Infertility can result from use, but specialists say effects may be reversible.
The consequences of anabolic steroid use is a treatment reality for many clinicians, including urologists. Although anabolic steroid use among professional athletes gets the lion’s share of attention in the media, many more casual competitors partake as well.
In 1994, the Substance Abuse and Mental Health Services Administration’s National Household Survey on Drug Abuse revealed that nearly 1.1 million Americans—0.5% of the adult population—said they had used anabolic steroids. The youngest users are largely found in middle schools and high schools nationwide.
Urologic problems can begin after just one cycle of use, eventually driving the person to seek professional evaluation and treatment. (The NIH’s National Institute on Drug Abuse defines “cycling” as taking the steroids—sometimes at doses as much as hundreds of times higher than recommended—for six to 12 weeks or longer, stopping for several weeks, and then starting again. Another commonly used method of steroid use, “stacking,” en-tails taking several different types of steroids at high doses.)
Although the term “anabolic steroids” has negative connotations, it encompasses testosterone gels and injectables that are legitimate medical treatments for various conditions.
For example, many aging men with naturally declining levels of the hormone—characterized by low energy, low mood, sexual dysfunction, and trouble concentrating—are prescribed a synthetic testosterone which, by definition, is an anabolic steroid. Nevertheless, many of these men require the care of a urologist when their testosterone treatments need to be re-evaluated, such as when spermatogenesis is affected.
Reproductive problems most common
Among both former and active users of anabolic steroids, the most common presentations in the urology setting are infertility and sexual dysfunction. “If they’re still on steroids, they typically will have high testosterone levels and low—almost zero, undetectable—luteinizing hormone [LH] and follicle- stimulating hormone [FSH] levels,” explains Stanton Honig, MD, associate clinical professor of urology at the University of Connecticut School of Medicine and an editorial advisory board member of Renal & Urology News. “If they have used steroids in the past and are now off them, they may still have a low LH, low FSH, and low testosterone because they may not rebound.”
Dr. Honig, who specializes in male reproduction and sexual dysfunction issues, sees around two patients per month who are trying to reverse the detrimental effects of anabolic steroids on spermatogenesis. In his experience, these effects can be reversed in about 80% of these men so that sperm is in the ejaculate or can be retrieved from the testicles for in vitro fertilization with or without medical therapy, he reports. About 20% of anabolic steroid users remain permanently azoospermic. In many cases, sperm production can be restored even in current users of anabolic steroids if they stop using the drugs, according to Dr. Honig.
However, “it may take three months, six months, nine months, 12 months, even up to two years to see a return,” he cautions. “The bodybuilders will take much longer. The longer they’ve been on the drug, the less likely they are to respond. But if they’ve just been on it for a couple of months or a couple of cycles and stop, they will bounce back and have good sperm parameters.”
Anabolic steroids—drugs derived from testosterone—eventually shut down the body’s own ability to produce this hormone by suppressing the hypothalamic-pituitary-gonadal axis. The exogenous testosterone signals the pituitary gland that there is enough testosterone, causing the pituitary to stop producing LH and, as a result, less intratesticular testosterone.
After stopping the steroids, “the patient comes in with an incredibly low testosterone level, which leaves him feeling poorly—depressed and no sex drive,” explains andrologist Thomas M. Jaffe, MD, assistant professor of urology at University of Pittsburgh Medical Center.