes, including [[Topical medication|topical]] [[gel|gels]] or [[transdermal patch|patches]], [[Nasal spray|nasal sprays]], subdermal implants, or [[Buccal administration|tablets dissolved inside the mouth]].<ref name=AHFS2016/> 

<!-- Side effects -->
Common [[side effect]]s of testosterone include [[acne]], [[swelling (medical)|swelling]], and [[gynecomastia|breast enlargement in men]].<ref name=AHFS2016/> Serious side effects may include [[liver toxicity]], [[heart disease]], and behavioral changes.<ref name=AHFS2016/> Women and children who are exposed may develop [[virilization|masculinization]].<ref name=AHFS2016/> It is recommended that individuals with [[prostate cancer]] should not use the medication.<ref name=AHFS2016/> It can cause harm to the baby if used during [[pregnancy]] or [[breastfeeding]].<ref name=AHFS2016/> Testosterone is in the [[androgen]] family of medications.<ref name=AHFS2016/>

<!-- History, society and culture -->
Testosterone was first isolated in 1935, and approved for medical use in 1939.<ref>{{cite book | vauthors = Taylor WN | title = Anabolic Steroids and the Athlete | date = 2002 | publisher = McFarland | isbn = 978-0-7864-1128-3 | page = 180 | edition = 2nd | url = https://books.google.com/books?id=OGcQ0Tp2AFcC&pg=PA180 | url-status = live | archive-url = https://web.archive.org/web/20160914142007/https://books.google.com/books?id=OGcQ0Tp2AFcC&pg=PA180 | archive-date = September 14, 2016}}</ref><ref name=Fis2006>{{cite book |vauthors=Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=481 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA481 |language=en |access-date=August 18, 2020 |archive-date=August 23, 2022 |archive-url=https://web.archive.org/web/20220823114136/https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA481 |url-status=live }}</ref> Rates of use have increased three times in the United States between 2001 and 2011.<ref name=Des2016>{{cite journal | vauthors = Desroches B, Kohn TP, Welliver C, Pastuszak AW | title = Testosterone therapy in the new era of Food and Drug Administration oversight | journal = Translational Andrology and Urology | volume = 5 | issue = 2 | pages = 207–12 | date = April 2016 | pmid = 27141448 | pmc = 4837303 | doi = 10.21037/tau.2016.03.13 | doi-access = free }}</ref> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> It is available as a [[generic medication]].<ref name=AHFS2016>{{cite web |title=Testosterone|url=https://www.drugs.com/monograph/testosterone.html|website=Drugs.com |publisher=American Society of Health-System Pharmacists|access-date=September 3, 2016|date=December 4, 2015 |archive-url=https://web.archive.org/web/20160820173417/https://www.drugs.com/monograph/testosterone.html |archive-date=August 20, 2016|url-status=live}}</ref> In 2022, it was the 118th most commonly prescribed medication in the United States, with more than 5{{nbsp}}million prescriptions.<ref>{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=August 30, 2024 | archive-date=August 30, 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Testosterone Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Testosterone | access-date = August 30, 2024 }}</ref>
{{TOC limit}}

==Medical uses==
{{See also|Androgen replacement therapy#Medical uses|Anabolic steroid#Medical}}

The primary use of testosterone is the treatment of males with too little or no natural testosterone production, also termed [[male hypogonadism]] or [[hypoandrogenism]] (androgen deficiency).<ref>{{cite journal | vauthors = Margo K, Winn R | title = Testosterone treatments: why, when, and how? | journal = American Family Physician | volume = 73 | issue = 9 | pages = 1591–8 | date = May 2006 | pmid = 16719252 | url = http://www.aafp.org/afp/2006/0501/p1591.html | access-date = October 3, 2016 | url-status = live | archive-url = https://web.archive.org/web/20161003184639/http://www.aafp.org/afp/2006/0501/p1591.html | archive-date = October 3, 2016 }}</ref> This treatment is referred to as [[hormone replacement therapy]] (HRT), or alternatively, and more specifically, as testosterone replacement therapy (TRT) or [[androgen replacement therapy]] (ART). It is used to maintain serum testosterone levels in the normal male range. Decline of testosterone production with age has led to interest in testosterone supplementation.<ref name="pmid16985841">{{cite journal | vauthors = Myers JB, Meacham RB | title = Androgen replacement therapy in the aging male | journal = Reviews in Urology | volume = 5 | issue = 4 | pages = 216–26 | year = 2003 | pmid = 16985841 | pmc = 1508369 }}</ref>

A 2020 guideline from the [[American College of Physicians]] supports the discussion of testosterone in adult men with age-related [[Low T|low levels of testosterone]] who have [[sexual dysfunction]]. They recommend yearly evaluation regarding possible improvement and, if none, to discontinue testosterone; physicians should consider intramuscular treatments, rather than transdermal treatments, due to costs and since the effectiveness and harm of either method is similar. Testosterone treatment for reasons other than possible improvement of sexual dysfunction may not be recommended.<ref name="ANN-20200106">{{cite journal | vauthors = Qaseem A, Horwitch CA, Vijan S, Etxeandia-Ikobaltzeta I, Kansagara D | title = Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians | journal = Annals of Internal Medicine | date = January 2020 | volume = 172 | issue = 2 | pages = 126–133 | pmid = 31905405 | doi = 10.7326/M19-0882 | doi-access = free }}</ref><ref name="MSCP-20200107">{{cite news |vauthors=Parry NM |title=New Guideline for Testosterone Treatment in Men With 'Low T' |url=https://www.medscape.com/viewarticle/923449 |date=January 7, 2020 |work=Medscape.com |access-date=January 7, 2020 |url-status=live |archive-date=January 8, 2020 |archive-url=https://web.archive.org/web/20200108011908/https://www.medscape.com/viewarticle/923449}}</ref>

===Deficiency===
{{Further|Hypogonadism#Treatment|Androgen deficiency#Treatment}}

Testosterone deficiency (also termed hypotestosteronism or hypotestosteronemia) is an abnormally low testosterone production. It may occur because of testicular dysfunction ([[primary hypogonadism]]) or hypothalamic–pituitary dysfunction ([[secondary hypogonadism]]) and may be [[congenital]] or acquired.<ref name="e930">{{cite book | vauthors = Sizar O, Leslie SW, Schwartz J | chapter = Male Hypogonadism | title = StatPearls | publisher=StatPearls Publishing | date=February 25, 2024 | pmid=30422528 | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK532933/ | access-date=August 30, 2024}}</ref>

{{Androgen replacement therapy formulations and dosages used in men}}

===Low levels due to aging===
{{Main|Late-onset hypogonadism#Management}}

Testosterone levels may decline gradually with age.<ref name="auto">{{cite book | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK216164/ | title = Testosterone and Aging: Clinical Research Directions. | chapter = Introduction | veditors = Liverman CT, Blazer DG, ((Institute of Medicine (US) Committee on Assessing the Need for Clinical Trials of Testosterone Replacement Therapy)) | date = January 1, 2004 | publisher = National Academies Press (US) | via = www.ncbi.nlm.nih.gov | isbn = 978-0-309-09063-6 | doi = 10.17226/10852 | pmid = 25009850 | access-date = November 11, 2016 | archive-date = January 10, 2016 | archive-url = https://web.archive.org/web/20160110170928/http://www.ncbi.nlm.nih.gov/books/NBK216164/ | url-status = live }}</ref><ref>{{cite journal | vauthors = Yeap BB, Almeida OP, Hyde Z, Norman PE, Chubb SA, Jamrozik K, Flicker L | title = In men older than 70 years, total testosterone remains stable while free testosterone declines with age. The Health in Men Study | journal = European Journal of Endocrinology| volume = 156 | issue = 5 | pages = 585–94 | date = May 2007 | pmid = 17468195 | doi = 10.1530/EJE-06-0714 | doi-access = free }}</ref> The United States [[Food and Drug Administration]] (FDA) stated in 2015 that neither the benefits nor the safety of testosterone supplement have been established for low testosterone levels due to aging.<ref name=FDA2015/> The FDA has required that labels on testosterone include warnings about increased risk of heart attacks and stroke.<ref name=FDA2015/>

===Transgender men===
{{Further|Transgender hormone therapy (female-to-male)}}

To take advantage of its [[virilizing]] effects, testosterone is administered to [[trans men|transgender men]] and other [[Transmasculine|transmasculine individuals]] as part of [[masculinizing hormone therapy]],<ref>{{cite web | url=http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx | title=Gender dysphoria – Treatment | publisher=NHS Gov.uk | date=May 21, 2012 | access-date=October 31, 2013 | url-status=live | archive-url=https://web.archive.org/web/20131102135038/http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx | archive-date=November 2, 2013}}</ref> titrated to clinical effect with a "target level" of the average male's testosterone level.<ref name="Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers">{{cite web | vauthors = Gorton RN, Buth J, Spade D | title = Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers | url = http://www.nickgorton.org/Medical%20Therapy%20and%20HM%20for%20Transgender%20Men_2005.pdf | publisher = Lyon-Martin Women's Health Services | access-date = December 11, 2016 | url-status = live | archive-url = https://web.archive.org/web/20161130005122/http://www.nickgorton.org/Medical%20Therapy%20and%20HM%20for%20Transgender%20Men_2005.pdf | archive-date = November 30, 2016}}</ref>

{{Medications and dosages used in hormone therapy for transgender men}}
{{clear}}

===Women===
Testosterone therapy is effective in the short-term for the treatment of [[hypoactive sexual desire disorder]] (HSDD) in women.<ref name=Wie2014/> However, its long-term [[drug safety|safety]] is unclear.<ref name=Wie2014>{{cite journal | vauthors = Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N | title = Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 99 | issue = 10 | pages = 3489–510 | date = Oct 2014 | pmid = 25279570 | doi = 10.1210/jc.2014-2260 | doi-access = free }}</ref> Because of a lack data to support its efficacy and safety, the [[Endocrine Society]] recommends against the routine use of testosterone in women to treat [[hypoandrogenism|low androgen levels]] due to [[hypopituitarism]], [[adrenal insufficiency]], [[oophorectomy|surgical removal of the ovaries]], high-dose [[corticosteroid]] therapy, or other causes.<ref name=Wie2014/> Similarly, because of a lack of data to support its efficacy and safety, the Endocrine Society recommends against the use of testosterone in women to improve general [[well-being]], to treat [[infertility]], [[sexual dysfunction]] due to causes other than HSDD, or to improve [[cognition|cognitive]], [[cardiovascular]], [[metabolic]], and/or [[bone]] health.<ref name=Wie2014/>

A 2014 systematic review and meta-analysis of 35 studies consisting of over 5,000 [[menopause|postmenopausal]] women with normal [[adrenal gland]] function found that testosterone therapy was associated with significant improvement in a variety of domains of sexual function.<ref name="pmid25279572">{{cite journal | vauthors = Elraiyah T, Sonbol MB, Wang Z, Khairalseed T, Asi N, Undavalli C, Nabhan M, Firwana B, Altayar O, Prokop L, Montori VM, Murad MH | title = Clinical review: The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis | journal = J. Clin. Endocrinol. Metab. | volume = 99 | issue = 10 | pages = 3543–50 | year = 2014 | pmid = 25279572 | pmc = 5393495 | doi = 10.1210/jc.2014-2262 }}</ref> These domains included frequency of [[human sexual activity|sexual activity]], [[orgasm]], [[sexual arousal|arousal]], and sexual satisfaction, among others.<ref name="pmid25279572" /> Women who were menopausal due to [[ovariectomy]] showed significantly greater improvement in sexual function with testosterone relative to those who had normal menopause.<ref name="pmid25279572" /> In addition to beneficial effects on sexual function, testosterone was associated with unfavorable changes in [[blood lipids]].<ref name="pmid25279572" /> These included decreased levels of total [[cholesterol]], [[triglyceride]]s, and [[high-density lipoprotein]] (HDL) cholesterol, and increased levels of [[low-density lipoprotein]] (LDL) cholesterol.<ref name="pmid25279572" /> However, the changes were small in magnitude, and the long-term significance in relation to [[cardiovascular]] outcomes is uncertain.<ref name="pmid25279572" /> The changes were more pronounced with oral [[testosterone undecanoate]] than with [[parenteral]] routes, such as [[transdermal administration|transdermal]] testosterone.<ref name="pmid25279572" /> Testosterone showed no significant effect on [[depression (mood)|depressed]] [[mood (psychology)|mood]] [[anxiety]], [[bone mineral density]] (BMD), or [[anthropometry|anthropomorphic measure]]s like [[body weight]] or [[body mass index]].<ref name="pmid25279572" /> Conversely, it was associated with a significant incidence of androgenic side effects, including [[acne]] and [[hirsutism]] (excessive facial/body hair growth).<ref name="pmid25279572" /> Other androgenic side effects, such as [[weight gain]], [[pattern hair loss]], and [[voice deepening]], were also reported in some trials, but were excluded from analyses due to insufficient data.<ref name="pmid25279572" /> The overall quality of the evidence was rated as low and was considered to be inconclusive in certain areas, for instance on long-term safety.<ref name="pmid25279572" />

