Anabolic steroid-induced hypogonadism: diagnosis and treatment

Fertil Steril. 2014 May;101(5):1271-9. doi: 10.1016/j.fertnstert.2014.02.002. Epub 2014 Mar 14.


Objective: To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management.

Design: Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria.

Setting: Not 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.

Keywords: Anabolic-androgenic steroids; androgens; clomiphene citrate; erectile dysfunction; gynecomastia; human chorionic gonadotropin; hypogonadotropic hypogonadism; tamoxifen; testicular atrophy.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anabolic Agents / adverse effects*
  • Humans
  • Hypogonadism / chemically induced*
  • Hypogonadism / diagnosis*
  • Hypogonadism / physiopathology
  • Hypogonadism / therapy
  • Male
  • Recovery of Function
  • Treatment Outcome


  • Anabolic Agents