Anabolic steroid-induced hypogonadism in young men
Coward RM, Rajanahally S, Kovac JR, Smith RP, Pastuszak AW, Lipshultz LI. J Urol. 2013 Jun 10. pii: S0022-5347(13)04580-1. doi: 10.1016/j.juro.2013.06.010. [Epub ahead of print]


Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.



Use of anabolic androgenic steroids (AAS) has not been traditionally discussed in mainstream medicine. With the increased diagnosis of hypogonadism, a very heterogeneous population of men is now being evaluated. Within this larger population of patients, the existence of anabolic steroid-induced hypogonadism (ASIH), whether transient or permanent, should now be considered.


An initial retrospective database analysis of all patients (2005-2010, n=6033) seeking treatment for hypogonadism was conducted. Subsequently, an anonymous survey was distributed in 2012 to established patients undergoing testosterone replacement therapy (TRT).


Profound hypogonadism, defined as a testosterone =50 ng/dL, was identified in 1.6% (n=97) of the large retrospective cohort initially reviewed. The most common etiology was prior AAS exposure, identified in 43% (42/97) of men. Because of this surprising data, a follow-up anonymous survey of our current hypogonadal patient population (n=382; mean age 49.2±13.0 years) was then performed which identified 20.9% of patients (n=80; mean age 40.4±8.4 years) with prior AAS exposure. Hypogonadal men <50 years old were greater than 10 times more likely to have prior AAS exposure than men >50 (OR 10.16, 95% CI 4.90-21.08). Prior AAS use was significantly negatively correlated with education level (ρ=-0.160, p=0.002) and number of children (ρ=-0.281, p<0.0001).


Prior AAS use is common in young men seeking treatment for symptomatic hypogonadism, and ASIH is the most common etiology of profound hypogonadism. These findings suggest a necessary refocused approach in the evaluation and treatment paradigms of young hypogonadal men.