A subsequent 2017 systematic review and meta-analysis of studies including over 3,000 postmenopausal women with HSDD similarly found that short-term transdermal testosterone therapy was effective in improving multiple domains of sexual function.<ref name="pmid27916205">{{cite journal | vauthors = Achilli C, Pundir J, Ramanathan P, Sabatini L, Hamoda H, Panay N | title = Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis | journal = Fertil. Steril. | volume = 107 | issue = 2 | pages = 475–482.e15 | year = 2017 | pmid = 27916205 | doi = 10.1016/j.fertnstert.2016.10.028 | doi-access = free }}</ref> Androgenic adverse effects such as acne and hirsutism were significantly greater in incidence with testosterone therapy, whereas no significant differences in "increase in facial hair, alopecia, voice deepening, urinary symptoms, breast pain, headache, site reaction to the patch, total adverse events, serious adverse events, reasons for withdrawal from the study, and the number of women who completed the study" were seen relative to controls.<ref name="pmid27916205" />

Although testosterone has been found to be effective at improving sexual function in postmenopausal women, the doses employed have been supraphysiological.<ref name="pmid26589379">{{cite journal | vauthors = Cappelletti M, Wallen K | title = Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens | journal = Horm Behav | volume = 78 | pages = 178–93 | date = February 2016 | pmid = 26589379 | pmc = 4720522 | doi = 10.1016/j.yhbeh.2015.11.003 }}</ref><ref name="pmid27785108">{{cite journal | vauthors = Reed BG, Bou Nemer L, Carr BR | title = Has testosterone passed the test in premenopausal women with low libido? A systematic review | journal = Int J Women's Health | volume = 8 | pages = 599–607 | year = 2016 | pmid = 27785108 | pmc = 5066846 | doi = 10.2147/IJWH.S116212 | doi-access = free }}</ref> In contrast to these high doses, there is little support for the notion that testosterone is a critical hormone for sexual desire and function in women under normal physiological circumstances.<ref name="pmid26589379" /><ref name="pmid27785108" /> Low doses of testosterone resulting in physiological levels of testosterone (<50&nbsp;ng/dL) have not been found to significantly increase sexual desire or function in women in most studies.<ref name="pmid26589379" /> Similarly, there appears to be little or no relationship between total or free testosterone levels in the normal physiological range and sexual desire in premenopausal women.<ref name="pmid27785108" /><ref name="pmid26589379" /> Only high doses of testosterone resulting in supraphysiological levels of testosterone (>50&nbsp;ng/dL) significantly increase sexual desire in women, with levels of testosterone of 80 to 150&nbsp;ng/dL "slightly" increasing sex drive.<ref name="pmid26589379" /><ref name="pmid27785108" /> In accordance, men experience [[sexual dysfunction]] at testosterone levels of below 300&nbsp;ng/dL, and men that have levels of testosterone of approximately 200&nbsp;ng/dL frequently experience such problems.<ref name="pmid27785108" /> The high doses of testosterone required to increase sexual desire in women may have a significant risk of masculinization with long-term therapy.<ref name="pmid27785108" /><ref name="pmid26589379" /> For this reason, and due to the unknown health effects and safety of testosterone therapy, its use may be inappropriate.<ref name="pmid27785108" /><ref name="pmid26589379" /> In 2003, the FDA rejected Intrinsa, a 300&nbsp;μg/day [[testosterone patch]] for the treatment of sexual dysfunction in postmenopausal women.<ref name="pmid26589379" /><ref name="pmid27785108" /> The reasons cited were limited efficacy (about one additional sexually satisfying event per month), concerns about safety and potential adverse effects with long-term therapy, and concerns about inappropriate [[off-label use]].<ref name="pmid26589379" /><ref name="pmid27785108" /> It appears that in women, rather than testosterone, [[estradiol]] may be the most important hormone involved in sexual desire, although data on the clinical use of [[estradiol (medication)|estradiol]] to increase sexual desire in women is limited.<ref name="pmid26589379" /><ref name="pmid26944462">{{cite journal | vauthors = Santoro N, Worsley R, Miller KK, Parish SJ, Davis SR | title = Role of Estrogens and Estrogen-Like Compounds in Female Sexual Function and Dysfunction | journal = J Sex Med | volume = 13 | issue = 3 | pages = 305–16 | date = March 2016 | pmid = 26944462 | doi = 10.1016/j.jsxm.2015.11.015 }}</ref><ref name="pmid28895561">{{cite journal | vauthors = Stone L | s2cid = 7140458 | title = Sexual medicine: Transdermal oestrogen is effective | journal = Nat Rev Urol | volume = 14 | issue = 11 | pages = 638 | date = November 2017 | pmid = 28895561 | doi = 10.1038/nrurol.2017.152 | doi-access = free }}</ref>

There are no testosterone products approved for use in women in the United States and many other countries.<ref name="PalSayegh2017">{{cite book|vauthors=Pal L, Sayegh RA|title=Essentials of Menopause Management: A Case-Based Approach|url=https://books.google.com/books?id=HVkLDgAAQBAJ&pg=PA180|date=January 21, 2017|publisher=Springer|isbn=978-3-319-42451-4|pages=180–|access-date=July 31, 2018|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414214953/https://books.google.com/books?id=HVkLDgAAQBAJ&pg=PA180|url-status=live}}</ref> There are approved testosterone products for women in Australia, where it is considered a drug of dependence, medicines that are subject to misuse and trafficking, <ref>{{cite web | title = Drugs of dependence and drug-dependent persons | url = http://www.health.vic.gov.au/drugs-and-poisons/drugs-of-dependence-and-drug-dependent-persons | work= Department of Health | publisher = Victorian Government | access-date = May 24, 2022 | archive-date = March 8, 2022 | archive-url = https://web.archive.org/web/20220308145610/https://www.health.vic.gov.au/drugs-and-poisons/drugs-of-dependence-and-drug-dependent-persons | url-status = live }}</ref> and some European countries.<ref name="PalSayegh2017" /> Testosterone pellet implants are approved for use in postmenopausal women in the United Kingdom.<ref name="LoboKelsey2000">{{cite book|vauthors=Lobo RA, Kelsey J, Marcus R|title=Menopause: Biology and Pathobiology|url=https://books.google.com/books?id=i9HXKhjvNVAC&pg=PA454|date=May 22, 2000|publisher=Academic Press|isbn=978-0-08-053620-0|pages=454–|access-date=September 27, 2018|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215015/https://books.google.com/books?id=i9HXKhjvNVAC&pg=PA454|url-status=live}}</ref><ref name="BagatellBremner2003">{{cite book|vauthors=Bagatell C, Bremner WJ|title=Androgens in Health and Disease|url=https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA374|date=May 27, 2003|publisher=Springer Science & Business Media|isbn=978-1-59259-388-0|pages=374–|access-date=September 27, 2018|archive-date=December 20, 2019|archive-url=https://web.archive.org/web/20191220150236/https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA374|url-status=live}}</ref> Testosterone products for men can be used [[off-label use|off-label]] in women in the United States.<ref name="PalSayegh2017" /> Alternatively, testosterone products for women are available from [[compounding pharmacy|compounding pharmacies]] in the United States, although such products are unregulated and manufacturing quality is not ensured.<ref name="pmid28509626">{{cite journal | vauthors = L'Hermite M | s2cid = 26079596 | title = Custom-compounded bioidentical hormone therapy: why so popular despite potential harm? The case against routine use | journal = Climacteric | volume = 20 | issue = 3 | pages = 205–211 | date = June 2017 | pmid = 28509626 | doi = 10.1080/13697137.2017.1285277 }}</ref>

{{Androgen replacement therapy formulations and dosages used in women}}

{{Androgen/anabolic steroid dosages for breast cancer}}

===Available forms===
[[File:Androderm testosterone skin patch.jpg|thumb|172x172px|Androderm testosterone skin patch]]
Testosterone has been marketed for use by [[oral administration|oral]], [[sublingual administration|sublingual]], [[buccal administration|buccal]], [[intranasal administration|intranasal]], [[transdermal administration|transdermal]] ([[transdermal patch|patches]]), [[topical medication|topical]] ([[gel (medication)|gel]]s), [[intramuscular injection|intramuscular]] ([[injection (medicine)|injection]]), and [[subcutaneous administration|subcutaneous]] ([[subcutaneous implant|implant]]) [[route of administration|administration]].<ref name="NieschlagBehre2012b">{{cite book|vauthors=Nieschlag E, Behre MH|title=Testosterone: Action - Deficiency - Substitution|url=https://books.google.com/books?id=jn3nCAAAQBAJ&pg=PA350|date=December 6, 2012|publisher=Springer Science & Business Media|isbn=978-3-642-72185-4|pages=1–,9,298,309–331,349–353,366–367|access-date=November 18, 2016 |archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215012/https://books.google.com/books?id=jn3nCAAAQBAJ&pg=PA350|url-status=live}}</ref><ref name="Melmed2016"/><!--Defined in Template:Available forms of testosterone--><ref name="Llewellyn2011" /><ref name="Brotherton1976"/><!--Defined in Template:Available forms of testosterone--> It is provided unmodified and as a [[testosterone ester]] such as [[testosterone cypionate]], [[testosterone enanthate]], [[testosterone propionate]], or [[testosterone undecanoate]], which act as [[prodrug]]s of testosterone.<ref name="NieschlagBehre2012b" /><ref name="Melmed2016" /><ref name="Llewellyn2011" /> The most common [[route of administration]] for testosterone is by intramuscular injection.<ref name="NieschlagBehre2012b" /> However, it has been reported that AndroGel, a transdermal gel formulation of testosterone, has become the most popular form of testosterone in androgen replacement therapy for hypogonadism in the United States.<ref name="Melmed2016" />

{{Available forms of testosterone}}

==Non-medical use==

===Athletics===
{{See also|Ergogenic use of anabolic steroids|Anabolic–androgenic steroids abuse}}

Testosterone is used as a form of [[Doping (sport)|doping]] among [[sportsperson|athlete]]s in order to improve performance.<ref name=":1">{{Cite web|url=http://list.wada-ama.org/list/s1-anabolic-agents|title=S1. Anabolic Agents {{!}} List of Prohibited Substances and Methods|website=list.wada-ama.org|access-date=June 6, 2016|url-status=dead|archive-url=https://web.archive.org/web/20160527144701/http://list.wada-ama.org/list/s1-anabolic-agents/|archive-date=May 27, 2016}}</ref> Testosterone is classified as an [[anabolic]] agent and is on the [[World Anti-Doping Agency]] (WADA) List of Prohibited Substances and Methods.<ref name=":1" /> Hormone supplements cause the endocrine system to adjust its production and lower the natural production of the hormone, so when supplements are discontinued, natural hormone production is lower than it was originally.{{citation needed|date=November 2016}}

[[Anabolic–androgenic steroid]]s (AAS), including testosterone and its esters, have also been taken to enhance muscle development, strength, or endurance. They do so directly by increasing the muscles' protein synthesis. As a result, muscle fibers become larger and repair faster than the average person's.{{citation needed|date=November 2016}}

After a series of scandals and publicity in the 1980s (such as [[Ben Johnson (Canadian sprinter)|Ben Johnson's]] improved performance at the [[1988 Summer Olympics]]), [[prohibition]]s of AAS use were renewed or strengthened by many sports organizations. Testosterone and other AAS were designated a "[[controlled substance]]" by the [[United States Congress]] in 1990, with the ''Anabolic Steroid Control Act''.<ref>{{cite web| title=Anabolic Steroid Control Act| url=http://www.ussc.gov/USSCsteroidsreport-0306.pdf#search=%22Anabolic%20Steroid%20Control%20Act%20of%201990%22| publisher=United States Sentencing Commission| year=1990| access-date=November 11, 2016| url-status=dead| archive-date=August 30, 2016| archive-url=https://web.archive.org/web/20160830201115/http://www.ussc.gov/USSCsteroidsreport-0306.pdf#search=%22Anabolic%20Steroid%20Control%20Act%20of%201990%22}}</ref> Their use is seen as an issue in modern sport, particularly given the lengths to which athletes and professional laboratories go to in trying to conceal such use from sports regulators. Steroid use once again came into the spotlight as a result of Canadian [[Professional wrestling|professional wrestler]] [[Chris Benoit]]'s double murder-suicide in 2007; however, there is no evidence implicating steroid use as a factor in the incident.{{citation needed|date=February 2014}}

