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Acknowledgements We acknowledge support from the National Institute on Alcohol Abuse and Alcoholism (AA029831), National Institute on Aging (AG057557, AG061388, AG062272, AG07664), from National Cancer Institute Case Comprehensive Cancer Center (CA221718, CA043703, CA2332216) Ethics declarations Competing interests The authors declare no competing interests

Testosterone is the original performance-enhancing drug

Patients had a mean age of 55 years and 51% were men

The US also has a privatized system but lacks a centralized pricing model

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The symptom usually peaks during dose increases and improves within days to weeks as tolerance develops