ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2011) 25 SE1.1

The metamorphosis of testosterone from a sex steroid to a universal health factor

Eberhard Nieschlag

Centre for Reproductive Medicine and Andrology, University Hospitals Münster, Münster, Germany.

When in the 1930s testosterone was isolated, synthesized and introduced to the clinic, it was considered predominantly a sex steroid to be used for the treatment of erectile dysfunction and hypogonadism. In the 1950s the anabolic effect was ‘discovered’ and triggered the misuse of high doses of testosterone in sports, still prevailing today. Consequently, pharmacologic research concentrated its efforts on anabolic steroids, i.e. testosterone analogues hopefully without sexual effects, thus neglecting the search for badly needed improved forms of testosterone application. Improved modes of application only became the focus of the pharmaceutical industry when in the 1990s, the increasing life expectancy of males and the anticipated parallel increase in late-onset hypogonadism (LOH) precipitated the invention of transdermal testosterone preparations, finally producing the desired physiological testosterone levels. Intensified research on the aging male revealed the role of testosterone in the pathognesis of obesity, diabetes type II and the metabolic syndrome as well as in osteoporosis, sarcopenia, atherosclerosis and coronary heart disease. Indeed, testosterone levels in blood are now considered a general predictor of morbidity and mortality. Thus, while the role of testosterone in erection and sexual function (supplemented by phosphodiesterase-5-inhibitors if needed) remained, its spectrum of action broadened to become a universal health factor.

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