Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery

Tatem, Alexander J.; Beilan, Jonathan; Kovac, Jason R.; Lipshultz, Larry I.

doi:10.5534/wjmh.190002

Cited by 45 publications

(53 citation statements)

References 75 publications

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“…Recognition of the specific details of the user’s AAS exposure is crucial for their medical management. Management strategies for male infertility secondary to AAS induced hypogonadism should focus on the underlying hypogonadal state [ 105 , 106 ]. According to a recent study, chronic AAS abuse should be considered when a muscular man presents with hypogonadism, onset of gynecomastia or hirsutism.…”

Section: Aas Use and Adverse Effectsmentioning

confidence: 99%

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

et al. 2021

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Anabolic-androgenic steroids (AASs) are a large group of molecules including endogenously produced androgens, such as testosterone, as well as synthetically manufactured derivatives. AAS use is widespread due to their ability to improve muscle growth for aesthetic purposes and athletes’ performance, minimizing androgenic effects. AAS use is very popular and 1–3% of US inhabitants have been estimated to be AAS users. However, AASs have side effects, involving all organs, tissues and body functions, especially long-term toxicity involving the cardiovascular system and the reproductive system, thereby, their abuse is considered a public health issue. The aim of the proposed review is to highlight the most recent evidence regarding the mechanisms of action of AASs and their unwanted effects on organs and lifestyle, as well as suggesting that AAS misuse and abuse lead to adverse effects in all body tissues and organs. Oxidative stress, apoptosis, and protein synthesis alteration are common mechanisms involved in AAS-related damage in the whole body. The cardiovascular system and the reproductive system are the most frequently involved apparatuses. Epidemiology as well as the molecular and pathological mechanisms involved in the neuropsychiatric side-effects of AAS abuse are still unclear, further research is needed in this field. In addition, diagnostically reliable tests for AAS abuse should be standardized. In this regard, to prevent the use of AASs, public health measures in all settings are crucial. These measures consist of improved knowledge among healthcare workers, proper doping screening tests, educational interventions, and updated legislation.

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Section: Aas Use and Adverse Effectsmentioning

confidence: 99%

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

et al. 2021

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“…While long-term prospective harm data are lacking, strong evidence exists for the development of accelerated atherosclerosis, left ventricular hypertrophy, arrhythmias, hypertension, and HDL suppression ( Achar et al, 2010 ; Alizade et al, 2016 ; Baggish et al, 2017 ; Santora et al, 2006 ; Thiblin et al, 2015 ). Polycythemia, infertility, tendon rupture of the upper extremity, and behavioral disorders are commonly associated with AAS use ( Coviello et al, 2008 ; Hauger et al, 2019 ; Kanayama, DeLuca, et al, 2015 ; Rahnema et al, 2014 ; Tatem et al, 2019 ; Thiblin et al, 1999 ). AAS withdrawal syndrome has also been reported and is due to the sudden decline in androgen levels with resultant anabolic steroid-induced hypogonadism (ASIH) and neuropsychiatric effects ( Bertozzi et al, 2019 ; Bhasin et al, 2018 ; Pope et al, 2014 ).…”

Section: Anabolic Androgenic Steroids: the State Ofthe Artmentioning

confidence: 99%

Characteristics and Attitudes of Men Using Anabolic Androgenic Steroids (AAS): A Survey of 2385 Men

2020

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Additional characterization of patients using anabolic androgenic steroids (AAS) is needed to improve harm reduction and cessation resources for patients. Our group sought to expand upon the currently limited data regarding AAS use by performing a web-based survey assessing experiences of males using AAS. Participants included men over the age of 18 with history of AAS use within the past 5 years. Data were collected between August 2019 and April 2020. Primary outcome measures included age when starting AAS, dose of AAS, motivations for use, experiences with health-care professionals, and rate of successful cessation. The survey was accessed 3640 times, resulting in 2385 completed surveys meeting the inclusion criteria (68.93% participation rate). Average participant age was 31.69 ± 10.09 years. Over half of respondents were from the United States ( n = 1271, 53.3%). Motives to use AAS included improving appearance ( n = 1959, 82.2%), strength gain ( n = 1192, 50%), and self-esteem/body image issues ( n = 712, 29.87%). Participants rated physicians poorly, regarding knowledge of AAS (4.08 ± 2.23). Most participants did not reveal AAS use to their health-care providers ( n = 1338, 56.1%); of those that did, 55.30% ( n = 579) reported feeling discriminated against for their use. Of 46.16% ( n = 1101) attempting AAS cessation, 60.22% ( n = 663) were unsuccessful. Challenges in the management of AAS use include early onset of use, supraphysiologic doses used, and frequently present body image disorders stress. Distrust of health-care providers, poor cessation rates, and lack of physician training further exacerbate this. These findings should serve to reinforce previous calls to action for further research on the treatment of AAS use disorder.

