presented with infertility. When the etiology of
hypogonadism was more accurately assessed, 77
men (79.4%) were found to have hypogonadotropic
hypogonadism. In this subgroup 42 men (55%) had
ASIH for a total prevalence of 43% (42 of 97)
(table 1). This value was significantly greater than
the that of other identified etiologies of hypogonad-
ism (p
<
0.05). Given the unexpectedly high preva-
lence of prior AAS use on retrospective analysis,
using an
anonymous survey
we subsequently
sought to prospectively identify the ASIH preva-
lence, AAS use patterns, and the demographics and
characteristics of men seeking treatment for ASIH.
A total of 382 surveys were included in analysis.
Mean
±
SD age in the entire cohort was 49.2
±
13.0 years. Overall 80 men (20.9%) reported a his-
tory of AAS exposure (table 2). Mean age of the 80
men with a history of AAS use was significantly less
than the age of the 302 without previous AAS use
(40.4
±
8.4 vs 51.5
±
13 years, p
<
0.0001). Average
age of first exposure to AAS was 25.6
±
7.6 years. Of
all respondents 50 years or younger 71 (35.0%)
reported prior AAS use compared to 9 (5.0%) older
than 50 years (p
<
0.0001). Patients younger than
50 years were more than 10 times more likely to
have a history of AAS use than men older than
50 years (OR 10.16, 95% CI 4.90
e
21.08). The figure
shows the percent of patients reporting prior AAS
exposure, stratified by decade.
Prior AAS use significantly correlated negatively
with age (
r
¼
e
0.361, p
<
0.0001), education level
(
r
¼
e
0.160, p
¼
0.002) and number of children
(
r
¼
e
0.281, p
<
0.0001), indicating that former AAS
users were more likely to be younger and less
educated, and have fewer children (table 2). ORs
supported these observations, showing an increased
likelihood of AAS use in single men (OR 3.46, 5% CI
1.87
e
6.44), and a decreased likelihood of prior AAS
use in men with a college education (OR 0.45, 95%
CI 0.27
e
0.75) and those with an annual income of
greater than $200,000 (OR 0.26, 95% CI 0.07
e
0.96).
A mean of 3.1 AASs were used per respondent.
The 3 most commonly used AASs, which were also
the same drugs used for the longest average dura-
tion, were nandrolone decanoate for 14.0 months in
60 patients (75%), stanozolol for 9.5 months in 45
(56.3%) and methandrostenolone for 10.7 months in
39 (48.8%) (table 3). The most frequently reported
AAS side effects were fluid retention in 45% of
cases, decreased testicular size in 41.3% and acne in
37.5% (table 4).
Table 2.
Demographics of patients with and without AAS
exposure history
Overall
AAS Naive
Prior AAS
Exposure
No. respondents (%)
382
(100)
302
(79.1)
80
(20.9)
Mean
±
SD age
49.2
±
13.0
51.5
±
13.0* 40.4
±
8.4*
Mean
±
SD body mass
index (kg/m
2
)
29.4
±
4.3
29.3
±
4.4
29.8
±
3.9
No. marital status (%):
Single
59
(15.5)
36
(12.0)* 23
(28.8)*
Married
270
(70.9)
227
(75.4)* 43
(53.7)*
Divorced
33
(8.6)
24
(8.0)
9
(11.3)
Cohabitating
19
(5.0)
14
(4.6)
5
(6.2)
No. highest education level (%):
Grade school
3
(0.8)
2
(0.7)
1
(1.3)
High school
30
(7.9)
21
(7.0)
9
(11.4)
Some college/university
90
(23.7)
63
(20.9)
27
(34.2)
College/university
159
(41.8)
130
(43.2)
29
(36.7)
Graduate level
98
(25.8)
85
(28.2)
13
(16.4)
No. $ current annual income (%):
Less than 25,000
12
(3.3)
7
(2.5)
5
(6.4)
25,000
e
50,000
15
(4.1)
13
(4.6)
2
(2.6)
50,001
e
75,000
58
(15.9)
39
(13.6)
19
(24.3)
75,001
e
100,000
78
(21.4)
65
(22.7)
13
(16.7)
100,001
e
150,000
73
(20.1)
57
(19.9)
16
(20.5)
150,001
e
200,000
57
(15.7)
45
(15.7)
12
(15.4)
Greater than 200,000
71
(19.5)
60
(21.0)
11
(14.1)
*p
<
0.05.
Age comparison of hypogonadal men who received TRT with
(red bars) vs without (black bars) previous AAS exposure.
Table 3.
AAS use in study cohort of 80 patients
AAS
No. Pts (%)
Mean
±
SD
Duration (mos)
Nandrolone decanoate (Deca-Durabolin)
60
(75)
14.0
±
16.7
Stanozolol (Winstrol)
45 (56.3)
9.5
±
12.3
Ethandrostenolone (Dianabol)
39 (48.8)
10.7
±
13.5
Trenbolone (Parabolan
Ò
)
28
(35)
3.1
±
1.3
Oxandrolone (Anavar
Ò
)
26 (32.5)
4.1
±
4.2
Oxymethalone (Anadrol
Ò
)
24
(30)
7.9
±
8.5
Drostanolone propionate (Masteron
Ô
)
4
(5)
2.7
±
1.5
Boldenone undecylenate (Equipoise
Ò
)
3 (3.8)
7.0
±
7.1
Methenolone enanthate (Primabolan
Ò
)
3 (3.8)
3.0
±
0
2202
ANABOLIC STEROID INDUCED HYPOGONADISM IN YOUNG MEN