Some female athletes may have naturally higher levels of testosterone than others, and may be asked to consent to [[sex verification in sports|sex verification]] and either surgery or drugs to decrease testosterone levels.<ref name="NYT-20140411">{{cite news | vauthors = Karkazis K, Jordan-Young R | title = The Trouble With Too Much T | url = https://www.nytimes.com/2014/04/11/opinion/the-trouble-with-too-much-t.html | date = April 11, 2014 | work=[[The New York Times]] | access-date = April 12, 2014 | archive-url = https://web.archive.org/web/20140412011234/http://www.nytimes.com/2014/04/11/opinion/the-trouble-with-too-much-t.html | archive-date = April 12, 2014 | url-status = live}}</ref> This has proven contentious, with the [[Court of Arbitration for Sport]] suspending the IAAF policy due to insufficient evidence of a link between high androgen levels and improved athletic performance.<ref>{{cite web| vauthors = Fagan K | author-link = Kate Fagan (sportswriter) | title = Katie Ledecky is crushing records, so why are we still worried about Caster Semenya?| work= [[ESPN]]| access-date = August 27, 2016| date = August 13, 2016| url = http://www.espn.com/espnw/voices/article/17275159/| url-status = live| archive-url = https://web.archive.org/web/20160818073128/http://www.espn.com/espnw/voices/article/17275159/| archive-date = August 18, 2016}}</ref><ref>{{Cite news| issn = 0362-4331| vauthors = Padawer R | title = The Humiliating Practice of Sex-Testing Female Athletes| work= [[The New York Times]]| access-date = August 27, 2016| date = June 28, 2016| url = https://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html| url-status = live| archive-url = https://web.archive.org/web/20160628124045/http://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html| archive-date = June 28, 2016}}</ref>

====Detection of abuse====
A number of methods for detecting testosterone use by athletes have been employed, most based on a [[urinalysis|urine test]]. These include the testosterone/[[epitestosterone]] ratio (normally less than 6), the testosterone/luteinizing hormone ratio and the [[carbon-13]]/[[carbon-12]] ratio (pharmaceutical testosterone contains less carbon-13 than endogenous testosterone). In some testing programs, an individual's own historical results may serve as a reference interval for interpretation of a suspicious finding. Another approach being investigated is the detection of the administered form of testosterone, usually an ester, in hair.<ref name="pmid19549614">{{cite journal | vauthors = Strahm E, Emery C, Saugy M, Dvorak J, Saudan C | title = Detection of testosterone administration based on the carbon isotope ratio profiling of endogenous steroids: international reference populations of professional soccer players | journal = British Journal of Sports Medicine | volume = 43 | issue = 13 | pages = 1041–44 | date = Dec 2009 | pmid = 19549614 | pmc = 2784500 | doi = 10.1136/bjsm.2009.058669 }}</ref><ref name="pmid20355155">{{cite journal | vauthors = Kicman AT, Cowan DA | title = Subject-based profiling for the detection of testosterone administration in sport | journal = Drug Testing and Analysis | volume = 1 | issue = 1 | pages = 22–4 | date = Jan 2009 | pmid = 20355155 | doi = 10.1002/dta.14 | doi-access = free }}</ref><ref name="pmid19353724">{{cite journal | vauthors = Pozo OJ, Deventer K, Van Eenoo P, Rubens R, Delbeke FT | title = Quantification of testosterone undecanoate in human hair by liquid chromatography-tandem mass spectrometry | journal = Biomedical Chromatography | volume = 23 | issue = 8 | pages = 873–80 | date = Aug 2009 | pmid = 19353724 | doi = 10.1002/bmc.1199 }}</ref><ref name="isbn0-9626523-6-9">{{cite book | vauthors = Baselt RC | title = Disposition of Toxic Drugs & Chemicals in Man | edition = 8th | publisher = Biomedical Publications | location = Foster City, Calif | year = 2008 | pages = 1501–04 | isbn = 978-0-9626523-7-0 }}</ref>

==Contraindications==
Absolute [[contraindication]]s of testosterone include [[prostate cancer]], [[Hematocrit#Elevated|elevated hematocrit]] (>54%), uncontrolled [[congestive heart failure]], various other [[cardiovascular disease]]s, and uncontrolled [[obstructive sleep apnea]].<ref name="KavoussiCostabile2012">{{cite book |veditors=Kavoussi P, Costabile RA, Salonia A|title=Clinical Urologic Endocrinology: Principles for Men's Health|url=https://books.google.com/books?id=Eko5nLSINv8C&pg=PA65|date=October 19, 2012|publisher=Springer Science & Business Media|isbn=978-1-4471-4405-2|pages=65–|access-date=November 13, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215026/https://books.google.com/books?id=Eko5nLSINv8C&pg=PA65|url-status=live}}</ref> [[Breast cancer]] is said by some sources to be an absolute contraindication of testosterone therapy,<ref name="KavoussiCostabile2012" /> but androgens including testosterone have also actually been used to treat breast cancer.<ref name="Perry2008">{{cite book| vauthors = Perry MC |title=The Chemotherapy Source Book |url=https://books.google.com/books?id=CDADMzS0TKUC&pg=PA368|year=2008|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-7328-7 |pages=368–|archive-url=https://web.archive.org/web/20170908214106/https://books.google.com/books?id=CDADMzS0TKUC&pg=PA368|archive-date=September 8, 2017|url-status=live}}</ref> Relative contraindications of testosterone include elevated [[prostate-specific antigen]] (PSA) in men with a high risk of prostate cancer due to [[ethnicity]] or family history, severe [[urinary tract infection|lower urinary tract symptom]]s, and elevated hematocrit (>50%).<ref name="KavoussiCostabile2012" />

==Side effects==
{{See also|Anabolic steroid#Adverse effects|Androgen replacement therapy#Adverse effects}}

In February 2025, the US [[Food and Drug Administration]] (FDA) specified label changes for products containing testosterone.<ref name="FDA 20250228" /> The changes include removing language from the [[boxed warning]] related to an increased risk of adverse cardiovascular outcomes and adding a new warning about increased blood pressure.<ref name="FDA 20250228">{{cite web | title=FDA issues class-wide labeling changes for testosterone products | website=U.S. [[Food and Drug Administration]] (FDA) | date=February 28, 2025 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-issues-class-wide-labeling-changes-testosterone-products | access-date=March 6, 2025}} {{PD-notice}}</ref>

Adverse effects may also include minor side effects such as oily skin, acne, and seborrhea, as well as loss of scalp hair, which may be prevented or reduced with [[5α-reductase inhibitors]]. In women, testosterone can produce [[hirsutism]] (excessive facial/body hair growth), [[voice change|deepening of the voice]], and other signs of [[virilization]]. Exogenous testosterone may cause suppression of [[spermatogenesis]] in men, leading to, in some cases, reversible [[infertility]].<ref name="pmid1977002">{{cite journal | s2cid = 25825354 | title = Contraceptive efficacy of testosterone-induced azoospermia in normal men. World Health Organization Task Force on methods for the regulation of male fertility | journal = Lancet | volume = 336 | issue = 8721 | pages = 955–9 | date = October 1990 | pmid = 1977002 | doi = 10.1016/0140-6736(90)92416-F }}</ref> [[Gynecomastia]] and [[breast tenderness]] may occur with high dosages of testosterone due to peripheral conversion of testosterone by [[aromatase]] into excessive amounts of the [[estrogen (medication)|estrogen]] [[estradiol (medication)|estradiol]].<ref>{{cite journal | vauthors = Rhoden EL, Morgentaler A | title = Treatment of testosterone-induced gynecomastia with the aromatase inhibitor, anastrozole | journal = International Journal of Impotence Research | volume = 16 | issue = 1 | pages = 95–7 | date = February 2004 | pmid = 14963480 | doi = 10.1038/sj.ijir.3901154 | doi-access = free }}</ref> Testosterone treatment, particularly in high dosages, can also be associated with [[mood changes]], increased [[aggression]], increased [[sex drive]], [[spontaneous erection]]s, and [[nocturnal emission]]s.<ref name="Yates2000">{{cite journal| vauthors=Yates WR |title=Testosterone in Psychiatry |journal=Archives of General Psychiatry |volume=57 |issue=2 |year=2000 |pages=155 |issn=0003-990X |doi=10.1001/archpsyc.57.2.155}}</ref><ref name="pmid24016385">{{cite journal |vauthors=Johnson JM, Nachtigall LB, Stern TA |title=The effect of testosterone levels on mood in men: a review |journal=Psychosomatics |volume=54 |issue=6 |pages=509–514 |year=2013 |pmid=24016385 |doi=10.1016/j.psym.2013.06.018}}</ref><ref name="pmid6814798">{{cite journal |vauthors=Davidson JM, Kwan M, Greenleaf WJ |title=Hormonal replacement and sexuality in men |journal= Clinics in Endocrinology and Metabolism |volume=11 |issue=3 |pages=599–623 |date=November 1982 |pmid=6814798 |doi=10.1016/s0300-595x(82)80003-0}}</ref><ref name="BagatellBremner2003-144etc">{{cite book |vauthors=Bagatell C, Bremner WJ |title=Androgens in Health and Disease |url=https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA259|date=May 27, 2003|publisher=Springer Science & Business Media|isbn=978-1-59259-388-0|pages=144, 259–261, 351|access-date=November 18, 2016|archive-date=April 14, 2019 |archive-url=https://web.archive.org/web/20190414215125/https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA259|url-status=live}}</ref>

Other side effects include increased [[hematocrit]], which can require [[venipuncture]] in order to treat, and exacerbation of [[sleep apnea]].<ref name=Pas2013>{{cite journal | vauthors = Pastuszak AW, Pearlman AM, Lai WS, Godoy G, Sathyamoorthy K, Liu JS, Miles BJ, Lipshultz LI, Khera M | title = Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy | journal = The Journal of Urology | volume = 190 | issue = 2 | pages = 639–44 | date = Aug 2013 | pmid = 23395803 | pmc = 4544840 | doi = 10.1016/j.juro.2013.02.002 }}</ref>

The FDA stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging.<ref name="FDA2015"/> The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.<ref name=FDA2015/> They have also required the label include concerns about abuse and dependence.<ref>{{cite web|title=Testosterone and Other Anabolic Androgenic Steroids (AAS): FDA Statement - Risks Associated With Abuse and Dependence |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm526151.htm |website=[[FDA]]|access-date=October 26, 2016|date=October 25, 2016|url-status=live|archive-url=https://web.archive.org/web/20161027052404/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm526151.htm |archive-date=October 27, 2016}}</ref>

Injectable forms of testosterone can cause a lung problem called pulmonary oil microembolism (POME).  Symptoms of POME include cough, shortness of breath, tightening of the throat, chest pain, sweating, dizziness, and fainting.<ref>{{Cite web|date=August 2, 2020|title=Testosterone Injection|website=Drugs.com |url=https://www.drugs.com/testosterone.html|access-date=January 4, 2021|archive-date=January 8, 2021|archive-url=https://web.archive.org/web/20210108041736/https://www.drugs.com/testosterone.html|url-status=live}}</ref><ref>{{Cite web|date=March 15, 2019|title=Testosterone Injection|website=MedlinePlus |url=https://medlineplus.gov/druginfo/meds/a614041.html|access-date=January 4, 2021|archive-url=https://web.archive.org/web/20191223210513/https://medlineplus.gov/druginfo/meds/a614041.html|archive-date=December 23, 2019|url-status=live}}</ref> A postmarketing analysis by the manufacturer of Aveed (testosterone undeconate injection) found that POME occurred at a rate of less than 1% per injection per year for Aveed.<ref>{{cite journal |vauthors=Pastuszak AW, Hu Y, Freid JD |title=Occurrence of Pulmonary Oil Microembolism After Testosterone Undecanoate Injection: A Postmarketing Safety Analysis |journal=Sexual Medicine |volume=8 |issue=2 |pages=237–242 |date=June 2020 |pmid=32184081 |pmc=7261689 |doi=10.1016/j.esxm.2020.01.009}}</ref>

===Long-term adverse effects===

====Cardiovascular disease====
{{See also|Testosterone and the cardiovascular system}}

Results from the TRAVERSE trial were submitted in 2023, concluding that there was no increase in the risk of adverse cardiovascular outcomes in men using testosterone for hypogonadism.<ref name="FDA 20250228" /><ref>{{cite journal | vauthors = Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, Cunningham GR, Granger CB, Khera M, Thompson IM, Wang Q, Wolski K, Davey D, Kalahasti V, Khan N, Miller MG, Snabes MC, Chan A, Dubcenco E, Li X, Yi T, Huang B, Pencina KM, Travison TG, Nissen SE | title = Cardiovascular Safety of Testosterone-Replacement Therapy | journal = The New England Journal of Medicine | volume = 389 | issue = 2 | pages = 107–117 | date = July 2023 | pmid = 37326322 | doi = 10.1056/NEJMoa2215025 }}</ref>

