Handelsman David J
ANZAC Research Institute, University of Sydney, Sydney, Australia.
Andrology Department, Concord Hospital, Sydney, Australia.
Endocr Rev. 2021 Jul 16;42(4):457-501. doi: 10.1210/endrev/bnab001.
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
雄激素是强效药物，需凭有效医学指征开具处方，但也会因无效、未经证实或超说明书使用的原因而被滥用，还会在无处方的情况下被非法用于非医疗用途以增强体能或改善形象。自20世纪30年代睾酮被发现并首次应用于临床后，睾酮及合成雄激素在二战后的几十年里大量商业化。它仍是仍在治疗中使用的最古老的上市药物之一，然而经过80年的临床应用，睾酮唯一明确的指征仍仅为病理性性腺功能减退、男性生殖系统器质性疾病的替代治疗。尽管如此，更广泛的说法声称睾酮有未经证实、不安全或不合理的益处，大多是对恢复活力的一厢情愿。近几十年来，这引发了睾酮滥用的流行，将其作为抗衰老、性功能障碍和/或肥胖的滋补品开具处方，但其疗效和安全性仍未得到证实且令人怀疑。雄激素滥用始于冷战时期，当时精英运动员中出现了雄激素兴奋剂泛滥的情况，目的是提高成绩。在20世纪80年代之前，这种现象蔓延到普通人群中，在足够富裕的社区成为药物滥用的一种地方变体，这些社区支持一个面向健美、旨在塑造超男性化体型和形象的非法药物产业。本综述聚焦于睾酮的滥用，即无有效临床指征开具处方，以及睾酮或合成雄激素的滥用（雄激素滥用），即无处方或有效指征非法使用雄激素，通常是运动员、健美运动员及其他人员出于形象、美容或职业原因而使用。