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“…По литературным данным, после замести-тельной терапии тестостероном или злоупотребления андрогенными анаболическими стероидами спонтанное восстановление системы гипофиз-гонады может продолжаться от нескольких месяцев до 2 лет, при этом описаны случаи необратимого ее повреждения [1]. Пользователи андрогенных анаболических стероидов для снижения негативного влияния препаратов на систему гипофиз-гонады применяют их так называемыми курсами, а между ними проводят послекурсовую терапию (post-cycle therapy), эффективность которой неизвестна, с целью восстановления системы гипофиз-гонады [8]. Таким образом, актуальным является исследование состояния системы гипофиз-гонады при использовании андрогенных анаболических стероидов и через 3 мес послекурсовой терапии на фоне отказа от препаратов тестостерона.…”

Section: обоснованиеunclassified

Peculiarity of recovery of the hypothalamic-pituitary-gonadal (hpg) axis, in men after using androgenic anabolic steroids

Lykhonosov

Бабенко

Макарьин

et al. 2020

Probl Endokrinol (Mosk)

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Backgraund: There is insufficient data on the duration of recovery of HPG axis after abuse of androgenic anabolic steroids (AAS). Aims: to evaluate the recovery of HPG axis in men, AAS users, after a 3-month of cessation of their use and after PCT. Materials and methods: An observational, single-center, prospective, sampling, open, uncontrolled study was conducted among male AAS users. While using of AAS and 3 months after the refusal of their administration and PCT, the clinical symptoms of hypogonadism were evaluated, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (Tt), prolactin, estradiol, inhibin B, thyroid-stimulating hormone (TSH) were determined. The scheme of rehabilitation therapy was the same and did not change throughout the study. Recovery criteria: Tt3.4 ng/ml and LH1.24 mIU/ml. The study was conducted from January to August 2019. Fisher's exact test, Mann-Whitney U-test, and Spearman's rank correlation coefficient were used. The differences were considered statistically significant at p 0.05. Results: The study included 44 men, their age 29 years [27.75;34], the duration of the use of AAS is 6 months [3.52;7]. During the use of AAS: LH 0.2 mIU/ml [0.04;0.47], Tt - 4.34 ng/ml [1.05;8.81]. In this group, the number of men with a LH level1.24mIU/ml was 84% (n=37) and Tt3.4ng/ml was 47.7%(n=21). After 3 months, the LH level reached 4.12 mIU/ml [2.58;5.84], Tt - 4.55 ng/ml [3.76;6.24]. At the same time, the level of Tt3.4 ng/ml remained in 20.5% (n=9); LH1.24 mIU/ml in 4.5%(n=2) men. According to the level of recovery of LH and Tt, patients were divided into two groups: with satisfying (n=35;79.5%) and poor (n=9;20.5%) recovery. A clear correlation was established between the duration of use (-0.857; p0.0001), the amount (-0.443; p=0.003), the dose (-0.7825; p0.0001), the type of AAS (-0.698; p0.0001). Conclusions: A three-month refusal to use AAS with PCT led to the restoration of HPG axis a in 79.5% of the volunteers. The negative effect of the duration of use, the number of simultaneously administered drugs, their dose and type of AAS on the restoration of HPG axis was established.

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Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery

Cited by 45 publications

References 75 publications

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

Characteristics and Attitudes of Men Using Anabolic Androgenic Steroids (AAS): A Survey of 2385 Men

Peculiarity of recovery of the hypothalamic-pituitary-gonadal (hpg) axis, in men after using androgenic anabolic steroids

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