that semen parameters can spontaneously recover within

–

12 months after discontinuation (Knuth

et al.

, 1989;

Turek

et al.

, 1995). Recovery may be delayed due to tes-

ticular atrophy and dysfunctional spermatogenesis (Schur-

meyer

et al.

, 1984; Turek

et al.

, 1995; Gazvani

et al.

1997; Menon, 2003) along with germ cell apoptosis

(Moretti

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

Broek

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

–

Has

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)

and

GRAPHPAD PRISM

6 software (GraphPad Software Inc.,

La Jolla, CA, USA) with a

0.05 considered statistically

signi±cant. All values were reported as means

SEM,

unless otherwise noted.

Results

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 (

0.450),

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

873

Andrologia

2015,

, 872–878

J. R. Kovac

et al.

Anabolic steroid use and regret