• Anabolic steroid induced hypogonadism in young men.

      Anabolic steroids and testosterone shut down the body's Hypothalamic-Pituitary-Testicular Axis (HPTA) while people use them and for a few weeks after cessation of these compounds. However, some men's testosterone production does not recover back to baseline values. These men have testosterone deficiency and often have symptoms of hypogonadism (erectile dysfunction, lack of energy, low mood, etc).

      Some young men (under 35 years of age) are seeking help after they become hypogonadal after anabolic steroid use. The best post cycle protocol for these patients to normalize HPTA function has not been established but usually include HCG, clomiphene (Clomid), Tamoxifen, etc

      This study found that:

      1- Men under 50 were more likely to have used anabolic steroids
      2- More educated men used anabolic steroids more than less educated men (more disposable income and more research online may be good explanations)
      3- Men with fewer children used anabolic steroids in the past more than those with more children (younger age, more disposable income and time to exercise are good explanations)

      J Urol. 2013 Dec;190(6):2200-5.
      Anabolic steroid induced hypogonadism in young men.
      Coward RM, Rajanahally S, Kovac JR, Smith RP, Pastuszak AW, Lipshultz LI.



      The use of anabolic androgenic steroids has not been traditionally discussed in mainstream medicine. With the increased diagnosis of hypogonadism a heterogeneous population of men is now being evaluated. In this larger patient population the existence of anabolic steroid induced hypogonadism, whether transient or permanent, should now be considered.


      We performed an initial retrospective database analysis of all 6,033 patients who sought treatment for hypogonadism from 2005 to 2010. An anonymous survey was subsequently distributed in 2012 to established patients undergoing testosterone replacement therapy.


      Profound hypogonadism, defined as testosterone 50 ng/dl or less, was identified in 97 men (1.6%) in the large retrospective cohort initially reviewed. The most common etiology was prior anabolic androgenic steroid exposure, which was identified in 42 men (43%). Because of this surprising data, we performed an anonymous followup survey of our current hypogonadal population of 382 men with a mean±SD age of 49.2±13.0 years. This identified 80 patients (20.9%) with a mean age of 40.4±8.4 years who had prior anabolic androgenic steroid exposure. Hypogonadal men younger than 50 years were greater than 10 times more likely to have prior anabolic androgenic steroid exposure than men older than 50 years (OR 10.16, 95% CI 4.90-21.08). Prior anabolic androgenic steroid use significantly correlated negatively with education level (ρ=-0.160, p=0.002) and number of children (ρ=-0.281, p<0.0001).


      Prior anabolic androgenic steroid use is common in young men who seek treatment for symptomatic hypogonadism and anabolic steroid induced hypogonadism is the most common etiology of profound hypogonadism. These findings suggest that it is necessary to refocus the approach to evaluation and treatment paradigms in young hypogonadal men.

      Here is a section of the book "Testosterone: A Man's Guide" about attempts to reset the HPT hormone axis after stopping testosterone (this section applies to men who had normal testosterone before starting anabolic steroids): http://www.excelmale.com/content/56-How-to-Stop-Testosterone-Safely-and-Possibly-Reset-Your-Hormonal-Ax

      This article was originally published in forum thread: Anabolic steroid induced hypogonadism in young men.
      Comments 6 Comments
      1. Excel Male's Avatar
        Excel Male -
        Shippen’s Chorionic Gonadotrophin Stimulation Test (for males under 75 years of age)

        Attachment 489
        Even though there seems not be an accepted and clinically proven protocol to dose HCG, Dr. Eugene Shippen (author of the book “The Testosterone Syndrome”), has developed his own after his experiences. Most doctors do not follow this protocol but I am showing it here since I get a lot of questions about it. I have never used this protocol myself since I have been on testosterone replacement for over 15 years.

        Dr. Shippen has found that a typical treatment course for three weeks is best for determining those individuals who will respond well to HCG treatment. It is administered daily by injection 500 units subcutaneously, Monday through Friday for three weeks. The patient is taught to self administer with 50 Unit insulin syringes with 30 gauge needles in anterior thigh, seated with both hands free to perform the injection. Testosterone, total and free, plus E2 (estradiol) are measured before starting the protocol and on the third Saturday after 3 weeks of stimulation (he claims that salivary testing may be accurate for adjusting doses. This is source of great debate). Studies have shown that subcutaneous injections of HCG are equal in efficacy to intramuscular administration.

        By measuring the effect on his HCG protocol on total testosterone, he identifies candidates that require testosterone replacement versus those who just require having their testicles “awaken” with HCG to produce normal testosterone. I am yet to see any data that substantiates his approach, however.

        Here is how he determines Leydig (testicular) cell function:

        1. If the HCG protocol causes less than a 20% rise in total testosterone he suggests poor testicular reserve of Leydig cell function (primary hypogonadism or eugonadotrophic hypogonadism indicating combined central and peripheral factors).

        2. 20-50% increase in total testosterone indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.

        3. More than 50% increase in total testosterone suggests primarily centrally mediated depression of testicular function.

        He then offers these options for treatment for patients depending on the response to HCG and patient determined choices.

