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.
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 (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.