Men regret anabolic steroid use due to a lack of
comprehension regarding the consequences on future
J. R. Kovac
, J. Scovell
, R. Ramasamy
, S. Rajanahally
, R. M. Coward
, R. P. Smith
& L. I. Lipshultz
1 Urology of Indiana, Male Reproductive Endocrinology and Surgery, Carmel, IN, USA;
2 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA;
3 Department of Urology, University of North Carolina, Chapel Hill, NC, USA;
4 Department of Urology, University of Virginia, Charlottesville, VA, USA
Anabolic steroids—hypogonadism—infertil-
Jason Kovac, Urology of Indiana, Male Repro-
ductive Endocrinology and Surgery, 12188-A
North Meridian Street, Carmel, IN, USA.
Tel./fax: +317-564-5130;
E-mail: Jkovac@urologyin.com
Accepted: July 8, 2014
doi: 10.1111/and.12340
We examined whether men with anabolic-steroid-induced hypogonadism
(ASIH) seeking testosterone supplementation therapy (TST) regretted their
decision to use anabolic-androgenic steroids (AAS) and what their reasons
were for this regret. An anonymous, prospective survey was distributed to 382
men seeking follow-up treatment for hypogonadism. Prior AAS use was con-
Frmed by self-report, and men were categorised based upon whether they
regretted (R) or did not regret (NR) their use of AAS. The average patient age
was 40
0.9 years (
79) and 15.2% expressed regret over AAS use. No
demographic differences were identiFed between those who regretted AAS use
12) and those who did not (
67). Regret was not related to ASIH
diagnosis or to AAS-related side effects like increased aggression, mood disor-
ders, erectile dysfunction, acne, ±uid retention or dyslipidemia. Those who
regretted AAS use were signiFcantly more likely to have not comprehended the
negative impact on future fertility (
0.030). Actual fertility issues were com-
parable in men who regretted AAS use (16.7%) and those who did not (13%).
A total of 15.2% of men regretted using AAS. A lack of awareness regarding
the negative long-term effects on fertility was the primary factor related to
regret of AAS use in men with ASIH.
The isolation of the testosterone molecule has resulted in
the development of multiple synthetic derivatives. Classi-
Fed as anabolic-androgenic steroids (AAS), the desirable
effects of these products included increased muscle mass
and strength along with decreased recovery times and
improved healing (Hough, 1990). Amongst the general
population, an estimated 3 million people have reported
using AAS (Maravelias
et al.
, 2005). Prior exposure to
AAS has recently been postulated to contribute to pro-
found hypogonadism (serum testosterone
50 ng ml
as well as anabolic-steroid-induced hypogonadism (ASIH)
et al.
, 2013). Indeed, a preliminary study in
1990 identiFed inhibited levels of luteinising (LH) and
follicle stimulating hormone (²SH) for 1
3 years follow-
ing last documented use of AAS (Jarow & Lipshultz,
While the duration of gonadotrophin suppression in
response to AAS is unknown, it is likely related to the
types of AAS used as well as the duration (Tan & Scally,
2009). While AAS contributes to effective muscle building
by diversion of nitrogenic compounds to lean body mass
et al.
, 2008), not all AAS compounds function
equally with regard to the ratio of anabolic to androgenic
effects (Kicman, 2008). In high doses, all AAS have the
potential to virilise (Shahidi, 2001) with other, adverse
effects being similarly both type- and dose-dependent
(Landry & Primos, 1990).
Of the numerous AAS side effects known, ±uid reten-
tion, decreased testicular size, acne, aggressiveness and
negative effects on sperm counts, cholesterol and haemat-
ocrit have been noted to be the most common (Coward
et al.
, 2013). Interestingly, the decreased sperm counts,
motility and altered morphology (Dohle
et al.
, 2003)
associated with AAS are typically transient, with evidence
2014 Blackwell Verlag GmbH
, 872–878