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]

Source

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

Abstract

PURPOSE:

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.

MATERIALS AND METHODS:

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).

RESULTS:

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).

CONCLUSIONS:

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.