Androgen abuse temporarily lowers fertility in male athletes
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Male athletes who tested positive for androgen use experienced a 26% lower fertility rate in the years before a doping sanction vs. controls, but rates gradually caught up with the general population in the years after testing, data show.
“We found that androgen abuse was associated with a temporary decline in fertility and most androgen users obtained parenthood without any help from the health care system,” Henrik Horwitz, MD, PhD, associate professor in the department of clinical pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark, told Healio. “Overall, the fertility rate and the prevalence of assisted reproduction among androgen users were close to that in the background population.”
Horwitz and colleagues analyzed data from 545 men who tested positive for androgen use in an anti-doping test program in Danish fitness centers between Jan. 3, 2006, and March 1, 2018 (mean age at time of doping sanction, 26 years). The confirmed users were matched by birth year with 5,450 men who served as controls. Researchers followed this cohort from 10 years prior to testing positive and until May 2018 (mean length of follow-up, 17 years). The findings were published in The Journal of Clinical Endocrinology & Metabolism.
Researchers found that during the 10-year period before testing positive, the group of androgen users experienced a 26% lower fertility rate vs. controls, with a rate ratio of 0.74 (95% CI, 0.6-0.9). However, in the years following the doping sanction, men who tested positive for androgen use had a total fertility rate that was only 7% lower than expected at follow-up, with an RR of 0.93 (95% CI, 0.84-1.03). The prevalence of assisted reproduction was similar among androgen users (5.69%) and controls (5.28%).
“On a population level, androgen abuse is not expected to have a great impact on the general fertility rate due to the relatively minor prevalence, but the results presented in this study is of importance in the counselling of the individual androgen abuser,” the researchers wrote. “Most of these men obtained fatherhood without any assistance from the health care system. Therefore, our data indicate that a ‘wait-and-see-strategy’ in combination with abstinence of androgen abuse may be a wise first step for the typical androgen user planning parenthood.”
For more information:
Henrik Horwitz, MD, PhD, can be reached at henrik.horwitz@regionh.dk.
Perspective
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Tamara Wexler, MD, PhD
This study suggests that men without any native deficiency who choose to take testosterone as a supplement — something that can have potentially serious health consequences — can resume fertility by stopping androgen use and waiting a period of time for their systems to resume functioning.
This is not surprising, given what we know from the treatment of clinical hypogonadism.
It is also not surprising that there was a clinically and statistically significant reduction in fertility, as measured by the authors, for individuals doping with androgen. Exogenous testosterone use, for example, can suppress the body’s signals that lead to production of not only testosterone, but of sperm. Nor is it surprising that there is recovery in the years thereafter, as the body’s own system “wakes up.”
In a clinical setting, testosterone is often prescribed to treat men who are diagnosed with hypogonadism — meaning that their body’s own system is not making enough testosterone, with subsequent clinical symptoms. In men who desire fertility, the testosterone can be stopped; men who lack sufficient gonadotropins can be given replacement gonadotropins to stimulate both testosterone and sperm production.
The authors do note a slight, nonsignificant difference in fertility in the years after the doping sanction. It is possible that despite the sanction, some prior androgen users continued to dope. It is also possible that men seeking fertility would know to stop doping given its suppressive effect. The data sources do not allow these details to be distinguished; the authors are careful to point out some of the limitations inherent in such a databank-based population study. The study also assumes that the androgen-positive individuals were doping vs. undergoing treatment for a preexisting hypogonadal condition.
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