Peculiarity of recovery of the hypothalamic-pituitary-gonadal (hpg) axis, in men after using androgenic anabolic steroids

Abstract

BACKGROUND: Spontaneous recovery of the hypothalamicpituitarygonadal (HPG) axis after cessation of testosterone replacement therapy or after male contraception may take up to 24 months. There is insufficient data on the duration of recovery of HPG axis after abuse of androgenic anabolic steroids (AAS). AAS users use post-cycle therapy (PCT) to restore HPG axis, the effectiveness of which is unknown and needs further investigation.
 AIMS: To evaluate the recovery of HPG axis in men, AAS users, after a 3-month of cessation of their use and after PCT.
 METHODS: An observational, single-center, prospective, sampling, open, uncontrolled study was conducted among male AAS users. While using of AAS and 3 months after the refusal of their administration and PCT, the clinical symptoms of hypogonadism were evaluated, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (Tt), prolactin, estradiol, inhibin B, thyroid-stimulating hormone (TSH) were determined. The scheme of rehabilitation therapy was the same and did not change throughout the study. Recovery criteria: Tt 3.4 ng/ml and LH 1.24 mIU/ml. The study was conducted from January to August 2019. Fishers exact test, Mann-Whitney U-test, and Spearmans rank correlation coefficient were used. The differences were considered statistically significant at p0.05.
 RESULTS: The study included 44 men, their age 29 years [27.75; 34], the duration of the use of AAS is 6 months [3.52; 7]. During the use of AAS: LH 0.2 mIU/ml [0.04; 0.47], Tt 4.34 ng/ml [1.05; 8.81]. In this group, the number of men with a LH level 1.24 mIU / ml was 84% (n=37) and Tt 3.4 ng/ml was 47.7% (n=21). After 3 months, the LH level reached 4.12 mIU/ml [2.58; 5.84], Tt 4.55 ng/ml [3.76; 6.24]. At the same time, the level of Tt 3.4 ng/ml remained in 20.5% (n=9), and LH 1.24 mIU/ml in 4.5% (n=2) men. According to the level of recovery of LH and Tt, patients were divided into two groups: with satisfying (n=35; 79.5%) and poor (n=9; 20.5%) recovery. A clear correlation was established between the duration of use (-0.857; p0.0001), the amount (-0.443; p=0.003), the dose (-0.7825; p0.0001), the type of AAS (-0.698; p0.0001) and testosterone level recovery. A correlation between inhibin B and Tt (0.418; p=0.005) was revealed.
 CONCLUSIONS: A three-month refusal to use AAS with PCT led to the restoration of HPG axis a in 79.5% of the volunteers. In 20.5% of cases, recovery did not occur. The negative effect of the duration of use, the number of simultaneously administered drugs, their dose and type of AAS on the restoration of HPG axis was established. The level of inhibin B may serve as a marker for the restoration of spermatogenic epithelium.