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Spermatogenesis recovery slow after use of performance-enhancing drugs
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NEW ORLEANS — Healthy men who used nonprescribed androgens to improve athletic performance experienced a slow recovery of suppressed testicular function after stopping drug use, with time to recovery ranging from 9 to 18 months, according to findings presented at the Endocrine Society annual meeting.
“Testicular function recovery after cessation of androgen abuse is prolonged but mostly reversible except for testicular volume,” Nandini Shankara Narayana, MBBS, FRACP, an endocrinologist in the andrology department at Concord Repatriation General Hospital, a clinical lecturer at Central and Concord Clinical School and doctoral student at ANZAC Research Institute at the University of Sydney, told Endocrine Today. “Recovery takes 9 to 18 months after cessation of use. It would be longer if subtle use is continued.”
Worldwide, approximately 6.4% of men and 13.4% of all athletes report using anabolic-androgenic steroids, and the prevalence is rising, including among high school-aged students, Shankara Narayana said during a press conference.
“Coming off these drugs is difficult,” Shankara Narayana said. “Mainly because there are symptoms of hypogonadism [after stopping]. When men stop using testosterone, they experience lethargy, loss of vitality, easy fatigue and sexual dysfunction. They also lose muscle mass and strength — the very reason for which they started using this [drug] in the first place. This leads to a cycle of habituation and dependence.”
Shankara Narayana and colleagues analyzed data from 93 men, including 41 current testosterone users, 31 past users (defined as at least 3 months since last use) and 21 healthy, eugonadal nonusers, all recruited via social media (mean age, 34 years). Men underwent physical exams, testicular ultrasound and semen analysis and provided blood samples to assess reproductive hormone levels.
“As an illicit activity, androgen abuse is difficult to study prospectively, so we undertook a cross-sectional, observational study of current and past androgen abusers together with healthy, eugonadal nonusers to determine the rate and extent of recovery of sperm output and reproductive hormones after cessation of androgen intake,” the researchers wrote in an abstract.
They found that current testosterone users experienced a suppression of mean orchidometric testicular volume when compared with past users and nonusers (mean testicular volume, 14.3 mL, 18.6 mL and 23.2 mL, respectively).
Apart from six vasectomized men, sperm output among current testosterone users was also lower vs. past users and nonusers (median, 104 million per ejaculate, 173 million per ejaculate and 189 million per ejaculate, respectively), as was mean serum luteinizing hormone (LH; median, 0.5 IU/L, 5.5 IU/L and 5.2 IU/L), follicle-stimulating hormone (FSH; median, 0.5 IU/L, 4.7 IU/L and 4.9 IU/L), sex hormone-binding globulin (median, 17.2 IU/L, 33.9 IU/L and 42 IU/L) and HDL cholesterol (median, 0.64 mM, 1.1 mM and 1.21 mM).
Current users also experienced marked increases in serum testosterone vs. past users and nonusers (median, 38.5 ng/mL, 6.2 ng/mL and 8.6 ng/mL, respectively), as well as in dihydrotestosterone (median, 1.5 ng/mL, 0.5 ng/mL and 0.7 ng/mL) and estradiol (median, 146 pg/mL, 41 pg/mL and 48 pg/mL). Hemoglobin and triglyceride levels were also elevated.
When researchers compared past users vs. nonusers, all parameters apart from testicular volume and SHBG were similar between groups, consistent with full recovery. Rate of recovery for androgen-suppressed variables, estimated as the time to reach the mean for nonusers, was 9 months for serum LH, 14.2 months for sperm output and 18.7 months for serum FSH, according to researchers.
“Suppressed serum LH and FSH represent convenient, useful and underutilized markers of androgen abuse and recovery,” Shankara Narayana said in an interview. “These results will help endocrinologists involved in the care of men who are using typically nonprescribed, high doses of androgens for body building, a practice that is increasingly recognized but for which virtually no prognostic information has been available to support medical care during recovery from androgen abuse.” – by Regina Schaffer
Reference:
Shankara Narayana N, et al. GP-42. Rate and Extent of Testicular Function Recovery after Ceasing Non-Prescribed Androgen Abuse. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.
Disclosure: Shankara Narayana reports no relevant financial disclosures.