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

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.