The effect of anabolic androgenic steroid abuse on male fertility: Review Study

Document Type : Review Article

Authors

1 PhD of Reproductive Health, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran.

2 Instructor, Department of Midwifery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran.

3 PhD student of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Young people's interest in strength exercises has led to the high use of anabolic steroids (AAS) regardless of its long-term side effects. Therefore, this review study was conducted with aim to investigate the effect of AAS drugs on male fertility.
Methods: In line with the aim of the present review study, search was performed in the databases of Scopus, Pubmed, Proquest, Science Direct, ISC, Irandoc, Magiran and Google Scholar with the keywords of energy drugs, male fertility, spermatogenesis, androgenic anabolic steroid drugs and AAS without time restrictions. Among a total of 8453 articles extracted, after reviewing the title, abstract and inclusion and exclusion criteria, finally 33 articles were reviewed.
Results: AAS drugs have long-term effects on the male reproductive system and disrupt spermatogenesis through four primary mechanisms including direct effects on gametes, hypothalamic axis change, pituitary and testis, erectile dysfunction or ejaculation, and decreased libido. It also reduces testosterone production and suppresses spermatogenesis by inhibiting negative feedback at LH and FSH levels. Most side effects are reversible after discontinuation, but long-term use during the reproductive ages and testicular developmental stages disrupts semen analysis and sperm function parameters, and there is no possibility of responding to alternative therapy. Not enough information has been reported about the time required to return male fertility after drug discontinuation.
Conclusion: Excessive use of AAS drugs has long-term adverse effects on male reproductive health, so, existence of various and unknown items of drugs in the market, advertising in clubs and cyberspace and high consumption of drugs regardless of its side effects, require management measures to solve this global health problem and maintain male reproductive health. Therefore, education is recommended to the community, athletes, coaches and health care providers.

