Are there medical risks of supplementing testosterone in adolescent males?
Executive summary
Supplementing testosterone in adolescent males carries real medical risks—some well-documented in short-term studies and others uncertain because long-term safety data are limited—so the decision hinges on clear medical indication and close specialist supervision [1] [2]. When given for true hypogonadism or to induce puberty, testosterone produces valuable benefits (pubertal maturation, growth, bone accrual), but non‑medically indicated use can produce harms ranging from mood/behavioral changes to cardiovascular and reproductive effects [3] [4] [5] [6].
1. Medical indication matters: benefits when testosterone is replacing a deficiency
In boys with constitutional delay of growth and puberty (CDGP) or with primary/secondary hypogonadism, short-term testosterone (for example testosterone enanthate or oral undecanoate) has been shown to safely induce pubertal changes, increase growth, and improve quality of life in specific populations such as boys with Duchenne muscular dystrophy receiving pubertal induction [1] [4] [3].
2. The core safety problem: lack of long‑term data and few approved adolescent formulations
Despite routine clinical use in certain conditions, a central limitation in the literature is the scarcity of long-term safety and efficacy data and a limited number of formulations formally approved for adolescents, leaving clinicians to extrapolate from adult studies or short pediatric series [1] [2].
3. Cardiovascular and thrombotic concerns—signals but not settled causality in youth
Studies and reviews note increased use of testosterone and raise concern about associations with stroke, thromboembolism, hypertension, and cardiac changes such as hypertrophy—particularly when doses raise testosterone above physiologic ranges—yet most robust cardiovascular safety trials focus on older men, so the magnitude of risk in adolescents remains incompletely defined [7] [8] [6].
4. Hematologic and metabolic effects require monitoring
Testosterone can raise hematocrit and blood pressure and alter metabolic parameters; elevated red blood cell mass (polycythemia) and adverse shifts in lipids or insulin sensitivity have been described and are practical reasons clinicians monitor blood counts and cardiometabolic markers during therapy [6] [9].
5. Reproductive and developmental tradeoffs: fertility and secondary effects
Exogenous testosterone can suppress the hypothalamic‑pituitary‑gonadal axis and impair spermatogenesis, risking reduced fertility if used without appropriate oversight; other androgenic side effects reported include acne, accelerated male‑pattern baldness in predisposed individuals, and altered physical development when misused [10] [6].
6. Behavior and mood: plausible links but weak longitudinal evidence
Puberty involves a large endogenous rise in testosterone that has been associated with aggression, risk taking, and depressive symptoms in some studies, but systematic reviews find insufficient high‑quality longitudinal data to definitively link changing testosterone levels to mood and behavior in adolescent males—meaning behavioral risks with supplementation are plausible but not conclusively proven [5] [11].
7. Non‑medical use and societal drivers amplify risk
A growing “testosterone‑maxxing” movement and direct-to-consumer optimization campaigns increase off‑label use among healthy adolescents, a practice experts warn has serious health risks and exploits body image insecurities; public‑facing reports and academic commentary urge that healthy youths pursue lifestyle measures rather than hormone use [10] [12] [6].
8. Clinical conclusion: risks are real, benefits context‑dependent, and oversight essential
For adolescents with verified hypogonadism or when pubertal induction is clinically indicated, testosterone therapy provides clear benefits and is an accepted practice, but clinicians must weigh uncertain long‑term safety, monitor hematologic and cardiometabolic parameters, and tailor dose/timing carefully; for healthy adolescents without a medical indication, the medical risks and social harms outweigh unproven benefits [1] [2] [3] [6].