Anabolic steroid–induced hypogonadism: diagnosis and treatment

ObjectiveTo develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management.DesignReview of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria.SettingNot 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.