Half of steroid users are hypogonadal

Steroids users will have caused lasting damage to their hormone balance after a couple of years, we wrote recently. That post was based on a Danish study that was recently published in PLoS One. A year before, researchers at Harvard Medical School published a similar study. While it’s not as solid as the Danish study, the results are just as unpleasant. According to the Harvardians, half of all ex steroids users never recover their hormone balance.

The researchers studied 55 male recreational bodybuilders. They only took people who could do at least 1 rep with 125 kg on the bench press.

Of the group, 19 bodybuilders had used steroids in the past but had since stopped. Ex-users who had had testosterone therapy because their testes no longer produced enough male sex hormone were excluded from the study. The 36 bodybuilders who said they had never used steroids were subjected to various tests to check whether they really were natural bodybuilders.

The percentage of ex-users with a relatively high testosterone level was noticeably higher than among the never-users. And yes, the differences between the groups were statistically significant.

The ex-users had less free testosterone in their blood than the never-users. The difference between the two groups was not quite statistically significant. The differences in libido and testes size were significant between the two groups.

Four ex-users had only stopped cycling 4-6 months before the experiment. The rest were already at least 7 months clean. Excluding the data for the four recent ex-users did not change the overall findings.

The researchers summarise the results of their study in this table.

Just over half of the ex-users showed “pronounced symptoms of anabolic steroids withdrawal hypogonadism”, according to the Harvardians. And although they only studied a small number of bodybuilders, they believe the results of their study give reason for concern.

“The present observations, despite their limitations, suggest that anabolic steroids induced hypogonadism likely represents an emerging issue in the growing world population of anabolic steroids users – an issue still apparently underrecognized in the scientific literature”, they wrote. “Hypogonadal symptoms are of particular concern because they may induce individuals to quickly resume anabolic steroids use after stopping a prior course of these drugs, in an attempt to self-treat dysphoric sexual and mood symptoms.”

“Repeated cycles of anabolic steroids re-use may then lead to anabolic steroids dependence, a disorder that appears to develop in as many as 30% of illicit steroids users.”

“To prevent anabolic steroids dependence, and to reduce the risk of prolonged hypogonadal syndromes, hypogonadal patients will likely require endocrinological treatment to restore normal hypothalamic-pituitary-testicular function, possible antidepressant treatment (if depressive symptoms are pronounced), and substance-dependence treatment to reduce the risk of relapse into steroids use.”

Prolonged hypogonadism in males following withdrawal from anabolic–androgenic steroids: an under-recognized problem

To assess the frequency and severity of hypogonadal symptoms in male long-term anabolic–androgenic steroid (AAS) misusers who have discontinued AAS use.

Cross-sectional, naturalistic.

Out-patient facility.

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.

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).

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.

Among long-term anabolic–androgenic steroid misusers, anabolic–androgenic steroid-withdrawal hypogonadism appears to be common, frequently prolonged and associated with substantial morbidity.