Unexpected testosterone, LH, FSH and SHBG levels can result from illicit use of androgens (“anabolic steroids”). Classic symptoms include truncal acne, excessive muscularity, testicular atrophy and gynaecomastia, usually in association with obsessive and intense exercise regimens. Consider asking specific questions regarding androgen misuse to males who display these behaviours and signs. Males who are currently using androgens may have elevated testosterone and suppressed LH, FSH and SHBG. Suppression of testosterone as well as LH, FSH and SHBG can indicate a recent history of androgen misuse. 4 The rate of recovery from HPG axis suppression is dependent on the duration and severity of the misuse, but will generally occur within 12 months after cessation of androgens. 4
ABSTRACT Introduction. Increasing interest in the use of supplemental testosterone has led to a heightened focus on the safety of testosterone in elderly males, with a particular emphasis on cardiovascular risk. Aims. To evaluate, based on available clinical trial data, whether exogenous testosterone administration in middle‐aged to elderly men increases cardiovascular risk, and to assess whether these effects differ in hypogonadal vs. eugonadal subjects. Methods. MEDLINE search from 2004 to present of all meta‐analyses and randomized, controlled clinical trials of testosterone administration in male subjects ≥45 years old that included measurements of cardiovascular outcomes or known cardiovascular risk factors before and after treatment with testosterone. Main Outcome Measures. The effects of testosterone treatment on cardiovascular events and cardiovascular risk factors were assessed. Results. In clinical trials where testosterone has been used in patients with preexisting cardiovascular conditions, the effect on disease symptoms has typically been either neutral or beneficial. Based on clinical trial data, testosterone treatment has minimal effect on cardiovascular risk factors with the exception of an increase in hematocrit, which is consistently seen with testosterone treatment, and a decrease in high‐density lipoprotein cholesterol, which is an inconsistent response. Responses of hypogonadal and eugonadal men to testosterone treatment in terms of cardiovascular risk are generally similar. Testosterone treatment has not been reported to increase the incidence of cardiovascular events with the possible exception of one trial in frail elderly men. Conclusions. Available clinical trial data indicate that the use of testosterone in middle‐aged to elderly men does not increase cardiovascular risk nor does it unfavorably modify cardiovascular risk profile. Prospective data from large, well‐designed, long‐term trials of testosterone treatment are lacking and will be required to verify the cardiovascular efficacy/safety of chronic treatment. Carson CC and Rosano G. Exogenous testosterone, cardiovascular events, and cardiovascular risk factors in elderly men: A review of trial data. J Sex Med 2012;9:54–67.