Adverse effects of testosterone supplementation may include increased cardiovascular events (including [[stroke]]s and [[heart attack]]s) and [[death]]s based on three peer-reviewed studies involving men taking testosterone replacement.<ref>{{cite journal | vauthors = Finkle WD, Greenland S, Ridgeway GK, Adams JL, Frasco MA, Cook MB, Fraumeni JF, Hoover RN | title = Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men | journal = PLOS ONE | volume = 9 | issue = 1 | page = e85805 | date = January 2014 | pmid = 24489673 | pmc = 3905977 | doi = 10.1371/journal.pone.0085805 | bibcode = 2014PLoSO...985805F | doi-access = free }}</ref> In addition, an increase of 30% in deaths and heart attacks in older men has been reported.<ref name="pmid24193080">{{cite journal | vauthors = Vigen R, O'Donnell CI, Barón AE, Grunwald GK, Maddox TM, Bradley SM, Barqawi A, Woning G, Wierman ME, Plomondon ME, Rumsfeld JS, Ho PM | title = Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels | journal = JAMA | volume = 310 | issue = 17 | pages = 1829–36 | date = Nov 2013 | pmid = 24193080 | doi = 10.1001/jama.2013.280386 | doi-access = free }}</ref> Due to an increased incidence of adverse cardiovascular events compared to a [[placebo group]], a Testosterone in Older Men with Mobility Limitations (TOM) trial (a [[National Institute of Aging]] randomized trial) was halted early by the [[Data monitoring committee#Safety concerns|Data Safety and Monitoring Committee]].<ref>{{cite journal | vauthors = Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S | title = Adverse events associated with testosterone administration | journal = The New England Journal of Medicine | volume = 363 | issue = 2 | pages = 109–22 | date = July 8, 2010 | pmid = 20592293 | pmc = 3440621 | doi = 10.1056/NEJMoa1000485 }}</ref> On January 31, 2014, reports of [[stroke]]s, [[heart attack]]s, and [[death]]s in men taking FDA-approved testosterone-replacement led the FDA to announce that it would be investigating the issue.<ref name="FDA-20140131">{{cite web |author=Staff |title=FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products |url=https://www.fda.gov/downloads/Drugs/DrugSafety/UCM383909.pdf |publisher=[[U.S. Food and Drug Administration]] |date=January 31, 2014 |access-date=September 17, 2014 |url-status=live |archive-url=https://web.archive.org/web/20140219213907/https://www.fda.gov/downloads/Drugs/DrugSafety/UCM383909.pdf |archive-date=February 19, 2014}}</ref> Later, in September 2014, the FDA announced, as a result of the "potential for adverse cardiovascular outcomes", a review of the appropriateness and safety of Testosterone Replacement Therapy (TRT).<ref name="NYT-20140917">{{cite news | vauthors = Tavernise S | title = F.D.A. Panel Backs Limits on Testosterone Drugs | url = https://www.nytimes.com/2014/09/18/health/testosterone-drugs-fda.html | date = September 17, 2014 | work=[[The New York Times]] | access-date = September 18, 2014 | url-status = live | archive-url = https://web.archive.org/web/20140917201336/http://www.nytimes.com/2014/09/18/health/testosterone-drugs-fda.html | archive-date = September 17, 2014}}</ref><ref name="CNN-20140905">{{cite news |author=Staff |title=FDA Panel To Review Testosterone Therapy Appropriateness and Safety |url=http://ireport.cnn.com/docs/DOC-1167887 |date=September 5, 2014 |work=[[CNN News]] |access-date=September 14, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140911081501/http://ireport.cnn.com/docs/DOC-1167887 |archive-date=September 11, 2014}}</ref><ref name="FDA-20140903">{{cite web |author=Staff |title=Joint Meeting for Bone, Reproductive and Urologic Drugs Advisory Committee (BRUDAC) and the Drug Safety And Risk Management Advisory Committee (DSARM AC) – FDA background documents for the discussion of two major issues in testosterone replacement therapy (TRT): 1. The appropriate indicated population for TRT, and 2. The potential for adverse cardiovascular outcomes associated with use of TRT |url=https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM412536.pdf |date=September 17, 2014 |work=[[Food and Drug Administration]] |access-date=September 14, 2014 |url-status=live |archive-url=https://web.archive.org/web/20140906043632/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM412536.pdf |archive-date=September 6, 2014}}</ref> The FDA now requires warnings in the drug labeling of all approved testosterone products regarding [[deep vein thrombosis]] and [[pulmonary embolism]].<ref>{{cite web|author=Staff|title=FDA adding general warning to testosterone products about potential for venous blood clots|url=https://www.fda.gov/Drugs/DrugSafety/ucm401746.htm|website=[[FDA]]|access-date=October 9, 2014|date=June 19, 2014|url-status=live|archive-date=October 6, 2014|archive-url=https://web.archive.org/web/20141006074106/https://www.fda.gov/Drugs/DrugSafety/ucm401746.htm}}</ref>

Up to the year 2010, studies had not shown any effect on the risk of death, [[prostate cancer]] or [[cardiovascular disease]];<ref name="pmid17285783">{{cite journal | vauthors = Haddad RM, Kennedy CC, Caples SM, Tracz MJ, Boloña ER, Sideras K, Uraga MV, Erwin PJ, Montori VM | title = Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials | journal = Mayo Clinic Proceedings | volume = 82 | issue = 1 | pages = 29–39 | date = Jan 2007 | pmid = 17285783 | doi = 10.4065/82.1.29 }}</ref><ref name=Fer2010>{{cite journal | vauthors = Fernández-Balsells MM, Murad MH, Lane M, Lampropulos JF, Albuquerque F, Mullan RJ, Agrwal N, Elamin MB, Gallegos-Orozco JF, Wang AT, Erwin PJ, Bhasin S, Montori VM | title = Clinical review 1: Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 95 | issue = 6 | pages = 2560–75 | date = Jun 2010 | pmid = 20525906 | doi = 10.1210/jc.2009-2575 | doi-access = free }}</ref> more recent{{when|date=January 2020}} studies, however, do raise concerns.<ref>{{cite web|title=Testosterone Products: Drug Safety Communication – FDA Investigating Risk of Cardiovascular Events|work=[[FDA]]|date=January 31, 2014 |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm384225.htm |access-date=February 3, 2014|url-status=live|archive-date=February 14, 2014|archive-url=https://web.archive.org/web/20140214183006/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm384225.htm}}</ref> A 2013 study, published in the Journal of the American Medical Association, reported "the use of testosterone therapy was significantly associated with increased risk of adverse outcomes." The study began after a previous, randomized, clinical trial of testosterone therapy in men was stopped prematurely "due to adverse cardiovascular events raising concerns about testosterone therapy safety."<ref name="pmid24193080"/>

However, when given to men with hypogonadism in the short- and medium-term, testosterone replacement therapy does not increase the risk of cardiovascular events (including strokes and heart attacks and other heart diseases). The long-term safety of the therapy is not known yet.<ref>{{Cite journal |date=February 6, 2023 |title=Research provides reassurance about the safety of testosterone treatment |url=https://evidence.nihr.ac.uk/alert/research-provides-reassurance-about-safety-testosterone-treatment/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_56696 |s2cid=257851823 |access-date=February 28, 2023 |archive-date=February 28, 2023 |archive-url=https://web.archive.org/web/20230228091540/https://evidence.nihr.ac.uk/alert/research-provides-reassurance-about-safety-testosterone-treatment/ |url-status=live }}</ref><ref>{{cite journal | vauthors = Hudson J, Cruickshank M, Quinton R, Aucott L, Aceves-Martins M, Gillies K, Bhasin S, Snyder PJ, Ellenberg SS, Grossmann M, Travison TG, Gianatti EJ, van der Schouw YT, Emmelot-Vonk MH, Giltay EJ, Hackett G, Ramachandran S, Svartberg J, Hildreth KL, Groti Antonic K, Brock GB, Tenover JL, Tan HM, Kong CH, Tan WS, Marks LS, Ross RJ, Schwartz RS, Manson P, Roberts S, Andersen MS, Magnussen LV, Hernández R, Oliver N, Wu F, Dhillo WS, Bhattacharya S, Brazzelli M, Jayasena CN | title = Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis | journal = The Lancet. Healthy Longevity | volume = 3 | issue = 6 | pages = e381–e393 | date = June 2022 | pmid = 35711614 | pmc = 9184259 | doi = 10.1016/S2666-7568(22)00096-4 }}</ref>

====Benign prostatic hyperplasia====
Testosterone therapy for patients with late-onset hypogonadism, in addition to increasing risk of cardiovascular disease and prostate cancer, may exacerbate the risk factors associated with [[benign prostatic hyperplasia]], a condition that involves the noncancerous enlargement of the prostate gland, which can lead to urinary symptoms.<ref name="pmid35266057">{{cite journal |vauthors=Snyder P |title=Testosterone treatment of late-onset hypogonadism - benefits and risks |journal=Rev Endocr Metab Disord |volume=23 |issue=6 |pages=1151–1157 |date=December 2022 |pmid=35266057 |doi=10.1007/s11154-022-09712-1}}</ref>

====Prostate cancer====
Testosterone in the presence of a slow-growing prostate cancer is assumed to increase its growth rate. However, the association between testosterone supplementation and the development of prostate cancer is unproven.<ref name="pmid19863857">{{cite journal | vauthors = Rhoden EL, Averbeck MA | s2cid = 20250546 | title = Testosterone therapy and prostate carcinoma | journal = Current Urology Reports | volume = 10 | issue = 6 | pages = 453–59 | date = Nov 2009 | pmid = 19863857 | doi = 10.1007/s11934-009-0072-1 }}</ref> Nevertheless, physicians are cautioned about the cancer risk associated with testosterone supplementation.<ref name="pmid16006887">{{cite journal | vauthors = Gaylis FD, Lin DW, Ignatoff JM, Amling CL, Tutrone RF, Cosgrove DJ | title = Prostate cancer in men using testosterone supplementation | journal = The Journal of Urology | volume = 174 | issue = 2 | pages = 534–38; discussion 538 | date = Aug 2005 | pmid = 16006887 | doi = 10.1097/01.ju.0000165166.36280.60 }}</ref>

Testosterone may accelerate pre-existing [[prostate cancer]] growth in individuals who have undergone androgen deprivation.<ref name=Pas2013/> It is recommended that physicians screen for prostate cancer with a digital rectal exam and [[prostate-specific antigen]] (PSA) level before starting therapy, and monitor PSA and hematocrit levels closely during therapy.<ref name="auto"/>

Ethnic groups have different rates of prostate cancer.<ref name=Cal2010/> Differences in sex hormones, including testosterone, have been suggested as an explanation for these differences.<ref name=Cal2010>{{cite journal |vauthors=Calistro Alvarado L |title=Population differences in the testosterone levels of young men are associated with prostate cancer disparities in older men |journal=American Journal of Human Biology |volume=22 |issue=4 |pages=449–455 |year=2010 |pmid=20087895 |doi=10.1002/ajhb.21016 |s2cid=21117845}}</ref> This apparent paradox can be resolved by noting that prostate cancer is very common. In autopsies, 80% of 80-year-old men have prostate cancer.<ref name="pmid15495199">{{cite journal |vauthors=Bostwick DG, Burke HB, Djakiew D, Euling S, Ho SM, Landolph J, Morrison H, Sonawane B, Shifflett T, Waters DJ, Timms B |title=Human prostate cancer risk factors |journal=Cancer |volume=101 |issue=10 Suppl |pages=2371–2490 |date=Nov 2004 |pmid=15495199 |doi=10.1002/cncr.20408 |s2cid=24807561}}</ref>

===Pregnancy and breastfeeding===
Testosterone is [[contraindication|contraindicated]] in [[pregnancy]] and not recommended during [[breastfeeding]].<ref>{{cite web|title=Testosterone Pregnancy and Breastfeeding Warnings |url=https://www.drugs.com/pregnancy/testosterone.html|access-date=February 1, 2014|url-status=live|archive-url=https://web.archive.org/web/20140201201902/http://www.drugs.com/pregnancy/testosterone.html|archive-date=February 1, 2014}}</ref> Androgens like testosterone are [[teratogen]]s and are known to cause [[fetus|fetal]] harm, such as producing [[virilization]] and [[ambiguous genitalia]].

