Testosterone has a long efficacy and safety record for its role in androgen replacement therapy in men with androgen deficiency. Testosterone and synthetic analogue androgens have also been used in pharmacological therapy to produce androgenic effects on marrow, muscle and bone.

Androgen misuse is the systematic over-prescribing for unproven medical indications. Misuse is increasingly evident for male ageing (“andropause”) and some other clinical conditions. Further trials for new indications for androgens require reliable safety data, but rising costs may make it increasingly attractive to circumvent the need for evidence by promoting off-label mass marketing.

Androgen abuse is the illicit administration of often massive doses of androgens for non medical purposes- especially power sports and body building. There is a growing need for effective detection in elite sports. In parallel, more focus is also needed on non-sporting cosmetic, recreational and occupational androgen abuse.