Keywords


  1. Mobasheri M, Mohammadi S, Soureshjani SH, Khosravi F, Alidousti M. The most important factors influencing the fertility patterns of single child families and without children in Shahre Kord City in 2013. 8th IRHRC Annual Meeting Reproductive and Infertility Updates 2015; 8.
  2. Yavari A. Abuse of anabolic androgenic steroids. Journal of stress physiology & biochemistry 2009; 5(3):22-32.
  3. Kicman AT. Pharmacology of anabolic steroids. British journal of pharmacology 2008; 154(3):502-21.
  4. Haupt HA, Rovere GD. Anabolic steroids: a review of the literature. The American journal of sports medicine 1984; 12(6):469-84.
  5. Kanayama G, Hudson JI, Pope Jr HG. Illicit anabolic–androgenic steroid use. Hormones and behavior 2010; 58(1):111-21.
  6. Lumia AR, McGinnis MY. Impact of anabolic androgenic steroids on adolescent males. Physiology & behavior 2010; 100(3):199-204.
  7. Sheffield-Moore M, Urban RJ. An overview of the endocrinology of skeletal muscle. Trends in Endocrinology & Metabolism 2004; 15(3):110-5.
  8. World Anti‐Doping Agency. The World Anti‐Doping Code International Standard‐Prohibited List; 2019.
  9. Fronczak CM, Kim ED, Barqawi AB. The insults of illicit drug use on male fertility. Journal of andrology 2012; 33(4):515-28.
  10. Arazi H, Bazyar F. The prevalence of anabolic steroid misuse and the awareness about its negative effects among bodybuilders in Karaj city. Alborz University Medical Journal 2014; 3(1):48-56.
  11. Bijeh N, Dehbashi M, Saghi M. Studying the amount of prevalence awareness and complications of anabolic steroids among the male athletes in Mashhad city. Journal of Practical Studies of Biosciences in Sport 2014; 2(4):78-89.
  12. Haerinejad MJ, Ostovar A, Farzaneh MR, Keshavarz M. The prevalence and characteristics of performance-enhancing drug use among bodybuilding athletes in the south of Iran, Bushehr. Asian J Sports Med 2016; 7(3):e35018.
  13. Saeidinejat S, Hooshmand E, Zahra H, Najar AV. Evaluating the pattern of anabolic androgenic steroid use and its relation with mental health of male members of bodybuilding Clubsof Iran, in 2015. Asian Journal of Sports Medicine 2018; 9(1).
  14. Fayyazi Bordbar MR, Abdollahian E, Samadi R, Dolatabadi H. Frequency of use, awareness, and attitudes toward side effects of anabolic–androgenic steroids consumption among male medical students in Iran. Substance use & misuse 2014; 49(13):1751-8.
  15. Kargarfard M, Shariat A, Lam E, Shaw B, Shaw I, Nayyeri F. Prevalence and Perceptions Toward Anabolicandrogenic Steroid Use Amongst University Students. Acta Medica Bulgarica 2015; 42(2):61-7.
  16. Ekramzadeh M, Taherinasab S. The Prevalence of Sport Dietary Supplements Consumption among Male Athlete Students in Shiraz University of Medical Sciences, Shiraz, Iran. International Journal of Nutrition Sciences 2017; 2(4):218-23.
  17. Evans NA. Current concepts in anabolic-androgenic steroids. The American journal of sports medicine 2004; 32(2):534-42.
  18. Nilsson S, Baigi A, Marklund B, Fridlund B. The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden. The European Journal of Public Health 2001; 11(2):195-7.
  19. Andrews MA, Magee CD, Combest TM, Allard RJ, Douglas KM. Physical effects of anabolic-androgenic steroids in healthy exercising adults: A systematic review and meta-analysis. Current sports medicine reports 2018; 17(7):232-41.
  20. Bahrke MS, Yesalis CE. Abuse of anabolic androgenic steroids and related substances in sport and exercise. Current opinion in pharmacology 2004; 4(6):614-20.
  21. Dorry K, Nedaeinia R, Hemayatkhah Jahromie V, Naderian M. The Effects of Anabolic-Androgenic Steroid Drugs Consumption on Blood Factors in bodybuilder’s athletes in jahrom, Iran. Medical Laboratory Journal 2010; 4(1):20-5.
  22. Hall RC, Hall RC. Abuse of supraphysiologic doses of anabolic steroids. Southern medical journal 2005; 98(5):550-5.
  23. Kam PC, Yarrow M. Anabolic steroid abuse: physiological and anaesthetic considerations. Anaesthesia 2005; 60(7):685-92.
  24. Loughton SJ, Ruhling RO. Human strength and endurance responses to anabolic steroids and training. J Sports Med Phys Fitness 1977; 17(3):285-96.
  25. Maravelias C, Dona A, Stefanidou M, Spiliopoulou C. Adverse effects of anabolic steroids in athletes: a constant threat. Toxicology letters 2005; 158(3):167-75.
  26. Medras M, Brona A, Józków P. The central effects of androgenic-anabolic steroid use. Journal of addiction medicine 2018; 12(3):184-92.
  27. Mottram DR, George AJ. Anabolic steroids. Baillieres Best Pract Res Clin Endocrinol Metab 2000; 14(1):55-69.
  28. Kanayama G, Barry S, Hudson JI, Pope HG. Body image and attitudes toward male roles in anabolic-androgenic steroid users. American Journal of Psychiatry 2006; 163(4):697-703.
  29. Miller KE, Barnes GM, Sabo DF, Melnick MJ, Farrell MP. Anabolic-androgenic steroid use and other adolescent problem behaviors: Rethinking the male athlete assumption. Sociological Perspectives 2002; 45(4):467-89.