==Interactions==

===5α-Reductase inhibitors===
[[5α-Reductase inhibitor]]s like [[finasteride]] and [[dutasteride]] can slightly increase circulating levels of testosterone by inhibiting its [[metabolism]].<ref name="JamesonKretser2013">{{cite book | vauthors = Jameson JL, de Kretser DM, Marshall JC, De Groot JL | title = Endocrinology Adult and Pediatric: Reproductive Endocrinology | url = https://books.google.com/books?id=Np8xxP6pcdUC&pg=RA1-PT1157 | date = May 7, 2013 | publisher = Elsevier Health Sciences | isbn = 978-0-323-22152-8 | pages = 1– | url-status = live | archive-url = https://web.archive.org/web/20170908214106/https://books.google.com/books?id=Np8xxP6pcdUC&pg=RA1-PT1157 | archive-date = September 8, 2017}}</ref> However, these drugs do this via prevention of the conversion of testosterone into its more potent [[metabolite]] [[dihydrotestosterone]] (DHT), and this results in dramatically reduced circulating levels of DHT (which circulates at much lower relative concentrations).<ref name="JamesonKretser2013" /><ref name="Blume-PeytaviWhiting2008">{{cite book | vauthors = Blume-Peytavi U, Whiting DA, Trüeb RM | title = Hair Growth and Disorders | url = https://books.google.com/books?id=pHrX2-huQCoC&pg=PA182 | date = June 26, 2008 | publisher = Springer Science & Business Media | isbn = 978-3-540-46911-7 | pages = 182– | url-status = live | archive-url = https://web.archive.org/web/20170908214106/https://books.google.com/books?id=pHrX2-huQCoC&pg=PA182 | archive-date = September 8, 2017}}</ref> In addition, local levels of DHT in so-called androgenic (5α-reductase-expressing) tissues are also markedly reduced,<ref name="JamesonKretser2013" /><ref name="Blume-PeytaviWhiting2008" /> and this can have a strong impact on certain effects of testosterone.<ref name="Llewellyn2011" /><ref name="BagatellBremner2003-p78">{{cite book | vauthors = Bagatelle C, Bremner WJ | title = Androgens in Health and Disease | url = https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA78 | date = May 27, 2003 | publisher = Springer Science & Business Media | isbn = 978-1-59259-388-0 | pages = 78– | access-date = December 6, 2016 | archive-date = April 14, 2019 | archive-url = https://web.archive.org/web/20190414215015/https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA78 | url-status = live }}</ref> For instance, growth of body and facial hair and [[penis enlargement|penile growth]] induced by testosterone may be inhibited by 5α-reductase inhibitors, and this could be considered undesirable in the context of, for instance, [[puberty induction]].<ref name="BagatellBremner2003-p78" /><ref name="Baskin2012">{{cite book|vauthors=Baskin LS|title=Hypospadias and Genital Development|url=https://books.google.com/books?id=8zfaBwAAQBAJ&pg=PA37|date=December 6, 2012|publisher=Springer Science & Business Media|isbn=978-1-4419-8995-6|pages=37–|access-date=December 6, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215056/https://books.google.com/books?id=8zfaBwAAQBAJ&pg=PA37|url-status=live}}</ref> On the other hand, 5α-reductase inhibitors may prevent or reduce adverse androgenic side effects of testosterone like [[androgenic alopecia|scalp hair loss]], [[Human skin#Oily skin|oily skin]], [[acne]], and [[seborrhea]].<ref name="Llewellyn2011" /> In addition to the prevention of testosterone conversion into DHT, 5α-reductase inhibitors also prevent the formation of [[neurosteroid]]s like [[3α-androstanediol]] from testosterone, and this may have neuropsychiatric consequences in some men.<ref name="Frontiers">{{cite book|title=Neurosteroids|url=https://books.google.com/books?id=fSgNRlZUwt0C&pg=PA358|publisher=Frontiers E-books|isbn=978-2-88919-078-2|pages=357–358|access-date=December 6, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414214952/https://books.google.com/books?id=fSgNRlZUwt0C&pg=PA358|url-status=live}}</ref>

===Aromatase inhibitors===
[[Aromatase inhibitor]]s like [[anastrozole]] prevent the conversion of testosterone into [[estradiol (medication)|estradiol]] by [[aromatase]].<ref name="Llewellyn2011" /> As only a very small fraction of testosterone is converted into estradiol, this does not affect testosterone levels, but it can prevent [[estrogen (medication)|estrogen]]ic side effects like gynecomastia that can occur when testosterone is administered at relatively high dosages.<ref name="Llewellyn2011" /> However, estradiol exerts [[negative feedback]] on the [[hypothalamic–pituitary–gonadal axis]] and, for this reason, prevention of its formation can reduce this feedback and disinhibit gonadal production of testosterone, which in turn can increase levels of endogenous testosterone.<ref name="pmid14623515">{{cite journal | vauthors = Simpson ER | s2cid = 11210435 | title = Sources of estrogen and their importance | journal = J. Steroid Biochem. Mol. Biol. | volume = 86 | issue = 3–5 | pages = 225–30 |date=September 2003 | pmid = 14623515 | doi = 10.1016/S0960-0760(03)00360-1 }}</ref> Testosterone therapy is sometimes combined with an aromatase inhibitor for men with secondary hypogonadism who wish to conceive children with their partners.<ref name="Nieschlag2010">{{cite book |veditors=Nieschlag E, Behre HM, Nieschlag S |title=Andrology: Male Reproductive Health and Dysfunction |date=2009 |publisher=Springer |location=Berlin |isbn=978-3-540-78354-1 |page=459 |edition=3rd}}</ref>

===Cytochrome P450 inhibitors===
[[Enzyme inhibitor|Inhibitor]]s and [[enzyme inducer|inducer]]s of [[cytochrome P450]] [[enzyme]]s like [[CYP3A4]] have been associated with little or no effect on circulating testosterone levels.{{Citation needed|date=December 2016}}

===Antiandrogens and estrogens===
[[Antiandrogen]]s like [[cyproterone acetate]], [[spironolactone]], and [[bicalutamide]] can block the androgenic and anabolic effects of testosterone.<ref name="WeckerWatts2009">{{cite book | vauthors = Wecker L, Crespo L, Dunaway G, Faingold C, Watts S | title = Brody's Human Pharmacology | url = https://books.google.com/books?id=kfsrz_-OrMQC&pg=PA468 | date = April 1, 2009 | publisher = Elsevier Health Sciences | isbn = 978-0-323-07575-6 | pages = 468–469 | access-date = November 13, 2016 | archive-date = April 14, 2019 | archive-url = https://web.archive.org/web/20190414215026/https://books.google.com/books?id=kfsrz_-OrMQC&pg=PA468 | url-status = live }}</ref><ref name="Becker2001"/><!--Defined in Template:Available forms of testosterone--> [[Estrogen (medication)|Estrogen]]s can reduce the effects of testosterone by increasing the hepatic production and in turn circulating levels of [[sex hormone-binding globulin]] (SHBG), a [[carrier protein]] that binds to and occupies androgens like testosterone and DHT, and thereby reducing free concentrations of these androgens.<ref name="Becker2001" /><ref name="WeinKavoussi2015">{{cite book | vauthors = Partin AW, Wein AJ, Kavoussi LR, Peters CA | title = Campbell-Walsh Urology | url = https://books.google.com/books?id=OH_OCgAAQBAJ&pg=PT7207 | date = October 23, 2015 | publisher = Elsevier Health Sciences | isbn = 978-0-323-26374-0 | pages = 7207– | access-date = December 6, 2016 | url-status = live | archive-date = April 14, 2019 | archive-url = https://web.archive.org/web/20190414215011/https://books.google.com/books?id=OH_OCgAAQBAJ&pg=PT7207}}</ref>

==Pharmacology==

===Pharmacodynamics===
{{See also|Testosterone#Mechanism of action|Anabolic steroid#Pharmacology}}

{{Relative androgenic to anabolic activity in animals}}

Testosterone is a high [[affinity (pharmacology)|affinity]] [[ligand (biochemistry)|ligand]] for and [[agonist]] of the [[nuclear receptor|nuclear]] [[androgen receptor]] (AR). In addition, testosterone binds to and activates [[membrane androgen receptor]]s (mARs) such as [[GPRC6A]] and [[ZIP9]]. Testosterone is also potentiated via [[biotransformation|transformation]] by [[5α-reductase]] into the more [[potency (pharmacology)|potent]] androgen DHT in so-called androgenic [[tissue (biology)|tissue]]s such as the [[prostate gland]], [[seminal vesicle]]s, [[skin]], and [[hair follicle]]s. In contrast to the case of testosterone, such potentiation occurs to a reduced extent or not at all with most [[synthetic compound|synthetic]] AAS (as well as with DHT), and this is primarily responsible for the dissociation of [[anabolic]] and androgenic effects with these agents.<ref name="Kicman2008">{{cite journal | vauthors = Kicman AT | title = Pharmacology of anabolic steroids | journal = British Journal of Pharmacology | volume = 154 | issue = 3 | pages = 502–21 | date = June 2008 | pmid = 18500378 | pmc = 2439524 | doi = 10.1038/bjp.2008.165 }}</ref> In addition to DHT, testosterone is converted at a rate of approximately 0.3% into the [[estrogen (medication)|estrogen]] [[estradiol (medication)|estradiol]] via [[aromatase]].<ref name="BurtisAshwood2012">{{cite book | vauthors = Burtis CA, Ashwood ER, Bruns DE | title = Tietz Textbook of Clinical Chemistry and Molecular Diagnostics | url = https://books.google.com/books?id=BBLRUI4aHhkC&pg=PA1947 | date = October 14, 2012 | publisher = Elsevier Health Sciences | isbn = 978-1-4557-5942-2 | pages = 1947– | url-status = live | archive-url = https://web.archive.org/web/20160522142447/https://books.google.com/books?id=BBLRUI4aHhkC | archive-date = May 22, 2016}}</ref> This occurs in many tissues, especially [[adipose tissue]], the [[liver]], and the [[brain]], but primarily in adipose tissue.<ref name="BurtisAshwood2012" /> Testosterone, after conversion into DHT, is also metabolized into 3α-androstanediol, a [[neurosteroid]] and potent [[positive allosteric modulator]] of the [[GABAA receptor|GABA<sub>A</sub> receptor]], and [[3β-androstanediol]], a potent and preferential agonist of the [[ERβ]].<ref name="KohtzFrye2012">{{cite book | vauthors = Kohtz AS, Frye CA | chapter = Dissociating Behavioral, Autonomic, and Neuroendocrine Effects of Androgen Steroids in Animal Models | title = Psychiatric Disorders | series = [[Methods in Molecular Biology]] | volume = 829 | pages = 397–431 | year = 2012 | publisher = Springer | pmid = 22231829 | doi = 10.1007/978-1-61779-458-2_26 | isbn = 978-1-61779-457-5 }}</ref> These metabolites, along with estradiol, may be involved in a number of the effects of testosterone in the brain, including its [[antidepressant]], [[anxiolytic]], [[psychological stress|stress]]-relieving, [[reward system|rewarding]], and [[pro-sexual]] effects.<ref name="KohtzFrye2012" /> Whereas testosterone produced both anabolic and androgenic effects, despite the lack of clear boundaries between these effects, as there is a great deal of mutual overlap between them,<ref name="pmid25905231">{{cite book | chapter = Androgen Physiology, Pharmacology and Abuse | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK279000/ | vauthors = Handelsman DJ | title = Endotext [Internet] | publisher = MDText.com, Inc | date = January 2013 | pmid = 25905231 | access-date = November 11, 2016 | archive-date = March 9, 2021 | archive-url = https://web.archive.org/web/20210309030923/https://www.ncbi.nlm.nih.gov/books/NBK279000/ | url-status = live }}</ref> the relative potency of these effects exerted by testosterone can depend on various factors and is a topic of ongoing research.<ref name="Ceponis-2017">{{cite book | chapter-url=https://link.springer.com/referenceworkentry/10.1007/978-3-319-29456-8_11-1 | doi=10.1007/978-3-319-29456-8_11-1 | chapter=Anabolic and Metabolic Effects of Testosterone and Other Androgens: Direct Effects and Role of Testosterone Metabolic Products | title=Thyroid Diseases | series=Endocrinology | date=2017 | vauthors = Čeponis J, Wang C, Swerdloff S, Liu PY | pages=1–22 | isbn=978-3-319-29195-6 | access-date=April 6, 2024 | archive-date=April 7, 2024 | archive-url=https://web.archive.org/web/20240407084734/https://link.springer.com/referenceworkentry/10.1007/978-3-319-29456-8_11-1 | url-status=live }}</ref><ref name="pmid12017555">{{cite journal |vauthors=Kuhn CM |title=Anabolic steroids |journal=Recent Prog Horm Res |volume=57 |issue= |pages=411–34 |date=2002 |pmid=12017555 |doi=10.1210/rp.57.1.411|doi-access=free }}</ref>

