Testing the boundaries: Self-medicated testosterone replacement and why it is practised

Background: Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as 'enhancement’ or 'doping’, and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance enhancing drugs (IPEDs), but never systematically explored.
Approach: This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as 'testosterone replacement therapy’ (TRT). In particular, it focuses on the 26 (84%) of these individuals who self-medicated TRT. Data was analysed thematically (using NVivo) in order to answer the question: 'how and why is testosterone self-medicated?’. Using Bacchi's (2016) problematization approach to policy analysis, this paper also asks, 'what happens to the 'problem’ of non-prescribed testosterone use if such use is therapeutic?’.
Findings: Self-medicated TRT was found to be very similar to TRT as practised in medical contexts. Self-medication was often practised because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use.
Conclusion: By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualisations of all illicit testosterone use as 'abuse’, and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment.