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Sperm Take Up to 3 Years to Recover After Anabolic Steroids
Sperm can take up to 3 years to recover after anabolic steroid use, hindering fertility.
www.medscape.com
Contrary to prior understanding, many hormones related to spermatogenesis take longer to recover than previously thought, and up to 3 years in some cases after anabolic steroid misuse, according to a fertility expert speaking at the Royal Society of Medicine webinar series.
Dr. Channa Jayasena, consultant in reproductive endocrinology and andrology at Imperial College and Hammersmith Hospital, London, gave a talk on male hypogonadism that he admitted might seem provocative to some people but addresses issues that extend current knowledge. The three key issues discussed were: how quickly can men recover fertility after androgen use; how to assist azoospermic men with Klinefelter syndrome (or XXY) father children; and whether testosterone therapy affects progression to diabetes in obese men.
Dr. Jayasena spoke at last week's 3-day webinar held by the Royal Society of Medicine, Endocrinology and Diabetes section, entitled, EDN50:What's new in endocrinology and diabetes 2020?
He began by asking how quickly do men who take anabolic steroids recover fertility? "This has never been studied too much extent."
Self-confessed steroid user and reality television star, Spencer Matthews, said in a tabloid newspaper article that the UK is in the grips of an epidemic of anabolic steroid use, Dr. Jayasena remarked. "I see men who take anabolic steroids but then they want a baby and want to know what's next?"
The nearest data to understanding recovery from anabolic steroids comes from studies of the male pill, said the andrologist. This involves giving a high level of progesterone to suppress luteinizing hormone and follicle-stimulating hormone (in effect the male pill), and then giving the men testosterone replacement. A Lancet paper (Liu et al 2006) involving this regimen looked at the time from stopping the male pill to the recovery of sperm. It shows that, by 12 months, all participants had recovered some sperm function, with 80% recovering to the pre-treatment semen level, explained Dr. Jayasena. "This has long been presumed to be the measure of recovery. However, this does not resonate with reality and the observation that actually there are many people who don't recover within this time frame and take a lot longer, some with azoospermia[semen containing no sperm]," he pointed out.
Another cross-sectional observational study looked at 41 current users of anabolic steroids, 31 recent ( 3 months since last use), and 21 healthy eugonadal men. All were 18-55 years, exercising at least three times a week. "The critical strength of this study is that these men were all clinically indistinct," Dr. Jayasena remarked. "This matching of baseline characteristics is critical for the interpretation of the data. Due to recruitment issues, we've never had such a good look at recovery in this way before."
The study looked at the reproductive endocrine profiles including the levels of luteinizing hormone, follicle-stimulating hormone, and testosterone. In current users, the former two were suppressed and the testosterone level was high, as expected, displaying a hypogonadotropic profile. "Past users and non-users have very similar profiles, suggesting reversible luteinizing hormone and follicle-stimulating hormone suppression," said Dr. Jayasena, adding, "this is really interesting and looking at acne, gynecomastia, hair loss and smaller testicles all classical features of androgen abuse - appear to persist in many of the men who are past users. It's important we counsel these men that we, the clinicians, are not really clear about how long these side effects will persist."
Results also showed low HDL cholesterol and high triglycerides in users, but not in non-users or past users, and cardiac hypertrophy in users but not past users. "The latter finding is encouraging," Dr. Jayasena pointed out.
Regarding fertility, the study by Shankara-Naranya found that when comparing non-users to users of anabolic steroids, it took a mean of 10.7 months for users to recover their luteinizing hormone levels to the mean luteinizing hormone of a non-user. "But recovery time is highly variable. Luteinizing hormone (and testosterone by inference), and sperm concentration seem to recover within a year, with a mean of 10 months, but all the other hormones that are important for spermatogenesis take much longer to recover so follicle-stimulating hormone was 20 months, inhibin B was 32 months, sperm motility was 38 months, up to 3 years to recover. This is critical and we didn't know this," reported Dr. Jaysena.
"In answer to what is the prognosis for recovery in men after androgen misuse? The endocrine system mostly recovers in the first year but sperm take much longer to recover," he concluded.
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