        1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.

        2. The area in between 20-50% will usually require HCG boosting for a period of time, plus natural boosting or “partial” replacement options.

        I am yet to see what he means with natural boosting! Dr. Shippen believes that full replacement with testosterone is always the last option in borderline cases since improvement over time may frequently occur as the testicles’ Leydig cell regeneration may actually happen. He claims that much of this is age dependent. He states that up to age 60, boosting is almost always successful. In the age range 60-75 is variable, but will usually be clear by the results of the stimulation test. Also, disease related depression of testosterone output might be reversible with adequate treatment of the underlying process (depression, obesity, alcohol, deficiency, etc.) He claims that this positive effect will not occur if suppressive therapy is instituted in the form of full testosterone replacement.

        3. If there is an adequate response of more than 50% rise in testosterone, there is very good Leydig cell reserve. HCG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response. But I am yet to see any data on long term use of HCG used in this approach! (I invite researchers to do such studies)

        4. Chorionic HCG can be self-administered and adjusted according to response. In younger, high output responders (T > 1100ng/dl), HCG can be given every third or fourth day. This also minimizes estradiol blood levels which raise with HCG administration. In lower level responders (600-800ng/dl), or those with a higher estradiol output associated with full dose HCG, 300-500 units can be given Mon-Wed-Fri. At times, sluggish responders may require a higher dose to achieve full testosterone response.

        Dr. Shippen believes in checking salivary levels of free testosterone on the day of the next injection, but before the next injection to determine effectiveness and to adjust the dose accordingly. He claims that later as Leydig cell restoration occurs, a reduction in dose or frequency of administration may be later needed.

        5. He recommends to monitor both testosterone and estradiol levels to assess response to treatment after 2 - 3 weeks after change in dose of HCG as well as periodic intervals during chronic administration. He claims that salivary testing will better reflect the true free levels of both estrogens and testosterone. (Pharmasan.com and others) Most insurance companies do not pay for salivary testing. Blood testing is the standard way to test for testosterone and estradiol.

        6. Except for reports of antibodies developing against HCG (he mentions that he has never seen this problem), the claims that there are no adverse effects of chronic HCG administration.

        Dr. Shippen’s book was published in the late 90’s. I know of no physician that uses his protocol. I have no opinion on its validity. The idea that testicular function can be improved with cycles of HCG in men with low testosterone caused by sluggish yet functioning Leydig cells is an interesting concept that needs to be studied. I guess that since this protocol requires very close monitoring, many doctors have avoided using it. The off label nature of the protocol’s use of HCG can also make it expensive for patients who will have to pay cash for its use and monitoring.

        Source: Testosterone: A Man's Guide
      1. Nelson Vergel's Avatar
        Nelson Vergel -
        Addiction. 2015 Jan 19. doi: 10.1111/add.12850. [Epub ahead of print]

        Prolonged Hypogonadism in Males Following Withdrawal from Anabolic-Androgenic Steroids: an Underrecognized Problem.

        Kanayama G1, Hudson JI, DeLuca J, Isaacs S, Baggish A, Weiner R, Bhasin S, Pope HG Jr.

        To assess the frequency and severity of hypogonadal symptoms in male long-term anabolic-androgenic steroid (AAS) misusers who have discontinued AAS use.

        Cross-sectional, naturalistic.

        Outpatient facility.

        Twenty-four male former long-term AAS users and 36 non-AAS-using weightlifters, recruited by advertisement in Massachusetts, USA. Five of the former users were currently receiving treatment with physiologic testosterone replacement, leaving 19 untreated users for the numerical comparisons below.

        The Structured Clinical Interview for DSM-IV, questions regarding history of AAS use, physical examination, serum hormone determinations, and the International Index of Erectile Function (IIEF).

        Compared with the 36 non-AAS-using weightlifters, the 19 untreated former AAS users displayed significantly smaller testicular volumes (estimated difference [95% confidence interval (CI)]: 2.3 [0.1, 4.5] ml; p = 0.042) and lower serum testosterone levels (estimated difference: 131 [25, 227] dL; p = 0.009), with five users showing testosterone levels below 200 ng/dL despite abstinence from AAS for 3-26 months. Untreated former users also displayed significantly lower scores on the IIEF Sexual Desire subscale (estimated difference: 2.4 [1.3, 3.5] points on a 10-point scale; p < 0.001). In the overall group of 24 treated plus untreated former users, 7 (29%) had experienced major depressive episodes during AAS withdrawal; 4 of these had not experienced major depressive episodes at any other time. Two men (8%) had failed to regain normal libidinal or erectile function despite adequate replacement testosterone treatment.

        Among long-term anabolic-androgenic steroid misusers, anabolic-androgenic steroid-withdrawal hypogonadism appears to be common, frequently prolonged, and associated with substantial morbidity.
      1. Garme's Avatar
        Garme -
        Interesting study that may answer my issue so if you get it young its more likely because of previous steroid use.
      1. Johnbeaming's Avatar
        Johnbeaming -
        Is it healthy?)
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