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BOSTON -- Men who stopped using illicit steroids experienced physical and mental adverse effects, according to a cross-sectional, observational study reported here.

Compared with current users, men who stopped using anabolic-androgenic steroids within the past year had lower scores in certain domains of sexual function as measured by the International Index of Erectile Function-15 (IIEF-15) questionnaire, said Bonnie Grant, MBBS, of Imperial College London, at ENDO 2024, the annual meeting of the Endocrine Society:

• Erectile function: Score of 30 for current users vs 28 for past users (P=0.015)
• Sexual desire: 9 vs 6 (P<0.0001)
• Overall satisfaction: 10 vs 7 (P=0.002)

In addition, about 20% of past users had moderate or severe depression as measured by the Beck Depression Inventory-II (BDI-II) compared with 6% of current users and no non-users. Past users with a psychiatric comorbidity had over two times higher odds for severe depression (OR 2.39, 95% CI 1.60-3.57, P<0.001).

"Interestingly, testosterone levels were not associated with level of depression," Grant noted.

A similar pattern was found for anxiety, with 12% of past users reporting moderate or severe anxiety compared with 2% of non-users, as measured by the General Anxiety Disorder (GAD-7) scale. Past users also scored lower for energy and fatigue, as measured by the Short Form-36, compared with non-users.

"What we know from current studies is that even when men stop using anabolic steroids and this testosterone is taken away, it can take anything from a couple of months to even up to a year or more for normal testosterone to recur," Grant explained. "It may be that this period of low natural testosterone in men is what causes them to have sexual dysfunction, low mood, and low energy."

Anabolic steroids are primarily used by men to boost muscle mass and are commonly used in bodybuilding. An estimated 6% of men globally used anabolic steroids at some point in their life, Grant noted.

Many adverse effects are linked with current steroid use, including erythrocytosis, liver damage, cardiac hypertrophy, dyslipidemia, hypertension, and infertility, but most of these are fully reversible once steroid use is stopped. However, approximately 30% of men are estimated to develop a dependency on steroids, and about 65% restart steroids within a year of stopping. This was unsurprisingly more common in men who reported lower well-being scores.

"This first year when stopping is really important because we need to determine what is it that causes these men to restart using and perhaps there's a targeted treatment in there," Grant said.

For this study, 165 men in the U.K. were recruited, mostly from gyms, and were divided into three groups: current anabolic steroid users (n=76), those who stopped steroids in the past year or less (n=46), and non-users (n=43). All completed questionnaires on substance misuse and underwent fasting morning blood sampling with urine toxicology.

Across groups, mean age was 35.6 to 38.6, and 60% to 75.8% were white. Past or present users were significantly more likely to have a self-reported psychiatric diagnosis -- primarily depression and anxiety -- and use other illicit substances, mostly cocaine and cannabis.

As expected, current users had significantly higher total testosterone and estradiol levels, and lower levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sex hormone-binding globulin (SHBG):

• Total testosterone: 62.8 nmol/L for current users vs 20.1 for past users vs 20 for non-users
• Estradiol: 283 vs 132 vs 116 pmol/L
• LH: 0.2 vs 2.2 vs 2.9 IU/L
• FSH: 0.3 vs 2.3 vs 3.7 IU/L
• SHBG: 14.9 vs 25.3 vs 35.3 nmol/L

While past users had somewhat similar testosterone levels to those who never used steroids, about 25% had a testosterone level that was lower than normal.

The only hormone that was linked with sexual function score was LH, with higher levels linked to worse sexual function in past users. "There were some men in this group who had very, very low LH levels, perhaps due to ongoing, concealed anabolic steroid use," Grant said. To address this, her team plans to run toxicology on the urine samples to test for presence of anabolic steroids and other illicit substances.

A limitation of the analysis was a lack of data on participants' baseline mood and sexual function prior to steroid use.

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