Men regret anabolic steroid use due to a lack of comprehension regarding the consequences on future fertility

Abstract

We examined whether men with anabolic-steroid-induced hypogonadism (ASIH) seeking testosterone supplementation therapy (TST) regretted their decision to use anabolic-androgenic steroids (AAS) and what their reasons were for this regret. An anonymous, prospective survey was distributed to 382 men seeking follow-up treatment for hypogonadism. Prior AAS use was confirmed by self-report, and men were categorised based upon whether they regretted (R) or did not regret (NR) their use of AAS. The average patient age was 40 ± 0.9 years (n = 79) and 15.2% expressed regret over AAS use. No demographic differences were identified between those who regretted AAS use (n = 12) and those who did not (n = 67). Regret was not related to ASIH diagnosis or to AAS-related side effects like increased aggression, mood disorders, erectile dysfunction, acne, fluid retention or dyslipidemia. Those who regretted AAS use were significantly more likely to have not comprehended the negative impact on future fertility (P < 0.030). Actual fertility issues were comparable in men who regretted AAS use (16.7%) and those who did not (13%). A total of 15.2% of men regretted using AAS. A lack of awareness regarding the negative long-term effects on fertility was the primary factor related to regret of AAS use in men with ASIH.

Keywords: Anabolic steroids; hypogonadism; infertility; regret; testosterone.

Figure 1

AAS use and regret. (A) Men who reported regret of AAS use experienced similar side-effects for cholesterol (p=0.29), aggression (p=1), acne (p=0.34) and fluid retention (p=0.35) to those who did not regret AAS use. (B) No differences in regret were found in situations where men had spouses who were aware of their use of AAS with no relationship effects (Column 1; p=0.44). No statistical differences were found between men who regretted prior AAS use and those who did not in the following situations: (Column 2) Spouse was aware of AAS use and this had effects on the relationship (Aware & Effect, p=1); (Column 3) Spouse was not aware of AAS use and this had no effects on the relationship (Not Aware & No Effect, p=1) and; (Column 4) Spouse was not aware and this effected the relationship (p=1). (C) Regret had no effect on erections and mood in men who reported AAS use. Decreased frequency and quality of erections (p=0.54) as well as poor mood (p=0.74) affected men who regretted AAS use to a similar degree as those who did not (Black bars=men with regret; white bars=men with NO regret).

Figure 2

Regret, AAS and the long-term effects on serum testosterone levels and fertility. (A) Men who regretted their AAS use (black bars) did not understand the potential long-term effects on their serum testosterone levels; however, this relationship did not reach statistical significance (p=0.06). Patients who regretted their prior AAS use were less aware of the potential long-term effects on future fertility (*, p=0.029) compared to those that did not regret AAS use (white bars). (B) Men with regret were equally as likely to experience actual problems with fertility as those without regret. These results suggest that patient perceptions had more impact on regret than actual events (Black bars=men with regret; white bars=men with NO regret).