  30. Ip EJ, Yadao MA, Shah BM, Doroudgar S, Perry PJ, Tenerowicz MJ, et al. Polypharmacy, infectious diseases, sexual behavior, and psychophysical health among anabolic steroid-using homosexual and heterosexual gym patrons in San Francisco's Castro District. Substance use & misuse 2017; 52(7):959-68.
  31. de Ronde W, Smit DL. Anabolic androgenic steroid abuse in young males. Endocrine connections 2020; 9(4):R102-11.
  32. Hallak J, Teixeira TA, de Souza GL. Effect of exogenous medications and anabolic steroids on male reproductive and sexual health. Male Infertility 2020:455-468.
  33. Cordes M, Vocks S, Düsing R, Bauer A, Waldorf M. Male body image and visual attention towards oneself and other men. Psychology of Men & Masculinity 2016; 17(3):243-54.
  34. Gough B. Embodied Masculinities: Men’s Body Projects. Contemporary Masculinities 2018: 19-38.
  35. Labre MP. Adolescent boys and the muscular male body ideal1. Journal of adolescent health 2002; 30(4):233-42.
  36. Peters MA, Phelps L. Body image dissatisfaction and distortion, steroid use, and sex differences in college age bodybuilders. Psychology in the Schools 2001; 38(3):283-9.
  37. Kargarfard M, Ghias M, Karim Zadegan R, Kashi A. Assumption of Anabolic-androgenic Steroids among Isfahan University Students: Prevalence, and Awareness about Their Side Effects. Journal of Fundamentals of Mental Health 2006; 8(32):73-80.
  38. Kindlundh AM, Isacson DG, Berglund L, Nyberg F. Doping among high school students in Uppsala, Sweden: A presentation of the attitudes, distribution, side effects, and extent of use. Scandinavian journal of social medicine 1998; 26(1):71-4.
  39. Bahrke MS, Yesalis CE, Kopstein AN, Stephens JA. Risk factors associated with anabolic-androgenic steroid use among adolescents. Sports Med 2000; 29(6):397-405.
  40. Madani AH, Aghamolaei T, Davoodi SH, Madani S, Safa P, Zaree F. Prevalence of Anabolic Steroids abuse and awareness of its effects in male athletes in Southern Iran. Journal of Preventive Medicine 2017; 4(1):27-33.
  41. de Souza GL, Hallak J. Anabolic steroids and male infertility: a comprehensive review. BJU international 2011; 108(11):1860-5.
  42. Graham MR, Davies B, Grace FM, Kicman A, Baker JS. Anabolic steroid use: patterns of use and detection of doping. Sport s Med 2008; 38(6):505-25.
  43. Kashi A, Kargarfard M, Molavi H. A few effective factors on use ergogenic aid among body builder athletics. Proceeding of the 8th Congress of Research’s Week 2005:42-3.
  44. Pasharavesh L, Ramandi M, Khoushbou S, Rezaei M, Rezvani S, Abbasi MR, et al. Prevalence of Doping Agents'abuse and Male Bodybuilders'knowledge About Their Side Effects in Kermanshah Gymnasiums. Journal of Kermanshah University of Medical Sciences (Behbood) 2008; 11(4):418-27.
  45. Jalilian F, Allahverdipour HA, Moeini B, Barati M, Moghimbeigi A, Hatamzadeh N. Relation of Self-efficacy and Perceived Behavior Control on Gym Users’ Anabolic Steroid Use Related Behaviors. Avicenna J Clin Med 2012; 19(1):45-52
  46. Gabrielsen JS, Tanrikut C. Chronic exposures and male fertility: the impacts of environment, diet, and drug use on spermatogenesis. Andrology 2016; 4(4):648-61.
  47. Yahyaei B, Nouri M, Matmir H. Healing effects of Ziziphus jujuba hydroalcoholic extract with exercise training on histopathological changes of male wistar rats testicular tissue in response to Boldenone steroid administration. Jorjani Biomed J 2018; 6(1):12-21
  48. Nudell DM, Monoski MM, Lipshultz LI. Common medications and drugs: how they affect male fertility. The Urologic clinics of North America 2002; 29(4):965-73.
  49. Sigman M. Medications that impair male fertility. Sexuality Reproduction and Menopause 2007; 5(2):11-15.
  50. Yahyavi Koochaksaraei F, Mirghafourvand M, Hasanpoor S, Bani S. Mental health and its socio-demographic predictors in male partner of Iranian infertile couples. Issues in mental health nursing 2016; 37(8):563-8.
  51. Mirghaforvand M, Hasanpoor S, Bani S, Yahyavi F. Perceived social support in infertile couples and its individual-social predictors. Journal of Mazandaran University of Medical Sciences 2014; 24(SUPPL. 1):212-23.
  52. Ajayi AF, Akhigbe RE. The physiology of male reproduction: Impact of drugs and their abuse on male fertility. Andrologia 2020; 52(9):e13672.
  53. Vergel N, Hodge AL, Scally MC. How to Stop Testosterone Safely and Possibly Reset Your Hormonal Axis.  Testosterone: A Man's Guide 2013. Avaelable at: http://www.excelmale.com.
  54. Carter MD, Hollander MB, Lipshultz LI. In the medicine cabinet, clues to infertility. Contemp Urol 1993; 5:51-63.
  55. Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics 2011; 66(4):691-700.
  56. Krausz C. Male infertility: pathogenesis and clinical diagnosis. Best practice & research Clinical endocrinology & metabolism 2011; 25(2):271-85.
  57. Thompson ST. Prevention of male infertility: an update. Urologic Clinics of North America 1994; 21(3):365-76.
  58. Takayanagi A, Kobayashi K, Hashimoto K, Kato R, Masumori N, Itoh N, et al. Case of androgenic anabolic steroid abuse caused hypogonadotropic hypogonadism. Nihon Hinyokika Gakkai zasshi. The japanese journal of urology 2008; 99(7):729-32.
