Former Steroid Users Have Low Testosterone

Have you ever thought about taking anabolic steroids? A new study reports that former steroid users have low testosterone, along with symptoms of hypogonadism, such as increased incidence of depression, fatigue, low libido, and erectile dysfunction.1

So you may want to think again.

Androgenic anabolic steroids

Anabolic androgenic steroids (AAS), commonly known merely as anabolic steroids, are synthetic derivatives of testosterone that bodybuilders and other athletes use to increase muscular size and strength. They are, of course, banned in almost all athletics, though to my knowledge they are not tested in the bodybuilding world anywhere, even among so-called “naturals”, who are not supposed to be taking them.

The study looked at 37 current users of anabolic androgenic steroids, 33 former users, and 30 healthy controls. All were between 18 and 50 years old and all regularly lifted weights.

The former users had an average total testosterone of 14.4 nmol/l — that’s 415 ng/dl in American terms — compared to 18.8 nmol/l (542 ng/dl) in healthy controls.

Steroid use also apparently causes your balls to shrink, not to put too fine a point on it. See chart below, which shows testis size according to duration of steroid use, in former users (solid line) and current users (dotted line).

Makes sense, since the chief function of the testes is to make testosterone, and either smaller testes make less testosterone, or since less is being made, the testes then shrink.

Testosterone replacement therapy and feedback mechanisms

Testosterone replacement therapy (TRT) can have the same effect while undergoing therapy: testes shrink, fertility is diminished — indeed, exogenous testosterone has been studied as a means of male contraception.

But in contrast to the use of anabolic steroids,

Rebound of the sperm count to baseline levels occurs within six to 18 months of cessation, and subsequent fertility has been demonstrated.2

Again, this makes sense, since testosterone, estrogens, luteinizing hormone (LH), and others all exhibit fine feedback control on the others.

Therefore there appears to be no danger of permanent changes with TRT.

The authors of the paper on steroids write:

Ongoing AAS abuse causes dramatic increases in plasma androgen levels that ultimately facilitate severe hypothalamic-pituitary-gonadal (HPG)-axis suppression due to negative feedback mechanisms involving testosterone and its metabolites.

As a result of steroid use, the mechanism of feedback control seems to be severely screwed up. Why it doesn’t rebound is a good question, but that seems to be the fact of the matter.

On Twitter it was suggested to me that this steroid-induced suppression of androgens wouldn’t occur if the users had done post-cycle therapy (PCT), which is a course of medication using estrogen antagonists such as Clomid or Tamoxifen.

While this may be necessarily unknown, it’s hard to see how that would affect the long-term decline in testosterone levels. Some of the former steroid users in the study were measured from 2 to 4 years after cessation of steroid use, and there was no association between time since cessation and testosterone levels. However, most of the users were measured from 6 months to one year after cessation, so it’s possible PCT would have made a difference. It’s also possible that some of these users would experience a rebound in testosterone even without PCT; after all, if it takes from 6 to 18 months to see a rebound in users of TRT, perhaps the same holds true in steroid users.

The authors of the study note that everything here is association; the sample could be biased by self-selection, and cause and effect have not been demonstrated. It’s possible, though it seems unlikely to me, that the steroid users had low testosterone to begin with, and that’s what motivated them to start steroid use.

All in all, this is a sobering look at the consequences of steroid use.

PS: To see how you can build muscle without steroids, and why you should, read my book Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.

  1. Rasmussen et al., Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study, http://dx.doi.org/10.1371/journal.pone.0161208
  2.  Bassil, Nazem, Saad Alkaade, and John E. Morley. “The benefits and risks of testosterone replacement therapy: a review.” Ther Clin Risk Manag 5.3 (2009): 427-48.
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14 comments
Simon Wood says August 21, 2016

As far as I’m aware, this is a well known consequence of any exogenous testosterone use. In simple terms, your testes detect there is no need for them to produce testosterone, and so they shut down. The higher the levels of exogenous testosterone, the more they shut down, and the longer they remain shut down for, the longer it takes them to get going again (if they do at all).

PCT should restore normal function within a relatively short period of time, with no long term consequences if carried out properly.

Testicular atrophy is another side effect of the testes shutting down in response to exogenous testosterone. Again, the longer the exogenous testosterone is present in the system, the greater the degree of atrophy. Correctly performed PCT should also counteract this.

For the case of TRT, when the levels of exogenous testosterone are comparatively low but constant, testicular atrophy is countered with the use of the peptide human chorionic gonadotropin (HCG). This tricks the testes into thinking they are still required (via the hormones LH & FSH), and so they remain normal sized.

Reply
    P. D. Mangan says August 21, 2016

    Right, but there a couple of differences here that I see. 1) anabolic steroids aren’t testosterone. How that would affect suppression of the HPG axis, I don’t know. 2) users of anabolic steroids use doses that would result in much higher levels of androgens than probably even TRT, and that could affect the HPG axis as well, maybe for the longer term.

    Reply
      Simon Wood says August 21, 2016

      Testosterone itself is, by definition, an anabolic steroid.

      The most commonly used anabolic steroids used for bodybuilding are simply testosterone attached to various different esters (cypionate/enanthate/propionate etc) which alter the half life. The most basic anabolic steroid cycle simply involves injecting 600mg testosterone cypionate per week for 12 weeks.

      TRT is exactly the same, except as a much lower dosage – 100-200mg/week.

      Perhaps we’re at cross ends here on the definition of an anabolic steroid? There are other types of steroid which are DHT based, amongst other things.

