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Specific information on drug use included age of onset, duration and weekly dose, other performance enhancing drugs, and therapeutic cycling practices. Participants were also asked about high-risk behaviors such as illicit drug use and criminal activities and further questioned on medical comorbidities and routine laboratory testing obtained. Given the length of the questionnaire, a separate analysis of the cohort and non-sexual dysfunction related responses was previously published as a separate manuscript 2.
Demographic variables are presented in Table 1. See Table 2 for additional details on T usage patterns. A total of men completed the IIEF-5 portion of the questionnaire, with a mean score of Erectile function was further categorized as no ED Interestingly, the use of post-cycle therapy was associated with higher rates of preserved libido when not taking T, suggesting a possible protective effect. See Table 4 for summary of variables associated with de novo ED and decreased libido when not taking T.
ED, erectile dysfunction. The current study represents the largest evaluation of sexual dysfunction in a cohort of AAS users and demonstrates several notable findings. Not surprisingly, increasing use of T was associated with higher rates of preserved erectile function in men currently using the therapy. Additionally, longer durations of use and higher frequency of use per year were associated with experiencing these symptoms.
De novo ED was also associated with multiple other classic low-T symptoms such as reduced libido, decreased energy, depression, subjective reduction in muscle mass, and increased subjective adiposity. These findings may suggest that to some degree, the body becomes dependent upon hyper-supplementation of T suppression of hypothalamic-pituitary-gonadal axis, possible change in androgen receptor density, possible down regulation at nuclear level , an effect that is only recognized after discontinuing.
The study however is not able to address if these symptoms remain persistent for an extended period of time or whether symptoms return to baseline after a further period of recovery. These findings do support our clinical impression from our practice, in which men often do present with symptoms of sexual dysfunctions after an extended history of AAS use. Further study is required to assess this important clinical question. As would be expected, results also demonstrated that those with increased comorbid conditions and higher rates of low T related symptoms were found to have lower IIEF scores.
Similarly, those experiencing low-T symptoms when not receiving T were more likely to have moderate to severe ED, suggesting a shared mechanism for ED and other low T symptoms. The use of estrogen-modulating therapies were found to be a protective factor in maintaining erectile function after discontinuing AAS.
Although this requires further evaluation to determine its significance, the mechanism behind commonly used selective estrogen receptor modulators, such as clomiphene citrate, includes partial estrogen receptor agonist activity. This is noteworthy, as T and estrogen have recently been shown by Finkelstein and colleagues to independently exhibit physiological effects on sexual function In their study of men aged 20—50 years , each was administered Goserelin acetate to deplete gonadal steroids. Next, participants were randomly assigned to be given placebo, varying doses of topical T alone, or topical T with anastrozole to prevent conversion of T to estradiol.
Results demonstrated preservation of sexual function in men receiving T, with greater improvements noted among those not receiving anastrozole. Findings suggested that both T and estrogen have important effects on sexual function and desire, which provides a potential mechanism for outcomes of the current study. Findings from the current study are consistent with other reported literature. In a small series of 33 prior AAS users, Rasmussen et al. The study found that participants suffered persistent low T levels after discontinuing AAS abuse, and there were also higher rates of decreased libido and ED among former AAS abusers than participants who were currently taking the substance as well as those in the control group, all of which were also found in our larger series.
Another small study of 36 weightlifters examined the long-term effects of AAS abuse on sexual function and prolonged hypogonadism Consistent with our findings, results demonstrated that former AAS abusers experienced lower sexual libido along with displaying an overall decreased testicular volume and serum T levels when compared with the weightlifters that had never used the substance. Two of the participants failed to regain erectile function or normal libido despite receiving T treatment. The current study has several notable limitations. The data were obtained from a survey posted on body-building forums and is therefore not necessarily representative of the population as a whole.
However, this was done intentionally, as data on men using high doses of AAS for extended periods of time cannot reasonably or ethically be obtained in other ways. The data are also captured at a single time point, with inability to track findings long-term and limited ability to compare findings between current and former AAS users. Despite these limitations, the current study represents the largest series of current and former AAS users with data on sexual function, utilizes a standardized IIEF questionnaire, and includes a detailed analysis of AAS frequency, duration, and dosage.
This permits a more in depth and higher power analysis on factors associated with de novo sexual dysfunctions compared to any prior study. The current study represents the largest series to date evaluating the impact of high dose, extended duration AAS supplementation on sexual function.
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Results demonstrate that increasing duration and frequency of AAS are associated with higher rates of de novo ED and decreased libido following discontinuation. Men with de novo ED were also more likely to report other low T symptoms, such as reduced libido, decreased energy, depression, subjective reduction in muscle mass, and increased subjective adiposity. Inversely, current use of higher T dosage and anti-estrogens i. Overall, findings suggest that increased frequency and duration of high-dose AAS may result in sexual dysfunctions following discontinuation and warrants further study.
Ethical Statement: Continued IRB review of this study is not required as it is currently written. However, any modifications to the study design or procedures must be submitted to the IRB to determine whether the study continues to be exempt. The Committee noted receipt of the study protocol undated. Conflicts of Interest: The authors have no conflicts of interest to declare.
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National Center for Biotechnology Information , U. Journal List Transl Androl Urol v. Transl Androl Urol. Joseph Matthew Armstrong , 1 Ross A.
Avant , 2 Cameron M. Charchenko , 2 Mary E. Westerman , 2 Matthew J. Ziegelmann , 2 Tanner S. Miest , 2 and Landon W. Trost 2. Ross A. Cameron M. Mary E. Matthew J. Tanner S. Landon W. Author information Article notes Copyright and License information Disclaimer. Corresponding author. I Conception and design: All authors; VII Final approval of manuscript: All authors. Correspondence to: Trost, MD. Received Feb 14; Accepted Apr What makes a carb good and what makes it bad?
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