There still is a lot unknown when older men with low testosterone are given testosterone replacement therapy. A large and long-term clinical trial is needed to answer some key questions. For example, would treating men with low testosterone change their risk for heart attacks? Would treatment reduce the number of fractures? Would treatment affect the prostate in any way? Until a testosterone trial is started and completed, doctors will have to rely upon the best available evidence from smaller and shorter studies to guide them. As with any therapy, there are always benefits and risks and treatment needs to be tailored to each patient. There is no one-size-fits-all when it comes to a blood level of testosterone or number of signs and symptoms.
All bets are off the table when high-dose testosterone and its many metabolites are used illegally, such as with anabolic steroid abuse. Strokes, embolisms, and cardiovascular disease are all more likely, as is sudden death, and liver and kidney disease. 44 In women, acne, irreversible deepening of the voice, baldness, increased facial hair, enlarged sex organs, breast reduction, depression, and infertility have all been reported. In adult men that abuse anabolic steroids, acne, baldness, permanent infertility, gynecomastia, loss of libido, erectile dysfunction, testicle shrinkage, and profuse sweating are all reported side effects. Increased testicular cancer hasn't been reported, though. 45,46