ORIGINAL ARTICLE

Men regret anabolic steroid use due to a lack of

comprehension regarding the consequences on future

fertility

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

Keywords

Anabolic steroids—hypogonadism—infertil-

ity—regret—testosterone

Correspondence

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

Summary

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.

Introduction

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)

(Coward

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,

1990).

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

(Sjoqvist

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

872

2014 Blackwell Verlag GmbH

Andrologia

2015,

, 872–878