====Effects in the body and brain====
The ARs are expressed widely throughout the body, including in the [[penis]], [[testicle]]s, [[epididymides]], [[prostate gland]], [[seminal vesicle]]s, [[adipose tissue|fat]], [[skin]], [[bone]], [[bone marrow]], [[muscle]], [[larynx]], [[heart]], [[liver]], [[kidney]]s, [[pituitary gland]], [[hypothalamus]], and elsewhere throughout the [[brain]].<ref name="NieschlagBehre2010">{{cite book | vauthors = Nieschlag E, Behre HM, Nieschlag S | title = Andrology: Male Reproductive Health and Dysfunction | url = https://books.google.com/books?id=mEgckDNkonUC&pg=PA442 | date = January 13, 2010 | publisher = Springer Science & Business Media | isbn = 978-3-540-78355-8 | pages = 49–54,441–446 | url-status = live | archive-url = https://web.archive.org/web/20160623203518/https://books.google.com/books?id=mEgckDNkonUC | archive-date = June 23, 2016}}</ref><ref name="StraussBarbieri2017">{{cite book |vauthors=Strauss JF, Barbieri RL, Gargiulo AR|title=Yen & Jaffe's Reproductive Endocrinology E-Book: Physiology, Pathophysiology, and Clinical Management |url=https://books.google.com/books?id=67ZEDwAAQBAJ&pg=PA292 |date=December 23, 2017|publisher=Elsevier Health Sciences|isbn=978-0-323-58232-2|pages=292–|access-date=March 31, 2018|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215014/https://books.google.com/books?id=67ZEDwAAQBAJ&pg=PA292|url-status=live}}</ref> Through activation of the ARs (as well as the mARs), testosterone has many effects, including the following:<ref name="NieschlagBehre2010" /><ref name="NieschlagBehre2012b" />{{Additional citation needed|date=April 2018}}
* Promotes growth, function, and maintenance of the [[prostate gland]], [[seminal vesicles]], and [[penis]] during [[puberty]] and thereafter
* Promotes growth and maintenance of [[muscle]]s, particularly of the [[upper body]]
* Causes [[subcutaneous fat]] to be [[android fat distribution|deposited in a masculine pattern]] and decreases overall [[body fat]]
* Suppresses [[breast development]] induced by [[estrogen]]s, but can also still produce [[gynecomastia]] via excessive conversion into [[estradiol]] if levels are too high
* Maintains skin health, integrity, appearance, and hydration and slows the rate of aging of the skin, but can also cause [[oily skin]], [[acne]], and [[seborrhea]]
* Promotes the growth of [[facial hair|facial]] and [[body hair]], but can also cause [[scalp hair loss]] and [[hirsutism]]
* Contributes to [[bone growth]] and causes [[shoulder broadening|broadening of the shoulders]] at puberty
* Modulates [[liver protein synthesis]], such as the production of [[sex hormone-binding globulin]] and many other proteins
* Increases production of [[erythropoietin]] in the [[kidney]]s and thereby stimulates [[red blood cell]] production in bone marrow and elevates [[hematocrit]]
* Exerts [[negative feedback]] on the [[hypothalamic–pituitary–gonadal axis]] by suppressing the [[secretion]] of the [[gonadotropin]]s [[follicle-stimulating hormone]] (FSH) and [[luteinizing hormone]] (LH) from the [[pituitary gland]], thereby inhibiting [[gonad]]al [[sex hormone]] [[biosynthesis|production]] as well as [[spermatogenesis]] and [[fertility]]
* Regulates the [[vasomotor system]] and [[body temperature]] via the [[hypothalamus]], thereby preventing [[hot flash]]es
* Modulates brain function, with effects on [[mood (psychology)|mood]], [[emotionality]], [[aggression]], and [[human sexuality|sexuality]], as well as [[cognition]] and [[memory]]
* Increases [[sex drive]] and [[erectile function|erectile capacity]] and causes [[spontaneous erection]]s and [[nocturnal emission]]s
* Increases the risk of [[benign prostatic hyperplasia]] and accelerates the progression of prostate cancer
* Decreases [[breast proliferation]] and the risk of [[breast cancer]]

===Pharmacokinetics===
{{Main|Pharmacokinetics of testosterone}}
{{See also|Testosterone (patch)|Androgen ester#Testosterone esters}}

Testosterone can be taken by a variety of different [[routes of administration]].<ref name="BehreNieschlag2012">{{cite book| vauthors = Behre HM, Nieschlag E |chapter=Testosterone preparations for clinical use in males| veditors = Nieschlag E, Behre HM, Nieschlag S |pages=309–335|doi=10.1017/CBO9781139003353.016|title=Testosterone: Action, Deficiency, Substitution|date=July 26, 2012|publisher=Cambridge University Press|isbn=978-1-107-01290-5}}</ref> These include [[oral administration|oral]], [[buccal administration|buccal]], [[sublingual administration|sublingual]], [[intranasal administration|intranasal]], [[transdermal administration|transdermal]] ([[gel]]s, [[cream (pharmacy)|cream]]s, [[transdermal patch|patch]]es), [[rectal administration|rectal]] [[suppository|suppositories]]), by [[intramuscular injection|intramuscular]] or [[subcutaneous injection|subcutaneous]] [[injection (medicine)|injection]] (in [[oil]] or [[aqueous]]), and as a [[subcutaneous implant]].<ref name="BehreNieschlag2012" /> The [[pharmacokinetics]] of testosterone, including its [[bioavailability]], circulating testosterone levels, [[metabolism]], [[biological half-life]], and other parameters, differ by route of administration.<ref name="BehreNieschlag2012" />

==Chemistry==
Testosterone is a [[natural product|naturally occurring]] [[androstane]] [[steroid]] and is also known by the chemical name androst-4-en-17β-ol-3-one.<ref name="Elks2014">{{cite book| vauthors = Elks J |title=The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies|url=https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA641|date=November 14, 2014|publisher=Springer|isbn=978-1-4757-2085-3|pages=641–642|url-status=live|archive-url=https://web.archive.org/web/20170215024945/https://books.google.com/books?id=0vXTBwAAQBAJ|archive-date=February 15, 2017}}</ref> It has a [[double bond]] between the C4 and C5 positions (making it an [[androstene]]), a [[ketone]] [[functional group|group]] at the C3 position, and a [[hydroxyl group|hydroxyl]] ([[alcohol (chemistry)|alcohol]]) group at the C17β position.<ref name="Elks2014" />

===Derivatives===
{{See also|Androgen ester#Testosterone esters|List of androgens/anabolic steroids}}

Testosterone esters are [[substituent|substituted]] at the C17β position with a [[lipophilicity|lipophilic]] [[fatty acid]] [[ester]] [[moiety (chemistry)|moiety]] of varying [[side chain|chain]] length.<ref name="JamesonGroot2015">{{cite book|vauthors=Jameson JL, De Groot LJ|title=Endocrinology: Adult and Pediatric|url=https://books.google.com/books?id=xmLeBgAAQBAJ&pg=PA2387|date=February 25, 2015|publisher=Elsevier Health Sciences|isbn=978-0-323-32195-2|pages=2387–|access-date=November 18, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414214952/https://books.google.com/books?id=xmLeBgAAQBAJ&pg=PA2387|url-status=live}}</ref> Major testosterone esters include [[testosterone cypionate]], [[testosterone enanthate]], [[testosterone propionate]], and [[testosterone undecanoate]].<ref name="Becker2001" /><ref name="Elks2014" /><ref name="ChappleSteers2011">{{cite book|vauthors=Chapple CR, Steers WD|title=Practical Urology: Essential Principles and Practice: Essential Principles and Practice|url=https://books.google.com/books?id=A9m8TkdCUqEC&pg=PA228|date=May 10, 2011|publisher=Springer Science & Business Media|isbn=978-1-84882-034-0|pages=228–|access-date=November 18, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215041/https://books.google.com/books?id=A9m8TkdCUqEC&pg=PA228|url-status=live}}</ref> A C17β [[ether]] [[prodrug]] of testosterone, [[cloxotestosterone acetate]], has also been marketed, although it is little known and is used very rarely or no longer.<ref name="Elks2014" /> Another C17β ether prodrug of testosterone, [[silandrone]], also exists but was never marketed, and is notable in that it is orally active.<ref name="Elks2014" /> In addition to ester and ether prodrugs, [[androgen prohormone]]s or [[precursor (biochemistry)|precursor]]s of testosterone, such as [[dehydroepiandrosterone]] (DHEA), [[4-androstenediol|androstenediol]], and [[4-androstenedione|androstenedione]], exist as well, and convert into testosterone to variable extents upon oral ingestion.<ref name="GregoryTravis2015">{{cite book|vauthors=Gregory HM, Travis TN|title=Essentials of Strength Training and Conditioning|edition=4th|url=https://books.google.com/books?id=bfuXCgAAQBAJ&pg=PA233|date=September 23, 2015|publisher=Human Kinetics|isbn=978-1-4925-0162-6|pages=229, 233|access-date=November 18, 2016|archive-date=February 17, 2018|archive-url=https://web.archive.org/web/20180217202709/https://books.google.com/books?id=bfuXCgAAQBAJ&pg=PA233|url-status=live}}</ref> Unlike testosterone ester and ether prodrugs however, these prohormones are only weakly androgenic/anabolic.<ref name="GregoryTravis2015" />

All synthetic AAS are [[chemical derivative|derivative]]s of testosterone.<ref name="GregoryTravis2015" /> Prominent examples include [[nandrolone]] (19-nortestosterone), [[metandienone]] (17α-methyl-δ<sup>1</sup>-testosterone), and [[stanozolol]] (a 17α-alkylated derivative of DHT). Unlike testosterone, AAS that are [[17α-alkylated anabolic steroid|17α-alkylated]], like metandienone and stanozolol, are orally active. This is due to [[steric hindrance]] of C17β-position metabolism during the first-pass through the liver. In contrast, most AAS that are not 17α-alkylated, like nandrolone, are not active orally, and must instead be administered via intramuscular injection. This is almost always in ester form; for instance, in the case of nandrolone, as [[nandrolone decanoate]] or [[nandrolone phenylpropionate]].

{{Structural properties of major testosterone esters}}

==History==
{{See also|Testosterone#History|Anabolic steroid#History}}

Testosterone was first isolated and [[chemical synthesis|synthesized]] in 1935.<ref name="M.D.2002">{{cite book | vauthors = Taylor WN | title = Anabolic Steroids and the Athlete | edition = 2nd | url = https://books.google.com/books?id=OGcQ0Tp2AFcC&pg=PA180 | date = January 16, 2002 | publisher = McFarland | isbn = 978-0-7864-1128-3 | pages = 180– | access-date = November 13, 2016 | archive-date = July 29, 2018 | archive-url = https://web.archive.org/web/20180729102024/https://books.google.com/books?id=OGcQ0Tp2AFcC&pg=PA180 | url-status = live }}</ref> Shortly thereafter, in 1937, testosterone first became commercially available as a [[pharmaceutical drug]] in the form of [[subdermal implant|pellet]]s and then in ester form for intramuscular injection as the relatively short-acting testosterone propionate.<ref name="Llewellyn2011">{{cite book|vauthors=Llewellyn W|title=Anabolics|url=https://books.google.com/books?id=afKLA-6wW0oC&pg=PT385|year=2011|publisher=Molecular Nutrition Llc|isbn=978-0-9828280-1-4|pages=385–394, 413, 426, 607, 666|access-date=December 18, 2017|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215102/https://books.google.com/books?id=afKLA-6wW0oC|url-status=live}}</ref><ref name="NieschlagBehre2012b" /><ref name="Hoberman2005">{{cite book | vauthors = Hoberman J | title = Testosterone Dreams: Rejuvenation, Aphrodisia, Doping | url = https://archive.org/details/testosteronedrea00hobe | url-access = registration | date = February 21, 2005 |publisher=University of California Press|isbn=978-0-520-93978-3|pages=[https://archive.org/details/testosteronedrea00hobe/page/134 134]–}}</ref> [[Methyltestosterone]], one of the first synthetic AAS and orally active androgens, was introduced in 1935, but was associated with hepatotoxicity and eventually became largely medically obsolete.<ref name="Hoberman2005" /> In the mid-1950s, the longer-acting testosterone esters [[testosterone enanthate]] and [[testosterone cypionate]] were introduced.<ref name="Hoberman2005" /> They largely superseded testosterone propionate and became the major testosterone esters used medically for over half a century.<ref name="Hoberman2005" /> In the 1970s, [[testosterone undecanoate]] was introduced for oral use in Europe,<ref name="Hoberman2005" /> although intramuscular testosterone undecanoate had already been in use in China for several years.<ref name="MundyFitzpatrick2010">{{cite book|vauthors=Mundy AR, Fitzpatrick J, Neal DE, George NJ|title=The Scientific Basis of Urology|url=https://books.google.com/books?id=h6HSBQAAQBAJ&pg=PA294|date=July 26, 2010|publisher=CRC Press|isbn=978-1-84184-749-8|pages=294–|access-date=November 18, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215011/https://books.google.com/books?id=h6HSBQAAQBAJ&pg=PA294|url-status=live}}</ref> Intramuscular testosterone undecanoate was not introduced in Europe and the United States until much later (in the early to mid 2000s and 2014, respectively).<ref name="MelmedPolonsky2015" /><ref>{{cite journal | vauthors = ((Adis R&D Profile)) | s2cid = 43349541 | year = 2004 | title = Testosterone Undecanoate—Schering AG | journal = Drugs | volume = 5 | issue = 6| pages = 368–369 | doi=10.2165/00126839-200405060-00012| pmid = 15563244 }}</ref>

