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2018 ; 7
(3
): 483-489
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Impact of anabolic androgenic steroids on sexual function
#MMPMID30050806
Armstrong JM
; Avant RA
; Charchenko CM
; Westerman ME
; Ziegelmann MJ
; Miest TS
; Trost LW
Transl Androl Urol
2018[Jun]; 7
(3
): 483-489
PMID30050806
show ga
BACKGROUND: To describe the impact of supra-physiologic anabolic-androgenic
steroid (AAS) use, including agent, dosage, and duration of therapy, on sexual
function. METHODS: We reviewed data from an online survey of AAS users to
evaluate their sexual function on and off AAS. The online survey consisted of
questions addressing demographics, anabolic steroid use and patterns, ancillary
medications, testosterone (T)-related symptoms while on and off of therapy, as
well as sexual function which was assessed using the 5-item, International Index
of Erectile Function (IIEF-5). RESULTS: A total of 321 men responded to the
survey, of which 90 failed to meet inclusion criteria, for a final cohort of 231
AAS users. The majority of men were Caucasian (85%), employed (62%), and younger
than 35 years (58%), while an equal mix were single (47%) or married (46%). The
mean IIEF-5 was 22.5, with higher scores associated with increased T dosages
(>600 mg/week), use of 17-alpha alkylated hormones and anti-estrogens, and
absence of concurrent medical conditions. Lower mean IIEF scores were associated
with current and pre-AAS low T symptoms, self-reported angry or violent
tendencies, self-reported erectile dysfunction (ED), decreased libido, decreased
energy, and depression. After controlling for age, low T symptoms and decreased
energy remained significantly associated with lower IIEF scores. Among 127 men
reporting de novo decreased libido when not taking AAS, several factors were
significantly associated including frequency and duration of T and use of
adjunctive therapies, while post-cycle therapies were protective. Men who
reported any other de novo symptom (decreased energy, libido, muscle mass or
depression) after discontinuing T were also more likely to report de novo ED, as
well as those using >10 years or for >40 weeks per year. CONCLUSIONS: The
long-term impact of high dose AAS use on sexual function remains poorly defined.
Although high T dosages appeared to be protective of erectile function during
use, de novo symptoms such as decreased libido and ED occurred more frequently
after discontinuing T, particularly among those using more frequently and for
longer durations. Given the importance of these findings, long-term studies
evaluating the impacts of discontinuing T on sexual dysfunction are indicated.