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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
Furthermore, pre-treatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer; as testosterone decreases, patients have an increased likelihood of non-organ confined disease and low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy. A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations (patch or gel) that achieve physiological testosterone serum levels without supra physiological escape levels. During the clinical development of a new testosterone patch in more than 200 primary or secondary hypogonadal patients, no prostate cancer was diagnosed.