The history of testosterone as a medication has been reviewed.<ref name="NieschlagNieschlag2017">{{cite book| vauthors = Nieschlag E, Nieschlag S |chapter=The History of Testosterone and the Testes: From Antiquity to Modern Times |title=Testosterone|year=2017|pages=1–19|publisher=Springer |doi=10.1007/978-3-319-46086-4_1|isbn=978-3-319-46084-0}}</ref><ref name="NieschlagNieschlag2019">{{cite journal | vauthors = Nieschlag E, Nieschlag S | title = ENDOCRINE HISTORY: The history of discovery, synthesis and development of testosterone for clinical use | journal = European Journal of Endocrinology | volume = 180 | issue = 6 | pages = R201–R212 | date = June 2019 | pmid = 30959485 | doi = 10.1530/EJE-19-0071 | doi-access = free }}</ref><ref name="NieschlagNieschlag2014">{{cite journal | vauthors = Nieschlag E, Nieschlag S | title = Testosterone deficiency: a historical perspective | journal = Asian Journal of Andrology | volume = 16 | issue = 2 | pages = 161–8 | year = 2014 | pmid = 24435052 | pmc = 3955324 | doi = 10.4103/1008-682X.122358 | doi-access = free }}</ref><ref name="MorgentalerTraish2018">{{cite journal | vauthors = Morgentaler A, Traish A | title = The History of Testosterone and the Evolution of its Therapeutic Potential | journal = Sexual Medicine Reviews | volume = 8 | issue = 2 | pages = 286–296 | date = April 2020 | pmid = 29661690 | doi = 10.1016/j.sxmr.2018.03.002 | s2cid = 4903551 }}</ref>

==Society and culture==
{{See also|Androgen replacement therapy#Society and culture|Anabolic steroid#Society and culture}}

===Usage===
In the US in the 2000s, companies and figures in the popular media have heavily marketed notions of "andropause" as something parallel to [[menopause]]; these notions have been rejected by the medical community.<ref name=NHSChoices>{{cite web|title=Male Menopause|url=http://www.nhs.uk/conditions/Male-menopause/Pages/Introduction.aspx|website=www.nhs.uk|publisher=NHS Choices|date=April 8, 2016|access-date=October 7, 2016|url-status=live |archive-url=https://web.archive.org/web/20161009181414/http://www.nhs.uk/conditions/Male-menopause/Pages/Introduction.aspx|archive-date=October 9, 2016}}</ref><ref>{{cite web | vauthors = Gorski D | title = "Low T": The triumph of marketing over science « Science-Based Medicine | url = https://www.sciencebasedmedicine.org/low-t-the-triumph-of-marketing-over-science/ | publisher = Science-Based Medicine | date = November 25, 2013 | url-status = live | archive-url = https://web.archive.org/web/20160911022624/https://www.sciencebasedmedicine.org/low-t-the-triumph-of-marketing-over-science/ | archive-date = September 11, 2016}}</ref> Additionally, advertising from drug companies selling testosterone and human growth hormone, as well as [[dietary supplement]] companies selling all kinds of "boosters" for aging men, have emphasized the "need" of middle-aged or ageing men for testosterone.<ref name=PerlsEd2015/> There is a medical condition called [[late-onset hypogonadism]]; according to Thomas Perls and David J. Handelsman, writing in a 2015 editorial in the ''[[Journal of the American Geriatrics Society]]'', it appears that this condition is [[overdiagnosed]] and [[Unnecessary health care|overtreated]].<ref name=PerlsEd2015>{{cite journal | vauthors = Perls T, Handelsman DJ | title = Disease mongering of age-associated declines in testosterone and growth hormone levels | journal = Journal of the American Geriatrics Society | volume = 63 | issue = 4 | pages = 809–11 | date = April 2015 | pmid = 25809947 | doi = 10.1111/jgs.13391 | s2cid = 328558 | doi-access = free }}</ref> Perls and Handelsman note that in the US, "sales of testosterone increased from $324 million in 2002 to $2 billion in 2012, and the number of testosterone doses prescribed climbed from 100 million in 2007 to half a billion in 2012, not including the additional contributions from compounding pharmacies, Internet, and direct-to-patient clinic sales."<ref name=PerlsEd2015/>

===Generic names===
''Testosterone'' is the [[generic drug|generic name]] of testosterone in English and Italian and the {{abbrlink|INN|International Nonproprietary Name}}, {{abbrlink|USAN|United States Adopted Name}}, {{abbrlink|USP|United States Pharmacopeia}}, {{abbrlink|BAN|British Approved Name|BAN}}, and {{abbrlink|DCIT|Denominazione Comune Italiana}} of the drug, while ''testostérone'' is its French name and the {{abbrlink|DCF|Dénomination Commune Française}}.<ref name="Elks2014" /><ref name="Drugs.com" /><ref name="IndexNominum2000">{{cite book|title=Index Nominum 2000: International Drug Directory|url=https://books.google.com/books?id=5GpcTQD_L2oC|date=January 2000|publisher=Taylor & Francis|isbn=978-3-88763-075-1|access-date=December 2, 2016|archive-date=October 21, 2021|archive-url=https://web.archive.org/web/20211021002502/https://books.google.com/books?id=5GpcTQD_L2oC|url-status=live}}</ref> It is also referred to in [[Latin language|Latin]] as ''testosteronum'', in Spanish and Portuguese as ''testosterona'', and in German, [[Dutch language|Dutch]], and Russian and other [[Slavic language]]s as ''testosteron''.<ref name="Drugs.com" /><ref name="IndexNominum2000" /> The [[Cyrillic script]] of testosterone is ''тестостерон''.<ref name="Мюллер2016">{{cite book|author=Владимир Мюллер|title=Англо-русский словарь. Русско-английский словарь. 250 000 слов|url=https://books.google.com/books?id=rOP6CwAAQBAJ&pg=PA643|date=April 15, 2016|publisher=ЛитРес|isbn=978-5-457-98308-3|pages=643–|access-date=December 2, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414214954/https://books.google.com/books?id=rOP6CwAAQBAJ&pg=PA643|url-status=live}}</ref>

===Brand names===
[[File:Depo-testosterone 200 mg ml crop.jpg|thumb|upright=0.8|A vial of Depo-Testosterone (testosterone cypionate in oil) for intramuscular injection]]

Testosterone is marketed under a large number of brand names throughout the world.<ref name="Drugs.com">{{cite web |title=Testosterone - International |url=https://www.drugs.com/international/testosterone.html |publisher=Drugs.com |access-date=November 12, 2016 |url-status=live |archive-url=https://web.archive.org/web/20161113175707/https://www.drugs.com/international/testosterone.html |archive-date=November 13, 2016}}</ref> Major brand names of testosterone and/or its esters include Andriol, Androderm, AndroGel, Axiron, Delatestryl, Depo-Testosterone, [[Intrinsa]], Nebido, [[Omnadren]], Primoteston, [[Testosterone propionate/testosterone phenylpropionate/testosterone isocaproate/testosterone decanoate|Sustanon]], Testim, TestoGel, TestoPatch, Testoviron, and Tostran.<ref name="Becker2001" /><ref name="Kicman2008" /><ref name="Drugs.com" />

===Availability===

====United States====
{{See also|List of androgens/anabolic steroids available in the United States#Testosterone and esters}}

{{As of|2016|11}}, unmodified (non-esterified) testosterone is available in the United States in the following formulations:<ref name="Drugs@FDA"/><!--Defined in Template:Available forms of testosterone-->
* [[Topical gels]]: AndroGel, Fortesta, Testim, Testosterone (generic)
* Topical solutions: Axiron, Testosterone (generic)
* Transdermal patches: Androderm, Testoderm (discontinued), Testoderm TTS (discontinued), Testosterone (generic)
* [[Nasal administration|Intranasal]] gels: Natesto
* Buccal tablets: Striant
* Pellet implants: Testopel

And the following ester prodrugs of testosterone are available in the United States in oil solutions for intramuscular injection:<ref name="Drugs@FDA" />
* [[Testosterone cypionate]]: Depo-Testosterone, Testosterone Cypionate (generic)
* [[Testosterone enanthate]]: Delatestryl, Xyosted (auto-injector), Testosterone Enanthate (generic)
* [[Testosterone propionate]]: Testosterone Propionate (generic)
* [[Testosterone undecanoate]]: Aveed

Unmodified testosterone was also formerly available for intramuscular injection but was discontinued.<ref name="Drugs@FDA" />

Testosterone cypionate and testosterone enanthate were formerly available in combination with [[estradiol cypionate]] and [[estradiol valerate]], respectively, under the brand names Depo-Testadiol and Ditate-DS, respectively, as oil solutions for intramuscular injection, but these formulations have been discontinued.<ref name="Drugs@FDA" />

Unlike in Europe, Canada, and much of the rest of the world, oral testosterone undecanoate is not available in the United States.<ref name="Drugs@FDA" />

<ref name="MorleyBerg1999">{{cite book | vauthors = Morley JE | chapter = Testosterone | veditors = Morley JE, van den Berg L | title = Endocrinology of Aging | series = Disease-a-Month | chapter-url = https://books.google.com/books?id=hGD0BwAAQBAJ&pg=PA141 | date = November 5, 1999 | volume = 34 | issue = 7 | publisher = Springer Science & Business Media | isbn = 978-1-59259-715-4 | pages = 141– | doi = 10.1016/s0011-5029(98)90024-4 | pmid = 3044718 | access-date = November 15, 2016 | archive-date = April 14, 2019 | archive-url = https://web.archive.org/web/20190414215126/https://books.google.com/books?id=hGD0BwAAQBAJ&pg=PA141 | url-status = live }}</ref><ref name="BagatellBremner2003-misc">{{cite book|vauthors=Bagatell C, Bremner WJ|title=Androgens in Health and Disease|url=https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA259|date=May 27, 2003|publisher=Springer Science & Business Media|isbn=978-1-59259-388-0|access-date=November 18, 2016|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215125/https://books.google.com/books?id=vDcBCAAAQBAJ&pg=PA259|url-status=live}}</ref>

====Canada====
{{as of|2016|11}}, testosterone is available in Canada in the form of topical gels (AndroGel, Testim), topical solutions (Axiron), transdermal patches (Androderm), and intranasal gels (Natesto).<ref name="DPD@HealthCanada">{{cite web |title=Drug Product Database - Health Canada |publisher=Health Canada |url=http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php |access-date=November 13, 2016 |url-status=live |archive-url=https://web.archive.org/web/20161119200516/http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php |archive-date=November 19, 2016 |date=March 18, 2010 }}</ref> Testosterone cypionate (Depo-Testosterone, Testosterone Cypionate (generic)), testosterone enanthate (Delatestryl, PMS-Testosterone Enanthate), and testosterone propionate (Testosterone Propionate (generic)) are available as oil solutions for intramuscular injection and testosterone undecanoate (Andriol, PMS-Testosterone, Taro-Testosterone) is available in the form of oral capsules.<ref name="DPD@HealthCanada" /> Testosterone buccal tablets and pellet implants do not appear to be available in Canada.<ref name="DPD@HealthCanada" />

====Other countries====
Testosterone and/or its esters are widely available in countries throughout the world in a variety of formulations.<ref name="Drugs.com" />

===Legal status===
{{See also|Anabolic steroid#Legal status}}

Testosterone and its esters, along with other AAS, are [[prescription drug|prescription-only]] [[controlled substance]]s in many countries throughout the world. In the United States, they are [[List of Schedule III drugs (US)|Schedule III]] drugs under the [[Controlled Substances Act]], in Canada, they are [[Controlled Drugs and Substances Act#Schedule IV|Schedule IV]] drugs under the [[Controlled Drugs and Substances Act]], and in the United Kingdom, they are [[Drugs controlled by the UK Misuse of Drugs Act#Class C drugs|Class C]] drugs under the [[Misuse of Drugs Act 1971|Misuse of Drugs Act]].<ref name="FFFLM2006b">{{cite book|vauthors=Karch SB|title=Drug Abuse Handbook, Second Edition|url=https://books.google.com/books?id=ZjrMBQAAQBAJ&pg=PA30|date=December 21, 2006|publisher=CRC Press|isbn=978-1-4200-0346-8|pages=30–|access-date=November 11, 2017|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215105/https://books.google.com/books?id=ZjrMBQAAQBAJ&pg=PA30|url-status=live}}</ref><ref name="LilleySnyder2016">{{cite book |vauthors=Lilley LL, Snyder JS, Collins SR |title=Pharmacology for Canadian Health Care Practice |url=https://books.google.com/books?id=dNgoDwAAQBAJ&pg=PA50 |date=August 5, 2016 |publisher=Elsevier Health Sciences |isbn=978-1-77172-066-3 |pages=50– |access-date=November 11, 2017 |archive-date=April 14, 2019 |archive-url=https://web.archive.org/web/20190414214954/https://books.google.com/books?id=dNgoDwAAQBAJ&pg=PA50 |url-status=live }}</ref>

===Litigation===
{{As of|2014}}, a number of lawsuits are underway against manufacturers of testosterone, alleging a significantly increased rate of stroke and heart attack in elderly men who use testosterone supplementation.<ref name=Harris2014>{{cite news | vauthors = Harris A | title = Abbott Labs Sued by Five Men Claiming Androgel Injuries | url = https://www.bloomberg.com/news/2014-02-05/abbott-labs-sued-by-five-men-claiming-androgel-injuries.html | website = Bloomberg.com | date = February 5, 2014 | publisher = Bloomberg, L.P. | access-date = June 16, 2014 | url-status = live | archive-url = https://web.archive.org/web/20140714195657/http://www.bloomberg.com/news/2014-02-05/abbott-labs-sued-by-five-men-claiming-androgel-injuries.html | archive-date = July 14, 2014}}</ref>{{update inline|date=January 2020}}

===Doping in sports===
{{See also|List of doping in sport cases#Testosterone and esters}}

There are many known cases of [[doping in sports]] with testosterone and its esters by [[professional sports|professional]] [[athlete]]s.

