NEW ORLEANS — Most men achieved near-full recovery of testicular function after stopping abuse of performance-enhancing steroid hormones, according to an observational study reported here.
In a sample of about 100 men, non-users and patients who last used the hormones a mean 300 days prior did not significantly differ in terms of mean sperm output (189 vs 173 million/ejaculate) or measures of pituitary function, including serum luteinizing hormone (LH; 5.2 vs 5.5 IU/L) and serum follicle stimulating hormone (FSH; 4.9 vs 4.7 IU/L), reported Nandini Shankara Narayana, MBBS, of the ANZAC Research Institute in Sydney, Australia.
But not all testicular function returned to normal for past users within the study period, as compared to non-users. Men who had used androgens in the past had significantly lower testicular volume (23.2 vs 18.6 mL) and sex hormone binding globulin (SHBG) levels (42 vs 33.9 IU/L), Narayana reported at ENDO 2019, The Endocrine Society annual meeting.
“Coming off these drugs is difficult, mainly due to the symptoms of hypogonadism,” Narayana said when presenting the findings. “When men stop using testosterone, they experience lethargy, loss of vitality, and sexual dysfunction, as well as loss of muscle mass and strength, the very reason they started using it in the first place.”
Christina Wang, MD, of the Los Angeles Biomed Research Institute in Torrance, California, agreed that it’s difficult for men to discontinue androgen use and that this is usually a slow process.
“Unfortunately, the abuser typically doesn’t use just one androgen or two, they keep stacking and stacking levels and they use a very high [number of] male hormones or androgens,” Wang, who was not involved in the study, told MedPage Today. “It’s very difficult to withdraw from them.”
Prior reports have estimated that about 6% of men have used anabolic-androgenic steroids globally. Use of these performance-enhancing hormones has ticked upward recently due to their availability online, Narayana said.
For this study, Narayana and colleagues used social media to recruit 41 current androgen users, 21 non-users, and 31 past users, defined as having last used androgens at least 3 months prior to enrolling in the study. Mean age for each group was 35, 33, and 34 years, respectively.
Current androgen users had poorer outcomes than past and non-users in terms of high-density lipoprotein cholesterol (24.7 vs 42.5 vs 46.8 mg/dL, respectively), serum testosterone (36.5 vs 6.2 vs 8.7 ng/mL, respectively), hemoglobin (164 vs 154 vs 151 g/L, respectively), and triglycerides (116.9 vs 90.4 vs 80.6 mg/dL, respectively), Narayana and colleagues reported.
It took a mean 9 months from when the men in the study quit taking androgens for LH levels to return to normal, a mean 14.2 months for sperm output to return, and a mean 18.7 months for FSH levels to be restored, Narayana and colleagues reported.
When asked whether other agents could be used to expedite the recovery process for men with histories of androgen abuse, Narayana told MedPage Today that there are currently no medications prescribed to enhance recovery time. Prior research has investigated the use of human chorionic gonadotropin (hCG) to stimulate the hypothalamic-pituitary-gonadal axis in men with past androgen abuse, but it has produced mixed results.
Some men use hCG, a placental hormone, as a “post-cycle” therapy to increase testosterone production after using androgens. But while hCG can increase testosterone levels, it has showed no benefit in terms of pituitary recovery, Narayana said.
Wang hypothesized that aromatase inhibitors, which are anti-estrogens, may be able to help recover function in the hypothalamus and pituitary glands, which produce FSH and LH. However, she emphasized this has not been evaluated in men with past or current androgen abuse, and said future research was necessary to confirm this idea.