Anabolic Steroid Induced Hypogonadism in Young Men
Robert M. Coward, Saneal Rajanahally, Jason R. Kovac, Ryan P. Smith,
Alexander W. Pastuszak and Larry I. Lipshultz*,†
From the Scott Department of Urology, Baylor College of Medicine, Houston, Texas
Purpose:
The use of anabolic androgenic steroids has not been traditionally
discussed in mainstream medicine. With the increased diagnosis of hypogonad-
ism a heterogeneous population of men is now being evaluated. In this larger
patient population the existence of anabolic steroid induced hypogonadism,
whether transient or permanent, should now be considered.
Materials and Methods:
We performed an initial retrospective database analysis
of all 6,033 patients who sought treatment for hypogonadism from 2005 to 2010.
An anonymous survey was subsequently distributed in 2012 to established
patients undergoing testosterone replacement therapy.
Results:
Profound hypogonadism, defined as testosterone 50 ng/dl or less, was
identified in 97 men (1.6%) in the large retrospective cohort initially reviewed.
The most common etiology was prior anabolic androgenic steroid exposure,
which was identified in 42 men (43%). Because of this surprising data, we
performed an anonymous followup survey of our current hypogonadal popula-
tion of 382 men with a mean
±
SD age of 49.2
±
13.0 years. This identified 80
patients (20.9%) with a mean age of 40.4
±
8.4 years who had prior anabolic
androgenic steroid exposure. Hypogonadal men younger than 50 years were
greater than 10 times more likely to have prior anabolic androgenic steroid
exposure than men older than 50 years (OR 10.16, 95% CI 4.90
e
21.08). Prior
anabolic androgenic steroid use significantly correlated negatively with educa-
tion level (
r
¼
e
0.160, p
¼
0.002) and number of children (
r
¼
e
0.281,
p
<
0.0001).
Conclusions:
Prior anabolic androgenic steroid use is common in young men who
seek treatment for symptomatic hypogonadism and anabolic steroid induced
hypogonadism is the most common etiology of profound hypogonadism. These
findings suggest that it is necessary to refocus the approach to evaluation and
treatment paradigms in young hypogonadal men.
Key Words:
testis; anabolic agents; hypogonadism; testosterone;
substance related disorders
F
IRST
identified in 1935, testosterone
is the principal androgen controlling
the development of the male body
with androgenic masculinizing effects
along with anabolic properties that
increase lean muscle mass.
1
Struc-
tural modifications to the testosterone
molecule
were
introduced
in
the
1950s to increase its anabolic effects
while minimizing androgenic effects,
resulting in the AAS family.
2
Al-
though testosterone is an AAS by
definition, in this study we denote TRT
separately from the term AAS, which
Abbreviations
and Acronyms
AAS
¼
anabolic androgenic
steroid
ASIH
¼
anabolic steroid induced
hypogonadism
TRT
¼
testosterone replacement
therapy
Accepted for publication June 3, 2013.
Study received institutional review board
approval.
* Correspondence: 6624 Fannin St., Suite 1700,
Houston, Texas 77030 (telephone: 713-798-6163;
FAX: 713-798-6007; e-mail: larryl@bcm.edu
).
†
Financial interest and/or other relationship
with Eli Lilly, Endo, Auxilium, Pfizer, Allergan and
American Medical Systems.
2200
j
www.jurology.com
0022-5347/13/1906-2200/0
THE JOURNAL OF UROLOGY
®
©
2013 by A
MERICAN
U
ROLOGICAL
A
SSOCIATION
E
DUCATION AND
R
ESEARCH
,I
NC
.
Vol. 190, 2200-2205, December 2013
Printed in U.S.A.