Endocrine Abstracts

Introduction: Anabolic androgenic steroids (AAS) are frequently used to improve athletic performance and/or appearance. However, there are many negative health sequelae associated with their use, with multisystem effects including on reproductive health. AAS misuse suppresses the hypothalamic-pituitary-gonadal axis and therefore suppresses endogenous gonadotropins and testosterone.

Method: A systematic review & meta-analysis was conducted using PRISMA guidelines. Eligibility was based on the PICO tool. Population: males >18 years with previous non-medical AAS use. Intervention: Cessation of AAS to allow gonadal recovery. Comparison: Control arm; no AAS use. Outcome: Recovery in gonadal function measurements.

Results: Seven studies were included in the meta-analysis with 288 former AAS users and 329 control subjects. Meta-analysis of hormonal changes showed a significant reduction in serum testosterone in former AAS users vs controls with a weighted mean difference (WMD) of -5.27 nmol/l, 95% confidence interval (CI) -7.04 to -3.50, P < 0.00001. There was no statistical difference in gonadotropins, FSH or LH. Of studies analysing semen changes, there was no difference in sperm concentration or motility between the groups. Using the International Index of Erectile function (IIEF), there was a decrease in erectile function with a WMD for erectile function -3.78(no units), CI 95% -6.32 to -1.24, P = 0.004 in former AAS users vs controls.

Conclusion: In former AAS users, serum gonadotropin levels return to normal after abstinence. However, there’s a lasting reduction in testosterone and erectile function which is potentially permanent. These lasting effects of AAS likely go beyond HPG axis disruption, given the recovery of gonadotropins.