Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery
Open accessAbstract
There is often inherent conflict in the overlapping fields of male fertility and andrology. While the goal of all male fertility specialists is to facilitate and preserve biologic paternity, many practitioners also care for a significant number of patients suffering from hypogonadism. Exogenous testosterone administration, the gold standard for the management of these patients, almost universally impairs spermatogenesis and can even completely eradicate it in some men. With steady increases in both the incidence of hypogonadism and average paternal age, practitioners are now encountering hypogonadal men who desire future fertility or men suffering the effects of earlier androgenic anabolic steroid use with increasing frequency. In this manuscript, we review management strategies for these complex patients and explore novel medications that may be of use in this population.
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Long-term use of anabolic steroids is associated with increased risks of hepatic dysfunction, carcinoma, cardiovascular disease, prolonged testicular suppression, and subfertility.
“While short-term use may lead to increased muscle mass, long-term use has been associated with increased risks of hepatic dysfunction, carcinoma, and cardiovascular disease, as well as prolonged testicular suppression and subfertility (33-35).”
From Non-testosterone management of male hypogonadism: an examination of the existing literature (2020) · cites this paper as [34]
The 'Mechanisms of Action > Androgenic anabolic steroids' section (page not supplied) describes cardiac and hepatic adverse effects, long-term hypogonadism after AAS use, and risks to future fertility. It does not mention carcinoma or establish that the cardiac and hepatic risks specifically increase with long-term use. (LLM, conf=0.88)
Experimental — accuracy not yet measuredhCG acts directly on the testis and is well-tolerated, but is expensive and requires multiple injections per week, leading many patients to elect alternative treatments.
“While hCG acts directly on the testis and is well-tolerated, this medication is expensive, and with the requirement for multiple injections per week, many patients elect alternative treatments (34).”
From Non-testosterone management of male hypogonadism: an examination of the existing literature (2020) · cites this paper as [34]
The ‘Human chorionic gonadotropin’ section (page unavailable) says hCG acts directly on the testicle and that its cost, subcutaneous administration, and short half-life limit its use as primary therapy. The ‘Maintenance of fertility with concurrent testosterone use’ section describes every-other-day injections, supporting multiple injections per week. The copy does not state that hCG is well-tolerated or that many patients elect alternative treatments. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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- Authors
- Tatem, A. J., Beilan, J., Kovac, J. R., & Lipshultz, L. I.
- Affiliations
- Baylor College of Medicine (US)
- Men's Health Center, Indianapolis, IN, USA.
- Corresponding author
- Lipshultz, Larry I.
- Venue
- The World Journal of Men's Health
- Publisher
- XMLink
- Published
- 2020
- Volume
- 38
- Issue
- 2
- Pages
- 141
- ISSN
- 2287-4208 (ISSN-L)
- 2287-4690
- PMC
- PMC7076311
- OpenAlex
- W2932790794
- Cited by
- 66
- References
- 75
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 8 · 2023: 13 · 2022: 11 · 2021: 9 · 2020: 6 · 2019: 3
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- The World Journal of Men s Health (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- hypogonadism, exogenous testosterone, spermatogenesis, male fertility preservation, fertility restoration, anabolic steroids, paternal age
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