Endocr Pract. 2020 Mar;26(3):340-353. doi: 10.4158/PS-2019-0540.
Over the past few decades, there has been an unprecedented rise in off-label use and misuse of testosterone, growth hormone, thyroid hormone, and adrenal supplements. Testosterone therapy is often promoted to men for the treatment of low energy, lower libido, erectile dysfunction, and other symptoms. Growth hormone is used in attempts to improve athletic performance in athletes and to attenuate aging in older adults. Thyroid hormone and/or thyroid supplements or boosters are taken to treat fatigue, obesity, depression, cognitive impairment, impaired physical performance, and infertility. Adrenal supplements are used to treat common nonspecific symptoms due to "adrenal fatigue," an entity that has not been recognized as a legitimate medical diagnosis. Several factors have contributed to the surge in off-label use and misuse of these hormones and supplements: direct-to-consumer advertising, websites claiming to provide legitimate medical information, and for-profit facilities promoting therapies for men's health and anti-aging. The off-label use and misuse of hormones and supplements in individuals without an established endocrine diagnosis carries known and unknown risks. For example, the risks of growth hormone abuse in athletes and older adults are unknown due to a paucity of studies and because those who abuse this hormone often take supraphysiologic doses in sporadic intervals. In addition to the health risks, off-label use of these hormones and supplements generates billions of dollars of unnecessary costs to patients and to the overall health-care system. It is important that patients honestly disclose to their providers off-label hormone use, as it may affect their health and treatment plan. General medical practitioners and adult endocrinologists should be able to begin a discussion with their patients regarding the unfavorable balance between the risks and benefits associated with off-label use of testosterone, growth hormone, thyroid hormone, and adrenal supplements. = dehydroepiandrosterone; = U.S. Food and Drug Administration; = growth hormone; = insulin-like growth factor 1; = L-triiodothyronine; = levothyroxine; = total triiodothyronine; = thyroxine; = thyroid-stimulating hormone.
在过去的几十年中，睾酮、生长激素、甲状腺激素和肾上腺补充剂的非适应证使用和滥用呈前所未有的上升趋势。睾酮治疗常用于治疗男性的低能量、低性欲、勃起功能障碍和其他症状。生长激素用于试图提高运动员的运动表现，并减缓老年人的衰老。甲状腺激素和/或甲状腺补充剂或增强剂用于治疗疲劳、肥胖、抑郁、认知障碍、身体机能下降和不孕。肾上腺补充剂用于治疗因“肾上腺疲劳”而引起的常见非特异性症状，而“肾上腺疲劳”尚未被认为是一种合法的医学诊断。导致这些激素和补充剂的非适应证使用和滥用激增的因素有：直接面向消费者的广告、声称提供合法医疗信息的网站以及营利性机构推广男性健康和抗衰老疗法。在没有明确内分泌诊断的个体中，这些激素和补充剂的非适应证使用和滥用存在已知和未知的风险。例如，由于缺乏研究以及滥用这种激素的人经常在零星间隔内服用超生理剂量，因此运动员和老年人滥用生长激素的风险尚不清楚。除了健康风险外，这些激素和补充剂的非适应证使用给患者和整个医疗保健系统带来了数十亿美元的不必要成本。重要的是，患者应诚实地向其提供者披露非适应证使用激素的情况，因为这可能会影响他们的健康和治疗计划。普通内科医生和成人内分泌学家应该能够与他们的患者就与睾酮、生长激素、甲状腺激素和肾上腺补充剂的非适应证使用相关的风险与益处之间的不利平衡展开讨论。 = 脱氢表雄酮； = 美国食品和药物管理局； = 生长激素； = 胰岛素样生长因子 1； = L-三碘甲状腺原氨酸； = 左甲状腺素钠； = 总三碘甲状腺原氨酸； = 甲状腺素； = 促甲状腺激素。
