title: Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study.
abstract: OBJECTIVE
  Abuse of anabolic androgenic steroids (AAS) is highly prevalent among male recreational athletes. The objective of this study was to investigate the impact of AAS abuse on reproductive hormone levels and symptoms suggestive of hypogonadism in current and former AAS abusers.
  
  
  METHODS
  This study had a cross-sectional case-control design and involved 37 current AAS abusers, 33 former AAS abusers (mean (95%CI) elapsed duration since AAS cessation: 2.5 (1.7; 3.7) years) and 30 healthy control participants. All participants were aged 18-50 years and were involved in recreational strength training. Reproductive hormones (FSH, LH, testosterone, inhibin B and anti-Müllerian hormone (AMH)) were measured using morning blood samples. Symptoms of hypogonadism (depressive symptoms, fatigue, decreased libido and erectile dysfunction) were recorded systematically.
  
  
  RESULTS
  Former AAS abusers exhibited significantly lower median (25th -75th percentiles) total and free testosterone levels than control participants (total testosterone: 14.4 (11.9-17.7) nmol/l vs. 18.8 (16.6-22.0) nmol/l) (P < 0.01). Overall, 27.2% (13.3; 45.5) of former AAS abusers exhibited plasma total testosterone levels below the lower reference limit (12.1 nmol/l) whereas no control participants exhibited testosterone below this limit (P < 0.01). Gonadotropins were significantly suppressed, and inhibin B and AMH were significantly decreased in current AAS abusers compared with former AAS abusers and control participants (P < 0.01). The group of former AAS abusers had higher proportions of participants with depressive symptoms ((24.2%) (11.1; 42.2)), erectile dysfunction ((27.3%) (13.3; 45.6)) and decreased libido ((40.1%) (23.2; 57.0)) than the other two groups (trend analyses: P < 0.05).
  
  
  CONCLUSIONS
  Former AAS abusers exhibited significantly lower plasma testosterone levels and higher frequencies of symptoms suggestive of hypogonadism than healthy control participants years after AAS cessation. Current AAS abusers exhibited severely decreased AMH and inhibin B indicative of impaired spermatogenesis.
authors.affiliation: Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Jon Jarløv
authors.identifier: http://orcid.org/0000-0003-2898-1771
authors.initials: JJ
authors.lastname: Rasmussen
authors.affiliation: Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Selmer
authors.affiliation: Department of Urology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Peter Busch
authors.initials: PB
authors.lastname: Østergren
authors.affiliation: Department of Internal Medicine, Copenhagen University Hospital, Slagelse, Denmark.
authors.forename: Karen Boje
authors.initials: KB
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals, Herlev and Gentofte, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.affiliation: Department of Cardiology, the Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.affiliation: Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Faber
authors.affiliation: Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Juul
authors.affiliation: Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kistorp
mesh_terms: D000293:Adolescent; D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects* / Q000494:pharmacology; D054304:Anti-Mullerian Hormone / Q000097:blood; D056352:Athletes; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000139:chemically induced; D007172:Erectile Dysfunction / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D005640:Follicle Stimulating Hormone / Q000097:blood; D006062:Gonadotropins / Q000097:blood; D006801:Humans; D007006:Hypogonadism / Q000139:chemically induced* / Q000175:diagnosis; D007265:Inhibins / Q000097:blood; D007989:Libido / Q000502:physiology; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D055070:Resistance Training / Q000379:methods*; D019966:Substance-Related Disorders / Q000473:pathology*; D013739:Testosterone / Q000097:blood* / Q000494:pharmacology; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D006062:Gonadotropins; C422364:inhibin B; D013739:Testosterone; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone