Endocrine Abstracts

JOINT3272

Background: Androgens are widely abused by men worldwide to enhance muscle size and physical performance. Recent studies have quantified the recovery of cardiovascular and testicular function post-cessation. Qualitative studies demonstrate that low mood, anxiety, suicidal ideation, and sexual dysfunction are common following androgen abuse cessation. However, no previous study has focused on quantifying symptoms within the first year of cessation, nor investigated independently associated factors for these symptoms.

Methods: Cross-sectional, observational study of 286 men in 3 groups; non-use (n=50); current-use (n=125); past-use ≤1 year (n=111). All participants completed questions on substance misuse, Beck Depression Inventory-II (BDI-II), International Index Erectile Function-15 (IIEF-15), General Anxiety Disorder (GAD-7), Quality-of-life (SF-36), and underwent fasting, morning blood sampling with urine toxicology.

Results: Current-use had lower gonadotropins and elevated serum total testosterone compared with past-use and non-use. Sexual function measured using IIEF-15 was impaired in past-use compared with current users: (1) total: 69.0 [IQR 61.0, 73.0], current-use; 62.0 [IQR 47.0, 71.0], past-use; P=0.0002; (2) erectile function: 30.0 [IQR 27.0, 30.0], current-use; 27 [IQR 20.0, 30.0], past-use; P=0.0002; (3) sexual desire: 9.0 [IQR 7.0, 10.0], current-use; 7.0 [IQR 5.0, 9.0], past-use; P<0.0001; (4) intercourse satisfaction: 12.0 [IQR 10.0, 15.0], current-use; 12.0 [IQR 8.0, 14.0], past-use; P=0.0445; (5) overall satisfaction: 10.0 [IQR 8.0, 10.0], current-use; 8.0 [IQR 6.0, 10.0], past-use; P=0.0001. Multivariable analysis suggested that psychiatric comorbidity (coefficient -6.5 [95% CI -13.0, -1.3]; P=0.03) and androgen cessation (coefficient -10.8 [95% CI -5.6, -17.2]; P<0.001) were associated with lower total IIEF-15 scores. Depression scoring was worse in the past-use compared with non-use and current-use: BDI-II 3.0 [IQR 0.0, 8.0], non-use; 6.0 [IQR 2.0, 11.0], current use; 8.0 [IQR 2.0, 18.0], past-use; P=0.0005. Multivariable analysis suggested that psychiatric comorbidity (OR 2.39 [95% CI 1.60, 3.57]; P<0.001) and lower serum total testosterone (OR 0.85 [95% CI 0.88, 0.94]; P=0.002) were associated with higher BDI-II scores. Anxiety scoring was worse in the past-use compared with the non-use: GAD-7 1.0 [IQR 0.0, 3.0], non-use; 2.0 [IQR 0.0, 6.0], past-use; P=0.0271. Energy and fatigue measured using SF-36 was lower in past-use compared with non-use and current-use: 70 [IQR 60, 76], non-use; 65 [IQR 50, 75], current-use; 55 [IQR 40, 50], past-use; P=0.0009.

Discussion: We report the first, detailed quantification and modelling of symptoms in men currently misusing and stopping androgens within the previous year. These data reveal potentially treatable factors to improve symptoms of androgen abuse cessation if proven within interventional studies.