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Anabolic androgenic steroid abuse can lead to serious cardiovascular and psychiatric adverse reactions (see DRUG ABUSE AND DEPENDENCE)and may also lead to premature death and brain damage.

The abuse of most anabolic androgenic steroids (AAS, DHEA, GH, T2, M and V, DHEA PED, and DHEAS) results in increased serum testosterone levels. However, in some individuals, steroid use also results in a decrease in serum testosterone levels. Testosterone replacement therapies (including testosterone cypionate, transdermal testosterone, or testosterone enanthate) and androgen receptor antagonists (such as finasteride, spironolactone, or nandrolone decanoate) can reduce the severity of these anabolic-androgenic steroid anabolic androgenic steroid problems (See ANABRITICS AND ANDROID ADMINISTRATION and DRUG ADMINISTRATION, section B.4). For individuals at risk for anabolic steroids abuse, the National Institute on Drug Abuse (NIDA) recommends a minimum dose of testosterone cypionate for treatment of a state-of-the-art severe anabolic-androgenic steroid abuse, or the use of anabolic-androgenic steroids only when directed to treat and prevent serious and chronic cardiovascular disease. In cases of milder abuse, doses are based on individual preference and may need to be decreased, but no dosage may be lower than that used in controlled drug applications (i.e., not recommended for the prevention of serious cardiovascular disease or sudden death).

In patients with benign prostatic hyperplasia and mild androgenic alopecia, testosterone therapy is not warranted (see CLINICAL PHARMACOLOGY); in patients with mild or moderate anabolic-androgenic steroid abuse, testosterone cypionate therapy should be considered (see CLINICAL PHARMACOLOGY and DRUG ABUSE AND DEPENDENCE).

The development of benign prostatic hyperplasia, benign prostatic hypertrophy, and benign prostatic hyperplasia/testicular hypertrophy (BPH/HT) may be associated with a normal serum luteinizing hormone (LH) level. As such, treatment with the progestin analog testosterone propionate should not be used for the treatment of BPH/HT. Therefore, the dose of testosterone propionate in the absence of LH suppression or treatment with the progestins analogs may also need to be increased in some patients without symptoms or symptoms of BPH/HT, especially during the

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