Prevalence of anabolic androgenic steroid use, its effect on the male pituitary-gonadal axis, and the possibility of reproductive rehabilitation

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The purpose of this review is to assess the prevalence of AA steroid use, to identify the steroids that are used, and to present the negative effects of AA steroids on the human body while describing the mechanisms of their actions on the male reproductive system. The review highlights the diagnostic features of steroid-induced hypogonadism, and assesses the effectiveness of various drugs in the reproductive rehabilitation of patients who cease taking AA steroids. Emphasis is placed on the feasibility and effectiveness of various drug treatments in the context of post cycle therapy (PCT), which seeks to stabilize and restore normal hormonal function. All this data is necessary for the development of modern treatment algorithms for steroid-induced hypogonadism in men.

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About the authors

Mykola P. Lykhonosov

Pavlov First Saint Petersburg State Medical University

Author for correspondence.
ORCID iD: 0000-0001-6460-5226
SPIN-code: 2102-5358

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197089


Alina Yu. Babenko

Pavlov First Saint Petersburg State Medical University; Almazov National Medical Research Centre

ORCID iD: 0000-0002-0559-697X
SPIN-code: 9388-1077

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197089; 2, Akkuratova str., Saint- Petersburg, 197341



  1. McBride JA, Coward RM. Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian J Androl. 2016;18(3):373-380. doi:
  2. Odoardi S, Castrignano E, Martello S, et al. Determination of anabolic agents in dietary supplements by liquid chromatography-high-resolution mass spectrometry. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2015;32(5):635-647. doi:
  3. Freeman ER, Bloom DA, McGuire EJ. A brief history of testosterone. J Urol. 2001;165(2):371-373. doi:
  4. Matfin G. The rejuvenation of testosterone: philosopher’s stone or Brown-Sequard Elixir? Ther Adv Endocrinol Metab. 2010;1(4):151-154. doi:
  5. Dotson JL, Brown RT. The history of the development of anabolic-androgenic steroids. Pediatr Clin North Am. 2007;54(4):761-769, xi. doi:
  6. Evans NA. Gym and tonic: a profile of 100 male steroid users. Br J Sports Med. 1997;31(1):54-58. doi:
  7. Дедов И.И., Мельниченко Г.А., Роживанов Р.В., Курбатов Д.Г. Рекомендации по диагностике и лечению гипогонадизма (дефицита тестостерона) у мужчин. Проект. // Проблемы эндокринологии. – 2015. – Т. 61. – №5. – С. 60-71. [Dedov II, Mel’nichenko GA, Rozhivanov RV, Kurbatov DG. The recommendations on diagnostics and treatment of male hypogonadism (deficit of testosterone). The project. Problems of endocrinology. 2015;61(5):60-71. (In Russ.)] doi:
  8. Mulligan T, Frick MF, Zuraw QC, et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769. doi:
  9. Kovac JR, Addai J, Smith RP, et al. The effects of advanced paternal age on fertility. Asian J Androl. 2013;15(6):723-728. doi:
  10. Liu PY, Swerdloff RS, Christenson PD, et al. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. Lancet. 2006;367(9520):1412-1420. doi:
  11. Dodge T, Hoagland MF. The use of anabolic androgenic steroids and polypharmacy: a review of the literature. Drug Alcohol Depend. 2011;114(2-3):100-109. doi:
  12. Boregowda K, Joels L, Stephens JW, Price DE. Persistent primary hypogonadism associated with anabolic steroid abuse. Fertil Steril. 2011;96(1):e7-8. doi:
  13. Molero Y, Bakshi AS, Gripenberg J. Illicit Drug Use Among Gym-Goers: a Cross-sectional Study of Gym-Goers in Sweden. Sports Med Open. 2017;3(1):31. doi:
  14. Pope HG, Jr., Kanayama G, Athey A, et al. The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates. Am J Addict. 2014;23(4):371-377. doi:
  15. Sagoe D, Torsheim T, Molde H, et al. Anabolic-androgenic Steroid Use in the Nordic Countries: A Meta-analysis and Meta-regression Analysis. Nordisk Alkohol Nark. 2014;0(0). doi:
