that semen parameters can spontaneously recover within
12 months after discontinuation (Knuth
et al.
, 1989;
et al.
, 1995). Recovery may be delayed due to tes-
ticular atrophy and dysfunctional spermatogenesis (Schur-
et al.
, 1984; Turek
et al.
, 1995; Gazvani
et al.
1997; Menon, 2003) along with germ cell apoptosis
et al.
, 2007; Shokri
et al.
, 2010).
In other studies examining illicit substance use, deci-
sions made in youth and adolescence tends to lead to
regret later in adult life (Byrnes, 2002). As usage of these
agents (such as AAS) may be ascribed to impulsiveness,
and given that a person’s values can change over time
leading to regret, it is tempting to speculate that prior
AAS use could lead to regret as individuals’ priorities and
values change over time (Igra & Irwin, 1995). Indeed,
regret has previously been shown to play a role in the
decision to alter substance abuse patterns (Blume &
Schmaling, 1998) and has been associated with less alco-
hol and marijuana use in young adults (Stoddard
et al.
2012) suggesting that men with prior AAS use are more
likely to seek medical assistance for ASIH given their
familiarity with the symptoms and long-term side effects.
Furthermore, previous studies (Sanford, 2012; Van den
et al.
, 2013) have found spousal and partner feel-
ings and anxiety to play a role in regret, so we hypothes-
ised that regretting AAS use may be associated with a
lack of spousal awareness that would then impact a cou-
ple’s relationship. We therefore sought to determine
whether patients presenting with ASIH regretted their
decision to use AAS and what factors drove this regret.
Materials and methods
After Institutional Review Board (IRB) approval, a self-
administered anonymous survey was distributed to male
patients seeking treatment for hypogonadism in a tertiary,
academic urology clinic. The survey was self-adminis-
tered, con±dential and anonymous. Hypogonadism was
diagnosed with serum total testosterone values combined
with patient history of hypogonadal symptoms and treat-
ments included injections, gels or pellets with modality of
TST not considered with regard to responses. Patients
seeking treatment for infertility were excluded and surveys
were also excluded from analysis if they contained incom-
plete or con²icting responses. Follow-up visits for hypog-
onadism and TST were used when administering the
survey. Patients undergoing initial consultations were
excluded since given the anonymous nature of the survey,
it was impossible to know whether these men were actu-
ally hypogonadal and if they were treated or not.
The survey included basic patient demographics such
as age, sexual orientation, marital status, level of educa-
tion and income. Those men who self-reported AAS use
were asked to complete a follow-up second survey. This
second portion gathered data that determined characteris-
tics of those patients who engaged in AAS use. Regret
was determined using a question in this second part of
the survey that stated ‘Do you regret using anabolic ste-
roids?’ and could have been answered either Yes or No.
In no survey was this question left blank. The effect of
AAS use on relationship was addressed by the question
‘Does your spouse/signi±cant other know about your pre-
vious or current steroid use’? The answer options were
(1) Yes
Has not affected relationship, (2) Yes
affected relationship, (3) No
Has not affected relation-
ship, (4) No
Has affected relationship and, (5) Not
applicable. No patient selected option 5 as a response. To
further assess impact of AAS use the following question
was asked: when you ±rst decided to use anabolic ste-
roids, did you understand the potential long-term effect
it could have on your (a) natural testosterone production
(Yes/No) (b) fertility (Yes/No). A follow-up question
asked: ‘Have anabolic steroids affected your: (a) Erections
(Yes/No), (b) Fertility (Yes/No)’. The majority of the
questions produced single-answer responses via multiple
choices or yes/no answers.
Data were analysed using Student’s
-test for scalar
variables and Fisher’s exact test for categorical variables.
Correlation analysis between variables was performed
using Spearman’s rank correlation, and odds ratios were
calculated when appropriate. Analysis was performed
using Microsoft Excel (Microsoft, Redmond, WA, USA)
6 software (GraphPad Software Inc.,
La Jolla, CA, USA) with a
0.05 considered statistically
signi±cant. All values were reported as means
unless otherwise noted.
Results from an anonymous, prospective survey distrib-
uted to hypogonadal men being treated with TST at a
high-volume academic Urology clinic were assessed. A
total of 79 men stated that they had previously used AAS
(Table 1). From these men, 84.8% (
67) stated that
they had no regret (NR) while 15.2% (
12) expressed
regret (R) about their AAS use (Table 1). A total of 382
surveys were distributed with 20.8% of patients reported
prior AAS exposure. No statistical differences were identi-
±ed between mean age (
0.070), height (
weight (
0.620) and BMI (
0.300). The majority of
the men were heterosexual and married. Men who regret-
ted use were more likely to have no children (58.3%)
while men who were not regretful of their prior AAS use
were more likely to have 1
2 children (58.2%). Both
groups were educated with a sizable percentage having
current income levels of
$150 000 (Table 1).
2014 Blackwell Verlag GmbH
, 872–878
J. R. Kovac
et al.
Anabolic steroid use and regret