Anabolic steroid-induced hypogonadism: diagnosis and treatment

Objective: To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management. Design: Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria. Setting: Not applicable. Patient(s): Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS. Intervention(s): History and physical examination followed by medical intervention if necessary. Main Outcome Measures(s): Serum testosterone and gonadotropin levels, symptoms, and fertility restoration. Result(s): Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators. Conclusion(s): Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management. (C) 2014 by American Society for Reproductive Medicine.