  16. Горчакова Н.А., Гудивок Я.С., Гунина Л.М. Фармакология спорта. / Под ред. Олейника С.А., Гуниной Л.М., Сейфуллы Р.Д. – Киев: Олимпийская литература; 2010. [Gorchakova NA, Gudivok YaS, Gunina LM / Oleynik SA, Gunina LM, Seyfulla RD, editors. Farmakologiya sporta. Кiev: Olympiyskaya literatura. (In Russ.)]
  17. Федоров А.В. Допинг и наркотики // Наркоконтроль. – 2017. – №2. – С. 10-21. [Fedorov AV. Doping and Drugs. Narkokontrol’. 2017;(2):10-21. (In Russ.)]
  18. Pope HG, Kanayama G, Ionescu-Pioggia M, Hudson JI. Anabolic steroid users’ attitudes towards physicians. Addiction. 2004; 99(9):1189-1194. doi:
  19. El Osta R, Almont T, Diligent C, et al. Anabolic steroids abuse and male infertility. Basic Clin Androl. 2016;26:2. doi:
  20. Bartsch W, Knabbe C, Voigt K-D. Regulation and compartmentalization ofandrogens in rat prostate and muscle. J Steroid Biochem. 1983;19(1):929-937. doi:
  21. de Souza GL, Hallak J. Anabolic steroids and male infertility: a comprehensive review. BJU Int. 2011;108(11):1860-1865. doi:
  22. Pope HG, Jr., Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341-375. doi:
  23. Nieschlag E, Vorona E. Mechanisms in endocrinology: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol. 2015;173(2):R47-58. doi:
  24. Rahnema CD, Crosnoe LE, Kim ED. Designer steroids – over-the-counter supplements and their androgenic component: review of an increasing problem. Andrology. 2015;3(2):150-155. doi:
  25. Herbst KL, Bhasin S. Testosterone action on skeletal muscle. Curr Opin Clin Nutr Metab Care. 2004;7(3):271-277. doi:
  26. Quaglio G, Fornasiero A, Mezzelani P, et al. Anabolic steroids: dependence and complications of chronic use. Intern Emerg Med. 2009;4(4):289-296. doi:
  27. Bhasin S, Taylor WE, Singh R, et al. The Mechanisms of Androgen Effects on Body Composition: Mesenchymal Pluripotent Cell as the Target of Androgen Action. J Gerontol A Biol Sci Med Sci. 2003;58(12):M1103-M1110. doi:
  28. Clark AS, Henderson LP. Behavioral and physiological responses to anabolic-androgenic steroids. Neurosci Biobehav Rev. 2003;27(5):413-436. doi:
  29. Sinha-Hikim I, Roth SM, Lee MI, Bhasin S. Testosterone-induced muscle hypertrophy is associated with an increase in satellite cell number in healthy, young men. Am J Physiol Endocrinol Metab. 2003;285(1):E197-205. doi:
  30. Mauras N. Testosterone Deficiency in Young Men: Marked Alterations in Whole Body Protein Kinetics, Strength, and Adiposity. J Clin Endocrinol Metab. 1998;83(6):1886-1892. doi:
  31. Frankenfeld SP, de Oliveira LP, Ignacio DL, et al. Nandrolone decanoate inhibits gluconeogenesis and decreases fasting glucose in Wistar male rats. J Endocrinol. 2014;220(2):143-153. doi:
  32. Elbers JM, Asscheman H, Seidell JC, et al. Long-term testosterone administration increases visceral fat in female to male transsexuals. J Clin Endocrinol Metab. 1997;82(7):2044-2047. doi:
  33. Defay R, Papoz L, Barny S, et al. Hormonal status and NIDDM in the European and Melanesian populations of New Caledonia: a case-control study. Int J Obes. 1998;22(9):927-934. doi:
  34. Finkelstein JS, Lee H, Burnett-Bowie SA, et al. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013;369(11):1011-1022. doi:
  35. Lykhonosov MP, Babenko AY. Some Indicators of Carbohydrate Metabolism in Individuals after the Abolition of the Use of Anabolic Androgenic Steroids. Diabetes. 2018;67(Supplement 1):2422-PUB. doi:
  36. Parssinen M, Seppala T. Steroid use and long-term health risks in former athletes. Sports Med. 2002;32(2):83-94. doi:
  37. Melchert RB, Welder AA. Cardiovascular effects of androgenic-anabolic steroids. Med Sci Sports Exerc. 1995;27(9):1252-1262. doi:
  38. Chen C-J, Yu M-W, Liaw Y-F. Epidemiological characteristics and risk factors of hepatocellular carcinoma. J Gastroenterol Hepatol. 1997;12(9-10):S294-S308. doi:
  39. Martorana G, Concetti S, Manferrari F, Creti S. Anabolic Steroid Abuse and Renal Cell Carcinoma. Journal of Urology. 1999;162(6):2089-2089. doi:
