Prolonged hypogonadism in males following withdrawal from anabolic-androgenic steroids: an under-recognized problem
- PMID:25598171
- PMCID: PMC4398624
- DOI: 10.1111/add.12850
Prolonged hypogonadism in males following withdrawal from anabolic-androgenic steroids: an under-recognized problem
Abstract
Aims: To assess the frequency and severity of hypogonadal symptoms in male long-term anabolic-androgenic steroid (AAS) misusers who have discontinued AAS use.
Design: Cross-sectional, naturalistic.
Setting: Out-patient facility.
Participants: Twenty-four male former long-term AAS users and 36 non-AAS-using weightlifters, recruited by advertisement in Massachusetts, USA. Five of the former users were currently receiving treatment with physiological testosterone replacement, leaving 19 untreated users for the numerical comparisons below.
Measurements: The Structured Clinical Interview for DSM-IV, questions regarding history of AAS use, physical examination, serum hormone determinations and the International Index of Erectile Function (IIEF).
Findings: Compared with the 36 non-AAS-using weightlifters, the 19 untreated former AAS users displayed significantly smaller testicular volumes [estimated difference, 95% confidence interval (CI) = 2.3 (0.1, 4.5) ml; P = 0.042] and lower serum testosterone levels [estimated difference: 95% CI = 131 (25, 227) dl; P = 0.009], with five users showing testosterone levels below 200 ng/dl despite abstinence from AAS for 3-26 months. Untreated former users also displayed significantly lower scores on the IIEF sexual desire subscale [estimated difference: 95% CI = 2.4 (1.3, 3.4) points on a 10-point scale; P < 0.001]. In the overall group of 24 treated plus untreated former users, seven (29%) had experienced major depressive episodes during AAS withdrawal; four of these had not experienced major depressive episodes at any other time. Two men (8%) had failed to regain normal libidinal or erectile function despite adequate replacement testosterone treatment.
Conclusions: Among long-term anabolic-androgenic steroid misusers, anabolic-androgenic steroid-withdrawal hypogonadism appears to be common, frequently prolonged and associated with substantial morbidity.
Keywords: Anabolic-androgenic steroids; drug withdrawal; erectile function; hypogonadism; libido; men; testosterone.
© 2015 Society for the Study of Addiction.
Conflict of interest statement
Dr. Pope has provided expert testimony approximately once per year in cases involving anabolic-androgenic steroids. Dr. Pope has received research funding from Shire Pharmaceuticals and Genentech Pharmaceuticals for work unrelated to this manuscript. Dr. Baggish has received research grants from the American Heart Association and American Society of Echocardiography for work unrelated to this manuscript. Dr. Bhasin has received research grants from NIA, NIDDK, NCATS, AbbVie, Regeneron, and Eli Lilly for work unrelated to this manuscript, and has equity interest in Function Promoting Therapies, LLC. Dr. Kanayama, Dr. Weiner, Mr. DeLuca, and Ms. Isaacs report no interests.
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