title: Anabolic steroid induced hypogonadism in young men.
abstract: OBJECTIVE
  The use of anabolic androgenic steroids has not been traditionally discussed in mainstream medicine. With the increased diagnosis of hypogonadism a heterogeneous population of men is now being evaluated. In this larger patient population the existence of anabolic steroid induced hypogonadism, whether transient or permanent, should now be considered.
  
  
  METHODS
  We performed an initial retrospective database analysis of all 6,033 patients who sought treatment for hypogonadism from 2005 to 2010. An anonymous survey was subsequently distributed in 2012 to established patients undergoing testosterone replacement therapy.
  
  
  RESULTS
  Profound hypogonadism, defined as testosterone 50 ng/dl or less, was identified in 97 men (1.6%) in the large retrospective cohort initially reviewed. The most common etiology was prior anabolic androgenic steroid exposure, which was identified in 42 men (43%). Because of this surprising data, we performed an anonymous followup survey of our current hypogonadal population of 382 men with a mean±SD age of 49.2±13.0 years. This identified 80 patients (20.9%) with a mean age of 40.4±8.4 years who had prior anabolic androgenic steroid exposure. Hypogonadal men younger than 50 years were greater than 10 times more likely to have prior anabolic androgenic steroid exposure than men older than 50 years (OR 10.16, 95% CI 4.90-21.08). Prior anabolic androgenic steroid use significantly correlated negatively with education level (ρ=-0.160, p=0.002) and number of children (ρ=-0.281, p<0.0001).
  
  
  CONCLUSIONS
  Prior anabolic androgenic steroid use is common in young men who seek treatment for symptomatic hypogonadism and anabolic steroid induced hypogonadism is the most common etiology of profound hypogonadism. These findings suggest that it is necessary to refocus the approach to evaluation and treatment paradigms in young hypogonadal men.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Coward
authors.forename: Saneal
authors.initials: S
authors.lastname: Rajanahally
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kovac
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Pastuszak
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D000728:Androgens / Q000009:adverse effects*; D006801:Humans; D007006:Hypogonadism / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D013256:Steroids
keywords: AAS; ASIH; TRT; anabolic agents; anabolic androgenic steroid; anabolic steroid induced hypogonadism; hypogonadism; substance related disorders; testis; testosterone; testosterone replacement therapy