  40. Froehner M, Fischer R, Leike S, et al. Intratesticular leiomyosarcoma in a young man after high dose doping with oral-turinabol. Cancer. 1999;86(8):1571-1575. doi:<1571::aid-cncr26>;2-c
  41. Liu PY, Swerdloff RS, Christenson PD, et al. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. Lancet. 2006;367(9520):1412-1420. doi:
  42. Knuth UA, Maniera H, Nieschlag E. Anabolic steroids and semen parameters in bodybuilders. Fertil Steril. 1989;52(6):1041-1047. doi:
  43. Dohle GR, Smit M, Weber RF. Androgens and male fertility. World J Urol. 2003;21(5):341-345. doi:
  44. Shokri S, Aitken RJ, Abdolvahhabi M, et al. Exercise and supraphysiological dose of nandrolone decanoate increase apoptosis in spermatogenic cells. Basic Clin Pharmacol Toxicol. 2010;106(4):324-330. doi:
  45. Moretti E, Collodel G, La Marca A, et al. Structural sperm and aneuploidies studies in a case of spermatogenesis recovery after the use of androgenic anabolic steroids. J Assist Reprod Genet. 2007;24(5):195-198. doi:
  46. Martins RA, Gomes GA, Aguiar O, Jr., et al. Chromosome damage and cytotoxicity in oral mucosa cells after 2 months of exposure to anabolic steroids (decadurabolin and winstrol) in weight lifting. Steroids. 2010;75(12):952-955. doi:
  47. Bahrke MS, Yesalis CE. Abuse of anabolic androgenic steroids and related substances in sport and exercise. Curr Opin Pharmacol. 2004;4(6):614-620. doi:
  48. Stolt A, Karila T, Viitasalo M, et al. QT interval and QT dispersion in endurance athletes and in power athletes using large doses of anabolic steroids. Am J Cardiol. 1999;84(3):364-366. doi:
  49. Baillargeon J, Urban RJ, Ottenbacher KJ, et al. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173(15):1465-1466. doi:
  50. Pitteloud N, Hayes FJ, Dwyer A, et al. Predictors of outcome of long-term GnRH therapy in men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 2002;87(9):4128-4136. doi:
  51. Rastrelli G, Corona G, Mannucci E, Maggi M. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology. 2014;2(6):794-808. doi:
  52. Depenbusch M, von Eckardstein S, Simoni M, Nieschlag E. Maintenance of spermatogenesis in hypogonadotropic hypogonadal men with human chorionic gonadotropin alone. Eur J Endocrinol. 2002;147(5):617-624. doi:
  53. Wenker EP, Dupree JM, Langille GM, et al. The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use. J Sex Med. 2015;12(6):1334-1337. doi:
  54. Hsieh TC, Pastuszak AW, Hwang K, Lipshultz LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013;189(2):647-650. doi:
  55. Carreau S, Bouraima-Lelong H, Delalande C. Estrogen, a female hormone involved in spermatogenesis. Adv Med Sci. 2012;57(1):31-36. doi:
  56. Pavlovich CP, King P, Goldstein M, Schlegel PN. Evidence of a Treatable Endocrinopathy in Infertile Men. J Urol. 2001;165(3):837-841. doi:
  57. Helo S, Ellen J, Mechlin C, et al. A Randomized Prospective Double-Blind Comparison Trial of Clomiphene Citrate and Anastrozole in Raising Testosterone in Hypogonadal Infertile Men. J Sex Med. 2015;12(8):1761-1769. doi:
  58. Ramasamy R, Ricci JA, Palermo GD, et al. Successful fertility treatment for Klinefelter’s syndrome. J Urol. 2009;182(3):1108-1113. doi:
  59. Taylor F, Levine L. Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: efficacy and treatment cost. J Sex Med. 2010;7(1 Pt 1):269-276. doi:
  60. Pasqualotto FF, Fonseca GP, Pasqualotto EB. Azoospermia after treatment with clomiphene citrate in patients with oligospermia. Fertil Steril. 2008;90(5):2014 e2011-2012. doi:
  61. Tan RS, Vasudevan D. Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. Fertil Steril. 2003; 79(1):203-205. doi:
  62. Whitten SJ, Nangia AK, Kolettis PN. Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. Fertil Steril. 2006;86(6):1664-1668. doi:

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Copyright (c) 2019 Lykhonosov M.P., Babenko A.Y.

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