What should a young patient with no medical history, currently using testosterone enanthate and possibly anastrozole (an aromatase inhibitor) without a prescription, do now?

Immediate Action Required: Stop Non-Prescribed Testosterone and Seek Medical Evaluation

You must immediately discontinue self-administered testosterone enanthate and anastrozole and seek evaluation by a qualified physician to assess for true hypogonadism and prevent serious health consequences. 1, 2

Why This Is Critical

Serious Health Risks of Unsupervised Testosterone Use

• Permanent infertility: Exogenous testosterone suppresses spermatogenesis and can cause prolonged or irreversible azoospermia (zero sperm count), which is particularly devastating in a young man 1, 2
• Cardiovascular risks: Testosterone therapy carries potential cardiovascular risks including increased risk of myocardial infarction and stroke, especially without proper monitoring 1
• Erythrocytosis: Injectable testosterone significantly increases red blood cell production, with up to 44% of users developing dangerously elevated hematocrit levels that increase blood viscosity and thrombotic risk 2, 3
• Suppression of natural production: Your body's natural testosterone production has likely shut down completely, and recovery may take months after stopping 2, 4

Why Self-Medication Is Dangerous

• No confirmed diagnosis: Approximately 20-30% of men receiving testosterone in the U.S. do not have documented low testosterone levels before treatment, violating evidence-based guidelines 2
• Lack of monitoring: Without baseline and ongoing laboratory monitoring (testosterone levels, hematocrit, PSA, liver function), you cannot detect serious complications until they become symptomatic 1, 2
• Unknown product quality: Non-prescribed testosterone products lack FDA oversight, resulting in considerable variation in potency and quality, even between samples from the same source 1, 4
• Inappropriate anastrozole use: Aromatase inhibitors like anastrozole are only conditionally recommended in specific clinical scenarios and can worsen bone and lipid health when used inappropriately 1

What You Need to Do Now

Step 1: Stop All Self-Administered Medications Immediately

• Discontinue testosterone enanthate injections today 2
• Stop anastrozole immediately 2
• Allow 2-4 weeks washout time before diagnostic testing to permit recovery of the hypothalamic-pituitary-gonadal axis 2

Step 2: Schedule Urgent Medical Evaluation

Find a physician (endocrinologist, urologist, or primary care physician with expertise in male hypogonadism) within the next 1-2 weeks 1, 2

Be completely honest about your self-medication history, including:

• Exact doses and frequency of testosterone enanthate
• Duration of use
• Whether you used anastrozole and at what dose
• Any symptoms you were trying to treat
• Whether you have concerns about fertility 1, 2

Step 3: Required Diagnostic Workup

After the 2-4 week washout period, your physician must obtain 1, 2:

• Two separate morning total testosterone measurements (drawn between 8-10 AM) to confirm true hypogonadism—levels must be <300 ng/dL on both occasions 1, 2
• Free testosterone by equilibrium dialysis to assess biologically active testosterone 2
• Sex hormone-binding globulin (SHBG) to distinguish true hypogonadism from SHBG-related changes 2
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to determine if hypogonadism is primary (testicular) or secondary (pituitary-hypothalamic) 1, 2
• Baseline hematocrit/hemoglobin to assess for erythrocytosis from prior testosterone use 2
• Prostate-specific antigen (PSA) if over age 40 1, 2
• Prolactin level if testosterone is low or loss of libido is present 2
• Fasting glucose to exclude diabetes 2

What Happens If You Actually Have Hypogonadism

If Confirmed Hypogonadism AND You Want to Preserve Fertility

Testosterone therapy is absolutely contraindicated 1, 2

You must receive gonadotropin therapy instead (recombinant human chorionic gonadotropin [hCG] plus FSH), which stimulates the testes directly and can restore both testosterone levels and fertility potential 1, 2

If Confirmed Hypogonadism AND You Do Not Need Fertility Preservation

Only then can testosterone replacement therapy be considered, but it must be:

• Prescribed by a qualified physician 1, 2
• Using FDA-approved commercially manufactured products (not compounded) 1
• With regular monitoring every 6-12 months for testosterone levels, hematocrit, and PSA 1, 2
• Targeting mid-normal testosterone levels (450-600 ng/dL) 1, 2

Realistic expectations for benefits 1, 2:

• Small but significant improvements in sexual function and libido (standardized mean difference 0.35)
• Little to no effect on physical functioning, energy, vitality, depressive symptoms, or cognition
• Modest quality of life improvements, primarily in sexual function domains

What If You Don't Actually Have Hypogonadism

If your testosterone levels are normal after washout, testosterone therapy is explicitly contraindicated 1, 2

The American Urological Association and European Association of Urology strongly recommend against testosterone therapy in men with normal testosterone levels (eugonadal men), even for:

• Weight loss 2
• Cardiometabolic improvement 2
• Cognition enhancement 2
• Vitality or physical strength in aging 2
• Athletic performance or body composition 2

Critical Pitfalls to Avoid

• Never restart self-medication: Even if you feel worse during the washout period, this is expected as your natural production recovers 2
• Never assume you have hypogonadism based on symptoms alone: Symptoms like fatigue, low energy, and decreased motivation are non-specific and do not independently justify testosterone therapy without confirmed low testosterone levels 2
• Never use testosterone if you might want children in the future: The fertility suppression can be prolonged and potentially irreversible 1, 2
• Never obtain testosterone or anastrozole without a prescription again: The legal, medical, and health risks far outweigh any perceived benefits 4

Bottom Line

Your current approach is medically dangerous and potentially illegal. You may have already caused harm to your fertility, cardiovascular system, and natural hormone production. The only safe path forward is immediate cessation of self-medication, honest disclosure to a qualified physician, proper diagnostic workup after washout, and evidence-based treatment only if true hypogonadism is confirmed. 1, 2, 4