Testosterone Should Not Be a Controlled Substance: A Mutual Agreement at the 27th Annual SMSNA Fall Scientific Meeting
On Friday, October 9, at the 27th Annual SMSNA Fall Scientific Meeting, Drs. Jasper Bash and Blaire Stokes engaged in a lively debate about whether testosterone should remain a controlled substance.
Dr. Stokes argued for maintaining testosterone's controlled-substance status to help mitigate misuse. He emphasized that testosterone treatment should not be stopped altogether, but that there are opportunities to reduce abuse. He drew attention to the use of anabolic-androgenic steroids (AAS) and related substances among young men, with some gym-goers reporting that they began using AAS as young as 19 years old. Potential side effects of AAS misuse include acne, sexual dysfunction, mood changes, insomnia, fluid retention, testicular atrophy, and excess breast tissue. Testosterone misuse may also affect fertility, potentially impacting future family planning. Outside of medical care, individuals may obtain testosterone from unreliable sources. However, Dr. Stokes concluded with a surprising admission: "I also don't really agree with what I talked about."
Dr. Bash argued for removing testosterone's controlled-substance classification, emphasizing its therapeutic benefits. Testosterone can improve sexual symptoms in men with testosterone deficiency, support masculinizing gender-affirming care, and help treat hypoactive sexual desire disorder in women. He also pointed to its stability, joking that he was able to carry it through airport security in his TSA-approved quart-sized bag. Testosterone has been classified as a Schedule III controlled substance since 1990, alongside medications such as ketamine. With testosterone increasingly available online, Dr. Bash questioned why physicians continue to face so many restrictions when prescribing it. He argued that removing these restrictions could improve access for patients who may otherwise struggle to receive treatment. "Testosterone is a medication. I should be able to prescribe it as I do anything else. The potential for abuse is so low that it should be treated that way."
Should testosterone remain a controlled substance to prevent misuse, or are current restrictions creating unnecessary barriers to patient care?
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