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More recently, androgen receptors have been shown to have a second mode of action. As has been also found for other steroid hormone receptors such as estrogen receptors , androgen receptors can have actions that are independent of their interactions with DNA.   Androgen receptors interact with certain signal transduction proteins in the cytoplasm. Androgen binding to cytoplasmic androgen receptors can cause rapid changes in cell function independent of changes in gene transcription, such as changes in ion transport . Regulation of signal transduction pathways by cytoplasmic androgen receptors can indirectly lead to changes in gene transcription, for example, by leading to phosphorylation of other transcription factors.
Athletes, like all others, may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the prohibited list, a therapeutic use exemption may give that athlete the authorization to take the needed medicine. Criteria for granting a therapeutic use exemption are 1.) The athlete would experience significant health problems without taking the prohibited substance or method, 2.) The therapeutic use of the substance would not produce significant enhancement of performance, and 3.) There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method. Note hormone replacement therapy (HRT), . supplementing with prescribed testosterone in any form to raise testosterone levels due to natural decreases that occur with aging (even if to just elevate levels to within ‘normal’ ranges), is NOT considered a medicinal exception. Persons using HRT would not be eligible for WPA/NANBF/IPE competition.