      Reply
        P. D. Mangan says August 21, 2016

        I couldn’t say what steroids are most commonly used, since I don’t hang in those circles, but what you are talking about there is better grouped under the concept of TRT, which involves those very forms of testosterone. Anabolic steroid use might be better characterized by Dianabol, or metandienone, which is “17α-methyl-δ1-testosterone”, in other words a synthetic steroid. The forms of testosterone such as cypionate etc function exactly as testosterone; they are chemically cleaved in vivo, leaving the naked testosterone molecule.

        Steroids (including testosterone) have both anabolic and androgenic effects, but different steroids have different ratios of these effects. A synthetc (non-testosterone) steroids have been designed to have much higher ratios of anabolic to androgenic effects. If testosterone itself has an anabolic/androgenic ratio of 1:1, some of the synthetic steroids are more like 10:1.

        That being said, I don’t want to get out of my depth here. For instance, steroids newer than dianobol may be safer, have different effects, etc.

        Reply
          Simon Wood says August 21, 2016

          I don’t either hang around in those circles per se 🙂 but I’ve certainly picked up a lot of information about it during my research into self-administering TRT.

          The only difference between TRT and the most basic steroid cycle is simply dosage. As I’m sure you know, a low TRT dose simply restores your T level to around where it could have been naturally (750-1250), but a cycle dose of test cyp will put it somewhere more around 2500-3500. Newbies to steroids are encouraged to simply run 600mg test cyp/week for 12 weeks to get them used to the whole process, before they try more advanced compounds.

          As you say, there are many other non-testosterone steroids, which could have different long-term implications. Without knowing what particular steroids the people in this survey were using, and whether they performed PCT, it’s a little difficult to draw any meaningful conclusions.

          Reply
          P. D. Mangan says August 21, 2016

          Here’s what the report says:

          One investigator (JJR) obtained a detailed AAS abuse history (total duration, compounds, doses, use of other performance enhancing drugs) during a clinical interview, using a structured questionnaire. We used total numbers of weeks of AAS abuse and total numbers of AAS compounds used as measures of the extent of AAS abuse. We did not calculate overall average AAS doses in the AAS participants because the pharmacodynamics and pharmacokinetics of AAS compounds can vary considerably depending on their chemical structures [1]. Furthermore, AAS abusers often use numerous AAS compounds and alter doses intermittently during a ‘cycle’ [17]. Other information such as medical history, illicit drug use, smoking habits, alcohol use, strength training history (total duration and weekly hours of training) and demographics were also obtained.

          Reply
        Conor says November 29, 2016

        Sorry to interject but I’m trying to get in contact with Simon, must have left twitter or id get him there.

        Looking to ask him about TRT in the UK.

        Reply
          P. D. Mangan says November 29, 2016

          Simon went pseudonymous on Twitter. I’d link him but since he wants to use a pseudonym now, I guess I can’t.

          Reply
          Simon says November 29, 2016

          Hey Conor – drop me an email at hlri5@slipry.net (burner address – expires in 8 days)

          Reply
Former Steroid Users Have Low Testosterone – Technology and Longevity Feed says August 21, 2016

[…] Original Article: Former Steroid Users Have Low Testosterone […]

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Anon says August 22, 2016

Thanks for the article PD.

Offtopic: do you have any idea how much it costs to commission a research paper, e.g. to see how autophagy varies with lenght of fast, or similar health related studies. I assume one would need to go to universities and talk with professors there, but would they agree to do a study based on your question if you gave them $? Just hypothetical

Reply
    P. D. Mangan says August 22, 2016

    Anon, I think the cost would be prohibitive – but maybe you’re a billionaire, I don’t know. Pharma companies commission them and they cost big bucks. There’s the question of recruiting participants, etc.

    That being said, I like your idea for a study and I’ve thought of it myself. There are no good human data on this, as far as I know. In theory, it’s relatively easy, since you can measure the quantity of a chemical, 8-OHdG, in urine. Not even a blood draw required. This has been done in rats, but what’s needed is a human study in which participants fast for a length of time and urine levels of this chemical tested.

    Also, it would be great to have a simple test for this chemical, such as on a test strip as is done for glucose and ketones. As it is, there’s no clinical test available for it; while it’s relatively simple for an analytical lab to perform, there are no automated kits for clinical labs. Billion dollar idea.

    Reply
David says August 23, 2016

It’s strange to me seeing adds for TRT all over the mainstream media in the past few years. Why aren’t these dudes trying to figure out what attacked their endogenous T levels in the first place?

It’s as if they had somebody come and steal their car and rob their house, and now they’re just happy that the thief is selling them their own stuff back. It’d be better to stop the criminal in the first place.

Also, as a white man, I know countless white couples who simply can’t have children, or they have to pay mind-boggling sums of money for fertility treatments. So the now ubiquitous use of TRT (which, as mentioned here, dramatically reduce sperm count) among white men is probably a major factor there. (Anybody who knows infertile couples sees that 99% of the time, it is the wife blaming herself and crying all night long; husbands have no right to be nuking their sperm counts and putting their wives through that hearbreak.)

Then, consequentially, whites have to use things like IVF, which is an extremely dysgenic procedure resulting in weaker children (who, ironically, grow up to be infertile adults themselves). Google “IVF babies long-term health”. Far from being the eugenics boom and savior of white demographics many whites theorize, artificial insemination has helped create a weak, sickly, and androgynous generation.

Except in extreme cases (testicular cancer or men doing specialized labor), the best way to have healthy hormone levels is to cut the alcohol, get your sleep, follow a paleo diet, get rigorous exercise, and have sex at least once weekly.

Reply
Selective Androgen Receptor Modulators (SARMs): Muscle Growth Without Side Effects? - Rogue Health and Fitness says February 26, 2017

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