A survey of 28,000 users found that many Italian males started an "excessive consumption" of porn sites as early as 14 years old. After daily use in their early to mid-20s, they become inured to "even the most violent" images. The effects of developing their sexuality largely divorced from real-life relationships are gradual and devastating. "It starts with lower reactions to porn sites, then there is a general drop in libido and in the end it becomes impossible to get an erection," Carlo Foresta, head of the Italian Society of Andrology and Sexual Medicine (SIAMS), told reporters. However, the condition is not irreversible and a proper recovery is possible within just a few short months.
Other side effects include increased risk of heart problems in older men with poor mobility, according to a 2009 study at Boston Medical Center. A 2017 study published in JAMA found that treatments increase coronary artery plaque volume. Additionally, the Food and Drug Administration (FDA) requires manufactures to include a notice on the labeling that states taking testosterone treatments can lead to possible increased risk of heart attacks and strokes. The FDA recommends that patients using testosterone should seek medical attention right away if they have these symptoms:
Dihydrotestosterone (DHT) (referred to as androstanolone or stanolone when used medically) can also be used in place of testosterone as an androgen. The availability of DHT is limited; it is not available in the United States or Canada, for instance, but it is available in certain European countries, including the United Kingdom , France , Spain , Belgium , Italy , and Luxembourg .  DHT is available in formulations including topical gel, buccal or sublingual tablets, and as esters in oil for intramuscular injection.  Relative to testosterone, and similarly to many synthetic AAS, DHT has the potential advantages of not being locally potentiated in so-called androgenic tissues that express 5α-reductase (as DHT is already 5α-reduced) and of not being aromatized into an estrogen (it is not a substrate for aromatase).