Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study

Abstract

AimsAbuse of anabolic androgenic steroids (AAS) is highly prevalent among male recreational athletes. The objective of this study was to investigate the impact of AAS abuse on reproductive hormone levels and symptoms suggestive of hypogonadism in current and former AAS abusers.MethodsThis study had a cross-sectional case-control design and involved 37 current AAS abusers, 33 former AAS abusers (mean (95%CI) elapsed duration since AAS cessation: 2.5 (1.7; 3.7) years) and 30 healthy control participants. All participants were aged 18–50 years and were involved in recreational strength training. Reproductive hormones (FSH, LH, testosterone, inhibin B and anti-Müllerian hormone (AMH)) were measured using morning blood samples. Symptoms of hypogonadism (depressive symptoms, fatigue, decreased libido and erectile dysfunction) were recorded systematically.ResultsFormer AAS abusers exhibited significantly lower median (25th –75th percentiles) total and free testosterone levels than control participants (total testosterone: 14.4 (11.9–17.7) nmol/l vs. 18.8 (16.6–22.0) nmol/l) (P < 0.01). Overall, 27.2% (13.3; 45.5) of former AAS abusers exhibited plasma total testosterone levels below the lower reference limit (12.1 nmol/l) whereas no control participants exhibited testosterone below this limit (P < 0.01). Gonadotropins were significantly suppressed, and inhibin B and AMH were significantly decreased in current AAS abusers compared with former AAS abusers and control participants (P < 0.01). The group of former AAS abusers had higher proportions of participants with depressive symptoms ((24.2%) (11.1; 42.2)), erectile dysfunction ((27.3%) (13.3; 45.6)) and decreased libido ((40.1%) (23.2; 57.0)) than the other two groups (trend analyses: P < 0.05).ConclusionsFormer AAS abusers exhibited significantly lower plasma testosterone levels and higher frequencies of symptoms suggestive of hypogonadism than healthy control participants years after AAS cessation. Current AAS abusers exhibited severely decreased AMH and inhibin B indicative of impaired spermatogenesis.

Serum androgen levels and their relation to performance in track and field: mass spectrometry results from 2127 observations in male and female elite athletes

“…Indeed, it has been reported that oral administration of androgens decreases both T (a well-known withdrawal phenomenon experienced when the athletes are approaching competitions and associated urinary anti-doping tests) and SHBG concentrations 23 24. Recently, Rasmussen et al showed that a significant proportion of former androgen abusers exhibit moderately or notably lowered testosterone levels years after cessation of androgen abuse 25. However, our male throwers did not show decreased LH concentrations (a reported consequence of doping with androgens via the negative feedback loop of the hypothalamic-pituitary-gonadal axis) 26.…”

Insulin sensitivity in relation to fat distribution and plasma adipocytokines among abusers of anabolic androgenic steroids

“…A total of 100 participants were included (current AAS abusers, n=37; former AAS abusers, n=33 and control participants, n=30). Demographics, details on training, extent of AAS abuse, plasma testosterone and SHBG concentrations among the participants have been described elsewhere . Total and free testosterone in plasma differed among all three groups, being clearly higher among current abusers and lower among former AAS abusers compared with control participants (Table ).…”

Baseline characteristics of the HAARLEM study: 100 male amateur athletes using anabolic androgenic steroids

“…Furthermore, official pharmacological data of testosterone derivates concern patients as opposed to athletes, clinical dosages are a fraction of dosages used by athletes, and athletes use mostly unofficial delivery and production lines of AAS. There is, however, reasonable evidence indicating that AAS use is associated with injuries such as tendon ruptures, cardiovascular toxicity, psychopathology such as mood and anxiety disorders, and hypogonadism after cessation of use—so‐called post‐AAS‐hypogonadism …”