Anabolic steroid-induced hypogonadism: diagnosis and treatment

Cyrus D Rahnema, Larry I Lipshultz, Lindsey E Crosnoe, Jason R Kovac, Edward D Kim
Fertility and Sterility 2014, 101 (5): 1271-9

OBJECTIVE: To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management.

DESIGN: Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria.

SETTING: Not applicable.

PATIENT(S): Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS.

INTERVENTION(S): History and physical examination followed by medical intervention if necessary.

MAIN OUTCOME MEASURES(S): Serum testosterone and gonadotropin levels, symptoms, and fertility restoration.

RESULT(S): Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators.

CONCLUSION(S): Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management.

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