Elsevier

Medical Hypotheses

Volume 72, Issue 6, June 2009, Pages 723-728
Medical Hypotheses

Anabolic steroid-induced hypogonadism – Towards a unified hypothesis of anabolic steroid action

https://doi.org/10.1016/j.mehy.2008.12.042Get rights and content

Summary

Anabolic steroid-induced hypogonadism (ASIH) is the functional incompetence of the testes with subnormal or impaired production of testosterone and/or spermatozoa due to administration of androgens or anabolic steroids. Anabolic–androgenic steroid (AAS), both prescription and nonprescription, use is a cause of ASIH. Current AAS use includes prescribing for wasting associated conditions. Nonprescription AAS use is also believed to lead to AAS dependency or addiction. Together these two uses account for more than four million males taking AAS in one form or another for a limited duration. While both of these uses deal with the effects of AAS administration they do not account for the period after AAS cessation. The signs and symptoms of ASIH directly impact the observation of an increase in muscle mass and muscle strength from AAS administration and also reflect what is believed to demonstrate AAS dependency. More significantly, AAS prescribing after cessation adds the comorbid condition of hypogonadism to their already existing chronic illness. ASIH is critical towards any future planned use of AAS or similar compound to effect positive changes in muscle mass and muscle strength as well as an understanding for what has been termed anabolic steroid dependency. The further understanding and treatments that mitigate or prevent ASIH could contribute to androgen therapies for wasting associated diseases and stopping nonprescription AAS use. This paper proposes a unified hypothesis that the net effects for anabolic steroid administration must necessarily include the period after their cessation or ASIH.

Introduction

The development of AAS compounds was originally for treatment of hypogonadal dysfunction and commencement of delayed puberty in men and for growth promotion [1]. AAS have, however, not always been used for pure medical purposes. Due to their anabolic effects, AAS became vastly popular among athletes, bodybuilders, and power lifters. Moreover, scientific and official court documents, including doctoral theses and scientific reports, demonstrate the positive effects of these and other hormonal drugs on muscle strength and performance in elite sports, which was common knowledge and had been in practice since the early 1960s [2].

Controversy raged for decades over the effectiveness of AAS in promoting muscle mass and muscle strength. Despite the admitted illicit use of AAS by athletes, the record breaking in Olympic events, and the obvious appearance in musculature enhancement, the medical and research community disputed and denied the AAS effects [3], [4]. After a considerable period of scientific controversy, it is now clear that anabolic–androgenic steroid hormones are effective in increasing both muscle mass and muscle strength [5].

Another of the beliefs held by the medical community deals with the period after anabolic steroid cessation, not their administration. The prevailing medical opinion is that clinically significant ASIH occurs from nonprescription AAS use but not from clinically prescribed AAS [6], [7]. The signs and symptoms of ASIH will necessarily impact upon our understanding for the clinical use of AAS. Additionally, these very same signs and symptoms might be instrumental in what has been described as AAS dependency.

Section snippets

Anabolic steroid-induced hypogonadism (ASIH)

Anabolic–androgenic steroids (AAS) are a class of compounds that include any drug or hormonal substance, chemically and pharmacologically related to testosterone that stimulates the growth or manufacturing of bone and muscle. It has long been held that nonprescription AAS use results in a functional type of hypogonadotropic hypogonadism. Boje was the first physician to suggest, in 1939, that AAS might enhance athletic performance, but he was also the first to forewarn athletes of potential

Psychological and behavioral effects

The association of AAS with adverse psychological and behavioral effects is extensive [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32]. Historically, researchers went so far as to categorically state that AAS are without any evidence upon muscle going so far as to argue that there is saturation of the androgen receptor with eugonadal levels of testosterone. This attitude spurned the concept that the large doses commonly used by illicit AAS users indicate that the drug use is for

Muscle effects

The idea that secretions of the testis might regulate body composition is as old as humanity itself. For decades, testosterone and testosterone analogues, anabolic–androgenic steroids (AAS), have long been used in the athletic community for improving muscle mass and muscle strength. Despite the obvious changes in musculature and appearance to even the most uninitiated, the academic community steadfastly refused to admit to any association. The scientific evidence shows the contrary to be true.

Future treatments

A treatment goal of HPTA restoration will have its basis in the regulation and control of testosterone production. The HPTA has two components, both spermatogenesis and testosterone production. In males, luteinizing hormone (LH) secretion by the pituitary positively stimulates testicular testosterone (T) production; follicle-stimulating hormone (FSH) stimulates testicular spermatozoa production. The pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus stimulates LH

Discussion – a unified hypothesis

There are reports of the use of anabolic steroids by athletes since the 1950s to increase muscle size and strength to improve performance. Anabolic steroids use became more prominent in the athletic world, but use by the lay public has also increased. Long confined to bodybuilding and professional sports, the use of AAS is nowadays a problem that involves a wider population. In 2006, a report demonstrates that AAS use is common among males over 18 years [75]. In the United States, prevalence

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