==Research==

===Depression===
Testosterone has been used to treat depression in men who are of middle age with low testosterone. However, a 2014 review showed no benefit on the mood of the men with normal levels of testosterone or on the mood of the older men with low testosterone.<ref name="pmid24501728">{{cite journal | vauthors = Amanatkar HR, Chibnall JT, Seo BW, Manepalli JN, Grossberg GT | title = Impact of exogenous testosterone on mood: a systematic review and meta-analysis of randomized placebo-controlled trials | journal = Annals of Clinical Psychiatry | volume = 26 | issue = 1 | pages = 19–32 | date = Feb 2014 | pmid = 24501728 | url = http://www.aacp.com/pdf%2F0214%2F0214ACP%5FAmanatkar%2Epdf }}{{Dead link|date=July 2020 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Conversely, a 2009 review found that testosterone had an antidepressant effect in men with depression, especially those with hypogonadism, HIV/AIDS, and in the elderly.<ref name="pmid19625884">{{cite journal | vauthors = Zarrouf FA, Artz S, Griffith J, Sirbu C, Kommor M | s2cid = 205423837 | title = Testosterone and depression: systematic review and meta-analysis | journal = J Psychiatr Pract | volume = 15 | issue = 4 | pages = 289–305 | date = July 2009 | pmid = 19625884 | doi = 10.1097/01.pra.0000358315.88931.fc }}</ref>

===Heart failure===
Testosterone replacement can significantly improve [[Physical exercise|exercise capacity]], [[Muscle|muscle strength]] and reduce [[QT interval]]s in men with [[Heart failure|chronic heart failure]] (CHF). Over the 3 to 6-month course of the studies reviewed, testosterone therapy appeared safe and generally effective, and (ruling out prostate cancer) the authors found no justification to absolutely restrict its use in men with CHF.<ref name=Wang2016>{{cite journal | vauthors = Wang W, Jiang T, Li C, Chen J, Cao K, Qi LW, Li P, Zhu W, Zhu B, Chen Y | title = Will testosterone replacement therapy become a new treatment of chronic heart failure? A review based on 8 clinical trials | journal = Journal of Thoracic Disease | volume = 8 | issue = 5 | pages = E269–77 | date = May 2016 | pmid = 27162680 | pmc = 4842839 | doi = 10.21037/jtd.2016.03.39 | doi-access = free }}</ref> A similar 2012 review also found increased exercise capacity and reasoned the benefits generlizable to women.<ref name=Toma2012>{{cite journal | vauthors = Toma M, McAlister FA, Coglianese EE, Vidi V, Vasaiwala S, Bakal JA, Armstrong PW, Ezekowitz JA | title = Testosterone Supplementation in Heart Failure: A Meta-Analysis | journal = Circulation: Heart Failure | volume = 5 | issue = 3 | pages = 315–21 | date = May 2012 | pmid = 22511747 | doi = 10.1161/CIRCHEARTFAILURE.111.965632 | doi-access = free }}</ref> However, both reviews advocate larger, longer term, [[randomized controlled trial]]s.<ref name=Wang2016/><ref name=Toma2012/>

===Male contraception===
Testosterone, as esters such as testosterone undecanoate or testosterone buciclate, has been studied and promoted as a [[male contraceptive]] analogous to [[combined oral contraceptive pill|estrogen-based contraceptives]] in women. Otherwise considered an adverse effect of testosterone, reduced spermatogenesis can be further suppressed with the addition of a [[progestin]] such as [[norethisterone enanthate]] or [[levonorgestrel butanoate]], improving the contraceptive effect.<ref>{{cite journal | vauthors = Wang C, Festin MP, Swerdloff RS | title = Male Hormonal Contraception: Where Are We Now? | journal = Current Obstetrics and Gynecology Reports | volume = 5 | pages = 38–47 | date = 2016 | pmid = 26949570 | pmc = 4762912 | doi = 10.1007/s13669-016-0140-8 }}</ref><ref>{{cite journal | vauthors = Chao JH, Page ST | title = The current state of male hormonal contraception | journal = Pharmacology & Therapeutics | volume = 163 | pages = 109–17 | date = July 2016 | pmid = 27016468 | doi = 10.1016/j.pharmthera.2016.03.012 }}</ref>

===Anorgasmia===
{{See also|List of investigational sexual dysfunction drugs}}

Testosterone is under development in a low-dose intranasal formulation for the treatment of [[anorgasmia]] in women.<ref name="AdisInsight">{{cite web |url=http://adisinsight.springer.com/drugs/800029680 |title=Testosterone intranasal (low-dose)  |access-date=September 5, 2017 |url-status=live |archive-url=https://web.archive.org/web/20170906035736/http://adisinsight.springer.com/drugs/800029680 |archive-date=September 6, 2017}}</ref>

===Miscellaneous===
Testosterone therapy may improve the management of [[type 2 diabetes]].<ref name="pmid18772488">{{cite journal | vauthors = Traish AM, Saad F, Guay A | title = The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance | journal = Journal of Andrology | volume = 30 | issue = 1 | pages = 23–32 | year = 2009 | pmid = 18772488 | doi = 10.2164/jandrol.108.005751 }}</ref> Low testosterone has been associated with the development of [[Alzheimer's disease]].<ref name="pmid16785599">{{cite journal | vauthors = Pike CJ, Rosario ER, Nguyen TV | s2cid = 13852805 | title = Androgens, aging, and Alzheimer's disease | journal = Endocrine | volume = 29 | issue = 2 | pages = 233–41 | date = Apr 2006 | pmid = 16785599 | doi = 10.1385/ENDO:29:2:233 }}</ref><ref name="pmid15383512">{{cite journal | vauthors = Rosario ER, Chang L, Stanczyk FZ, Pike CJ | title = Age-related testosterone depletion and the development of Alzheimer disease | journal = JAMA | volume = 292 | issue = 12 | pages = 1431–32 | date = Sep 2004 | pmid = 15383512 | doi = 10.1001/jama.292.12.1431-b }}</ref>

Topical androgens like testosterone have been used and studied in the treatment of [[cellulite]] in women.<ref name="pmid12626029">{{cite journal | vauthors = Gruber CJ, Wieser F, Gruber IM, Ferlitsch K, Gruber DM, Huber JC | s2cid = 37424524 | title = Current concepts in aesthetic endocrinology | journal = Gynecol. Endocrinol. | volume = 16 | issue = 6 | pages = 431–41 | date = December 2002 | pmid = 12626029 | doi = 10.1080/gye.16.6.431.441 }}</ref>

==References==
{{Reflist}}

==Further reading==
{{refbegin}}
* {{cite book|vauthors=Nieschlag E, Behre JM, Nieschlag S|title=Andrology: Male Reproductive Health and Dysfunction|url=https://books.google.com/books?id=mEgckDNkonUC|date=January 13, 2010|publisher=Springer Science & Business Media|isbn=978-3-540-78355-8|access-date=November 13, 2016|archive-date=June 23, 2016|archive-url=https://web.archive.org/web/20160623203518/https://books.google.com/books?id=mEgckDNkonUC|url-status=live}}
* {{cite book|vauthors=Nieschlag E, Behre HM, Nieschlag S|title=Testosterone: Action, Deficiency, Substitution|url=https://books.google.com/books?id=MkrAPaQ4wJkC|date=July 26, 2012|publisher=Cambridge University Press|isbn=978-1-107-01290-5|access-date=July 31, 2018|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215108/https://books.google.com/books?id=MkrAPaQ4wJkC|url-status=live}}
* {{cite book|vauthors=Hohl A|title=Testosterone: From Basic to Clinical Aspects|url=https://books.google.com/books?id=Et6TDgAAQBAJ|date=March 30, 2017|publisher=Springer|isbn=978-3-319-46086-4|access-date=July 31, 2018|archive-date=April 14, 2019|archive-url=https://web.archive.org/web/20190414215052/https://books.google.com/books?id=Et6TDgAAQBAJ|url-status=live}}
* {{cite journal | vauthors = Nieschlag E, Nieschlag S | title = Testosterone deficiency: a historical perspective | journal = Asian J. Androl. | volume = 16 | issue = 2 | pages = 161–8 | date = 2014 | pmid = 24435052 | pmc = 3955324 | doi = 10.4103/1008-682X.122358 | doi-access = free }}
* {{cite book|vauthors=Llewellyn W|title=Anabolics|url=https://books.google.com/books?id=afKLA-6wW0oC|year=2011|publisher=Molecular Nutrition Llc|isbn=978-0-9828280-1-4|access-date=November 18, 2016|archive-date=April 14, 2021|archive-url=https://web.archive.org/web/20210414083125/https://books.google.com/books?id=afKLA-6wW0oC|url-status=live}}
* {{cite journal | vauthors = Shoskes JJ, Wilson MK, Spinner ML | title = Pharmacology of testosterone replacement therapy preparations | journal = Translational Andrology and Urology | volume = 5 | issue = 6 | pages = 834–843 | date = December 2016 | pmid = 28078214 | pmc = 5182226 | doi = 10.21037/tau.2016.07.10 | doi-access = free }}
* {{cite journal | vauthors = Celec P, Ostatníková D, Hodosy J | title = On the effects of testosterone on brain behavioral functions | journal = Frontiers in Neuroscience | volume = 9 | pages = 12 | date = February 2015 | pmid = 25741229 | pmc = 4330791 | doi = 10.3389/fnins.2015.00012 | doi-access = free }}
{{refend}}

==External links==
* {{cite web | title=Testosterone Transdermal Patch | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a601118.html }}
* {{cite web | title=Testosterone Buccal | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a603034.html }}
* {{cite web | title=Testosterone Topical | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a605020.html }}
* {{cite web | title=Testosterone Injection | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a614041.html }}
* {{cite web | title=Testosterone Nasal Gel | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a615025.html }}

{{Testosterone}}
{{Androgens and antiandrogens}}
{{Navboxes
| title = [[Pharmacodynamics]]
| titlestyle = background:#ccccff
| list1 =
{{Androgen receptor modulators}}
{{Estrogen receptor modulators}}
{{GABAA receptor positive allosteric modulators}}
{{Growth factor receptor modulators}}
}}
{{Portal bar|Medicine}}

[[Category:1935 in biology]]
[[Category:1935 in Germany]]
[[Category:Alkene derivatives]]
[[Category:Anabolic–androgenic steroids]]
[[Category:Androstanes]]
[[Category:Cyclopentanols]]
[[Category:Drugs acting on the gastrointestinal system and metabolism]]<!--As an appetite stimulant-->
[[Category:Drugs developed by Eli Lilly and Company]]
[[Category:Drugs developed by AbbVie]]
[[Category:Enones]]
[[Category:Erectile dysfunction drugs]]
[[Category:Estrogens]]<!--Via metabolism into estradiol and androstanediols-->
[[Category:GABAA receptor positive allosteric modulators]]<!--Via metabolism into 3α-androstanediol-->
[[Category:Hormonal antineoplastic drugs]]<!--For breast cancer-->
[[Category:Testosterone]]
[[Category:Masculinizing hormone therapy]]
[[Category:World Health Organization essential medicines]]
[[Category:Wikipedia medicine articles ready to translate]]