Mental health, sexual function worsen for men in first year of quitting steroids
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Key takeaways:
- About 65% of men who stop anabolic steroids restart, likely due to withdrawal symptoms.
- Worsened mental health and sexual function should be targeted during the first year of steroid cessation.
BOSTON — In the first year after stopping anabolic steroid misuse, men had worse sexual function than those who continued using or never used the agents as well as more depression and anxiety, according to a presenter at ENDO 2024.
Anabolic-androgenic steroids are drugs with effects similar to testosterone and are used by about 6.4% of men worldwide. Use often centers around gyms for bodybuilding and aesthetic goals, Bonnie Grant, MBBS, a clinical researcher at Imperial College London, said during a press briefing. During use, these agents can cause hypogonadism and have adverse cardiometabolic effects and infertility. Adverse effects of discontinuing use include continued hypogonadism, depression and suicidal ideation, low libido and erectile dysfunction, fatigue, and dependence syndrome.
“Many men [about 65%] will restart using anabolic steroids within the first year, often due to difficult withdrawal symptoms,” Grant told Healio. “[Our study] reveals potentially treatable factors to improve symptoms that men experience when they stop using anabolic steroids within the first year.”
To quantify symptoms of withdrawal, Grant and colleagues conducted a cross-sectional, observational study with 245 men; 45 (mean age, 38.6 years; 60% white; 11% Asian British) had never used anabolic-androgenic steroids, 116 (mean age, 36.2 years; 75.8% white; 16.4% Asian British) were current users and 84 (mean age, 35.6 years; 75% white; 21.4% Asian British) had discontinued use during the past year. Among the never users, 6.6% had a psychiatric diagnosis and 17.7% reported illicit drug use. Among current users, 29% had a psychiatric diagnosis and 47.4% reported illicit drug use. Among recent quitters, 25% had a current psychiatric diagnosis and 40.5% reported illicit drug use.
The researchers administered questionnaires on substance misuse and used the Beck Depression Inventory-II (BDI-II) and the General Anxiety Disorder-7 (GAD-7) scale to assess mental health (higher scores indicate more severe depression or anxiety), the International Index Erectile Function-15 (IIEF-15) scale to assess sexual function (lower scores indicate worse function), and fasting morning blood samples and urine toxicology to assess hormone levels.
As expected, current steroid users had higher testosterone and lower luteinizing hormone and follicle-stimulating hormone levels than those who had never used or stopped using steroids.
Men who had stopped using steroids had lower sexual function scores (IIEF-15 = 70; 95% CI, 67-71) compared with current users (IIEF-15 = 64; 95% CI, 60-67) and past users (IIEF-15 = 64; 95% CI, 60-67; P = .0009). Men with higher luteinizing hormone levels reported worse sexual function (coefficient, –2.6; 95% CI, –4.9 to –0.7; P = .01).
Recent steroid cessation was associated with higher depression scores (BDI-II = 7; 95% CI, 4-11) compared with no past steroid use (BDI-II = 3; 95% CI, 1-6; P = .0079).
Quitting steroids exacerbated existing poor mental health. Depression scores were tripled for recent quitters with vs. without a psychiatric diagnosis (OR = 3.04; 95% CI, 1.72-5.38; P < .001), whereas a psychiatric diagnosis was associated with doubled depression scores for current steroid users (OR = 2.04; 95% CI, 1.34-3.09; P = .001).
Men who quit steroids in the past year also had higher anxiety scores (GAD-7 = 2; 95% CI, 1-3) compared with those who had never used steroids (GAD-7 = 1; 95% CI, 0-2; P = .035).
“We don’t actually know how long [men who stop using steroids] experience symptoms of depression and sexual function,” Grant told Healio. “More studies need to be done, but ultimately support [for men quitting steroids] is going to look like something that addresses the hormone loss, but a big part is going to be what’s addressed in the psychiatric aspects, so it’s probably going to be a joint treatment between physicians and psychiatrists.”
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Grant B, et al. OR24-02. Presented at: ENDO annual meeting; June 1-4, 2024; Boston.
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