Abstract
Objective: Androgenic-anabolic steroids (AAS) are commonly used by athletes and recreational athletes. In some cases they induce persistent anabolic steroid-induced hypogonadism (ASIH). Design: In an observational study we assessed the function of the pituitary-gonadal axis in a series of men with suspected ASIH. Methods: Clomiphene stimulation test (CST) was performed in 13 hypogonadal adult men with previous, prolonged exposure to AAS. We evaluated the response of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and total testosterone (T) to 50 mg of clomiphene daily administered for a week. Results: Mean concentrations of hormones before and after clomiphene administration were respectively (mean ± SD): 3 ± 1.2 and 8.3 ± 2 mIU/ml for LH; 3 ± 1.1 and 10 ± 14.6 mIU/ml for FSH; and 2.3 ± 0.6 and 7.2 ± 1.7 ng/ml for T (p<0.001). Conclusions: Men with ASIH, after a long-time withdrawal of AAS, present an intact reaction of gonadotropins and testosterone to clomiphene stimulation.
Highlights
Illicit use of anabolic steroids (AAS) is widespread in many parts of the world
Recent surveys show that 2.4% of Australian students report lifetime AAS use [1], while in Sweden between 10 000 and 100 000 subjects may be exposed to AAS every year [2]
The gonadal function usually recovers after withdrawal of AAS, in a growing number of cases there is observed a secondary, functional, often hypogonadotropic, anabolic steroidinduced hypogonadism (ASIH) [10]
Summary
Illicit use of AAS is widespread in many parts of the world. In Poland 6.2% of young males and 2.9% of young females admit that they use anabolic agents. Data from other countries and continents suggest that AAS users can be counted in millions [3,4,5]. Side effects of AAS are common and involve diverse body organs and systems [7,8,9]. One of the most prominent AAS effects is suppression of the hypothalamo-pituitary-gonadal (HPG) axis leading to decreased production of testosterone and spermatozoa. The gonadal function usually recovers after withdrawal of AAS, in a growing number of cases there is observed a secondary, functional, often hypogonadotropic, anabolic steroidinduced hypogonadism (ASIH) [10]. Low concentration of testosterone may persist even after several months-long cessations of AAS
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