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
Over the last three decades it has become apparent that testosterone plays a significant role in the maintenance of bone and muscle mass, in erythropoiesis, and in mental functions. But testosterone is also a key player in glucose homeostasis and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to late onset diabetes mellitus, atherosclerosis and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, glucose intolerance, raised blood pressure and dyslipidaemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol),and a pro-inflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Lower total testosterone and sex hormone-binding globulin(SHBG) predict a higher incidence of the metabolic syndrome. There is now evidence to argue that hypotestosteronaemia should be an element in the definition of the metabolic syndrome. Administration of testosterone to hypogonadal men reverses the unfavorable risk profile for the development of diabetes and atherosclerosis. Testosterone should be regarded as a pivotal hormone for men's health.
Similar to other hormones, the onset of perimenopause and menopause cause the decline in production of testosterone (by at least 50%) in women. Again, hysterectomy with or without removal of the ovaries will cause a more significant decline in testosterone levels . Also, high levels of stress can divert the precursors for testosterone hormone production in women over to cortisol production and create a further reduction. High stress levels can also contribute to symptoms earlier in the perimenopause when a woman is in her late thirties or early forties. This means less energy, brittle hair, less bone and muscle strength, and a diminished sexual drive. A hysterectomy and some prescription drugs can also result in lower levels of testosterone for women .