  59. Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroid–induced hypogonadism: diagnosis and treatment. Fertility and sterility 2014; 101(5):1271-9.
  60. Tan RS, Scally MC. Anabolic steroid-induced hypogonadism–towards a unified hypothesis of anabolic steroid action. Medical hypotheses 2009; 72(6):723-8.
  61. Kanayama G, Hudson JI, DeLuca J, Isaacs S, Baggish A, Weiner R, et al. Prolonged hypogonadism in males following withdrawal from anabolic–androgenic steroids: an under‐recognized problem. Addiction 2015; 110(5):823-31.
  62. Beaver KM, Vaughn MG, DeLisi M, Wright JP. Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the United States. American journal of public health 2008; 98(12):2185-7.
  63. McGinnis MY. Anabolic androgenic steroids and aggression: studies using animal models. Annals of the New York Academy of Sciences 2004; 1036(1):399-415.
  64. Farrell SF, McGinnis MY. Long-term effects of pubertal anabolic–androgenic steroid exposure on reproductive and aggressive behaviors in male rats. Hormones and behavior 2004; 46(2):193-203.
  65. Wesson DW, McGinnis MY. Stacking anabolic androgenic steroids (AAS) during puberty in rats: a neuroendocrine and behavioral assessment. Pharmacology Biochemistry and Behavior 2006; 83(3):410-9.
  66. McGinnis MY, Lumia AR, Tetel MJ, Molenda-Figueira HA, Possidente B. Effects of anabolic androgenic steroids on the development and expression of running wheel activity and circadian rhythms in male rats. Physiology & behavior 2007; 92(5):1010-8.
  67. Purkayastha S, Mahanta R. Effect of Chronic Use of Recreational Drugs on the Sperm Count in Albino Mice. International Journal of Sciences: Basic and Applied Research (IJSBAR) 2014; 13(1):466-74.
  68. Rasmussen JJ, Selmer C, Østergren PB, Pedersen KB, Schou M, Gustafsson F, et al. Former abusers of anabolic androgenic steroids exhibit decreased testosterone levels and hypogonadal symptoms years after cessation: a case-control study. PloS one 2016; 11(8):e0161208.
  69. Boregowda K, Joels L, Stephens JW, Price DE. Persistent primary hypogonadism associated with anabolic steroid abuse. Fertility and sterility 2011; 96(1):e7-8.
  70. Schürmeyer T, Belkien L, Knuth UA, Nieschlag E. Reversible azoospermia induced by the anabolic steroid 19-nortestosterone. The lancet 1984; 323(8374):417-20.
  71. Bonetti A, Tirelli F, Catapano A, Dazzi D, Dei Cas A, Solito F, et al. Side effects of anabolic androgenic steroids abuse. International journal of sports medicine 2008; 29(08):679-87.
  72. Torres-Calleja J, Gonzalez-Unzaga M, DeCelis-Carrillo R, Calzada-Sanchez L, Pedron N. Effect of androgenic anabolic steroids on sperm quality and serum hormone levels in adult male bodybuilders. Life sciences 2001; 68(15):1769-74.
  73. Mesbah AS, Shokri S, Karbalaei DS, Mirkhani H. Effects of nandrolone decanoate on ultrastructure of testis in male adult rats. Iran J Med Sci 2008; 33(2):94-100.
  74. Min T, Lee KH. Effects of nandrolone decanoate on expression of steroidogenic enzymes in the rat testis. Asian-Australasian journal of animal sciences 2018; 31(5):658-71.
  75. Hoffman JR, Ratamess NA. Medical issues associated with anabolic steroid use: are they exaggerated?. Journal of sports science & medicine 2006; 5(2):182-93.
  76. Knuth UA, Maniera H, Nieschlag E. Anabolic steroids and semen parameters in bodybuilders. Acta Endocrinologica 1989; 120(3):S121-2.
  77. Kuipers H. Anabolic steroids: side effects. Encyclopedia of sports medicine and science. Internet Society for Sport Science 1998.
  78. Jalali AS, Najafi G, Hosseinchi M, Sedighnia A. Royal Jelly alleviates sperm toxicity and improves in vitro fertilization outcome in Stanozolol-treated mice. Iranian journal of reproductive medicine 2015; 13(1):15-22.
  79. Coward RM, Rajanahally S, Kovac JR, Smith RP, Pastuszak AW, Lipshultz LI. Anabolic steroid induced hypogonadism in young men. The Journal of urology 2013; 190(6):2200-5.
  80. Azarnia M, Feyzi M, Shakoor A, Rabiei M. Thesis submitted for degree of master of science in animal biology(Developmental Biology). Quarterly Journal of Science Kharazmi University 2005; 18(50):305-314
  81. Christou MA, Christou PA, Markozannes G, Tsatsoulis A, Mastorakos G, Tigas S. Effects of anabolic androgenic steroids on the reproductive system of athletes and recreational users: a systematic review and meta-analysis. Sports Medicine 2017; 47(9):1869-83.
  82. Feinberg MJ, Lumia AR, McGinnis MY. The effect of anabolic-androgenic steroids on sexual behavior and reproductive tissues in male rats. Physiology & behavior 1997; 62(1):23-30.
  83. Cunningham RL, Lumia AR, McGinnis MY. Androgenic anabolic steroid exposure during adolescence: ramifications for brain development and behavior. Hormones and behavior 2013; 64(2):350-6.
  84. Hoffmann U. Anabolic steroids—a problem in popular sports. Toxichem Krimtech 2002; 69(3):136-42.
  85. McBride JA, Coward RM. Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian journal of andrology 2016; 18(3):373-80.