Male central hypogonadism secondary to exogenous androgens: a review of the drugs and protocols highlighted by the online community of users for prevention and/or mitigation of adverse effects

Abstract

SummaryAndrogen-or anabolic steroid-induced hypogonadism (ASIH) is no longer confined to professional athletes; its prevalence amongst young men and teenagers using androgens and/or anabolic steroids (AASs) is rising fast, and those affected can experience significant symptoms. Clinicians are increasingly encountering demanding, well-informed men affected by ASIH, yet lacking authoritative information on the subject may struggle to project a credible message. In this article, we overview the methods and drugs that men use in an attempt to counteract ASIH (with a view to either preventing its onset, or reversing it once it has developed) and summarize the scientific evidence underpinning these. The main channel for obtaining these drugs is the Internet, where they can be readily sourced without a valid prescription. An Internet search using relevant terms revealed a huge number of websites providing advice on how to buy and use products to counteract ASIH. Drugs arising repeatedly in our search included human chorionic gonadotrophin (hCG), selective oestrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The quality and accuracy of the online information was variable, but review of medical literature also highlighted a lack of scientific data to guide clinical practice. It is important for clinicians to be aware of the AAS user's self-treatment strategies with regard to ASIH side-effect mitigation. By ensuring that they are well-informed, clinicians are more likely to retain the credibility and trust of AAS users, who will in turn likely be more open to engage with appropriate management.

Lifestyle causes of male infertility

“…AAS are used primarily by males to enhance their athletic performance and/or personal appearance [45] . The use of AAS has expanded beyond that of professional athletes and the prevalence of anabolic steroid-induced hypogonadism (ASIH) amongst young men and teenagers is on the rise [46] . A retrospective study found that ASIH was the most common cause of profound hypogonadism (≤50 ng/dL testosterone) amongst men who sought treatment for hypogonadism [47] .…”

Adverse effects of sports supplements in men

“…14, 16 Excess circulating testosterone is converted into oestradiol, providing further negative feedback to the pituitary. High concentrations of oestrogen may lead to oestrogenic adverse effects including gynaecomastia.…”

“…Symptomatic individuals may then use post-cycle drugs such as aromatase inhibitors, to slow the conversion of endogenous androgens to oestrogen, or selective oestrogen receptor modulators such as clomiphene and tamoxifen, to reduce the effects of circulating oestrogen. 16 While these are prescription drugs in Australia, they are readily purchased online and may also be found in some supplements. There is little evidence that these approaches increase endogenous testosterone after supplement use.…”

“…There is little evidence that these approaches increase endogenous testosterone after supplement use. 16 …”

“…16 Consider whether this may be for the mitigation of adverse effects of androgen or anabolic steroidinduced hypogonadism.…”