with a history of AAS regretted their decision to use AAS
and what factors drove these feelings (Buckley
et al.
1988; Kanayama
et al.
, 2001; Evans, 2004; Parkinson &
Evans, 2006; Cohen
et al.
, 2007). Most men who under-
stood the effects that AAS would have on their fertility
did not experience regret; however, those who regretted
AAS use were signiFcantly more likely to not have com-
prehended the negative impact on fertility. In contrast,
the rates of actual fertility issues were equal in men who
regretted AAS use and those who did not.
Given the illicit nature of AAS, information regarding
their usage patterns is difFcult to identify in the context
of the medical literature. The only study to date that has
examined feelings of regret with regard to AAS use was
conducted in 1995; however, it was focused on profes-
sional athletes who used AAS for competitive reasons
(Silvester, 1995). In that study by Silvester (1995) from
the cohort of 22 competitive shot-put/discus athletes
studied, only 9.1% (
2) noted that they regretted their
prior AAS use. ±urthermore, a total of 86% believed there
were no long-term physical health problems, with only
one patient (4.5%) stating that AAS caused a permanent
reduction in the size of his testicles (Silvester, 1995).
Indeed, the majority of the patients in the Silvester
(1995) perceived their health problems to be a nuisance,
rather than a severe or debilitating condition. While the
population in the current study is different, the frequency
at which patients reported regret is similar.
When considering the long-term impact of AAS on
health, the current study examined whether the well-
known side effects of altered cholesterol values and
increased levels of aggression, acne and ²uid retention
were a reason for regret (±ig. 1). While no differences
were found, a possible limitation to our anonymous sur-
vey approach was that it was not possible to ascertain the
exact medical history of our study participants. As such,
we relied on patient self-report rather than actual medical
records. ±urthermore, given the anonymous nature of the
survey, we were unable to ascertain the reliability of the
survey or to correlate serum levels to patient responses.
Given that AAS users have previously been shown to
experience poor parental relationships (Skarberg & Eng-
strom, 2007), and partner/spousal anxiety and depression
results in emotional distress (Van den Broek
et al.
, 2013),
we sought to analyse whether spousal awareness and the
resultant relationship consequences had any in²uence on
AAS-induced regret. In our population, the majority of
spouses and partners were aware of their partners AAS
use; with most mentioning that it had no effect on their
relationship (±ig. 1). Similarly, mood affective disorders
have been recognised as a complication of AAS use with
case reports describing everything from unspeciFed mood
disturbances (Lindstrom
et al.
, 1990) as well as hypomania,
mania, irritability and feelings of power and invincibility
et al.
, 2007). In our study population, spousal
communication does not appear to be an issue, and while
we were unable to capture any psychiatric disorders,
mood disturbances were similar between men with and
without regret.
Unfortunately, as most men begin AAS at a young age
and are presumed to obtain the medication from illicit
sources, they are not educated regarding the possible nega-
tive outcomes that come with their use. AAS suppress LH
and ±SH leading to acute hypogonadotropic hypogona-
dism (Coward
et al.
, 2013). In a subset of men, this ana-
bolic-steroid-induced hypogonadism (ASIH) can result in
long-term or permanent inhibition of their hypothalamic
pituitary axis (Jarow & Lipshultz, 1990; Pirola
et al.
, 2010;
et al.
, 2011). ±urthermore, the exogenously
elevated serum testosterone levels obtained from AAS
results in oligospermia and azoospermia (Dohle
et al.
2003). A primary Fnding of our study was that regretful
prior AAS users did not understand the possibility that
ASIH could result and future fertility could be hampered
(±ig. 2). Indeed, those men with regret were less likely to
have understood the potential negative impacts on both
long-term testosterone levels (
0.06) and fertility
0.029) than men without regret.
The Fndings in the current study are important when
dealing with hypogonadal patients with ASIH seeking
TST. As a proportion of patients may be hypogonadal due
to ASIH (Coward
et al.
, 2013), asking about AAS is
important. ±urthermore, it is valuable for men with ASIH
to understand the impact that exogenous AAS may have
had on their fertility. In these men with a previous history
of AAS who present with infertility and hypogonadism,
multiple pharmacological treatments are available, includ-
ing exogenous testosterone, human chorionic gonadotro-
pin (hCG), human menopausal gonadotropin (hMG),
recombinant ±SH and clomiphene citrate (Martikainen
et al.
, 1986; Gill, 1998; Menon, 2003; Ioannidou-Kadis
et al.
, 2006; Hsieh
et al.
, 2013; Rahnema
et al.
, 2014).
JRK and RR are NIH K12 Scholars supported by a Male
Reproductive Health Research Career (MHRH) Develop-
ment Physician-Scientist Award (HD073917-01) from the
Eunice Kennedy Shriver National Institute of Child
Health and Human Development (NICHD) Program.
Blume AW, Schmaling KB (1998) Regret, substance abuse, and
readiness to change in a dually diagnosed sample.
2014 Blackwell Verlag GmbH
, 872–878
Anabolic steroid use and regret
J. R. Kovac
et al.