Treatment of impotence related to anabolic steroid use – adapted from the Western Journal of Medicine, February 1995 – Tips from Other Journals
Athletes commonly use anabolic steroids to improve their performance and appearance. Use of anabolic steroids has led to multiple side effects, including psychologic dependence and hypogonadotropic hypogonadism. Underground literature discusses the use of human chorionic gonadotropin (hCG), clomiphene (Clomid) and tamoxifen to counter the side effects of gynecomastia and reduced testicular volume. Bickelman and associates describe a case of impotence and decreased libido associated with the use of anabolic steroids.
The patient, a 29-year-old man, used anabolic steroids (testosterone cypionate, 1,500 to 1,800 mg per week and oxymetholone, 560 mg per week) for eight months, after which time he became impotent, with no spontaneous erections and diminished libido. He had also completed a self-prescribed four-week trial of hCG without any change in symptoms. After being symptomatic for one year, the patient sought endocrinologic consultation. Both serum gonadotropin and free testosterone levels were abnormal (follicle-stimulating hormone level of 0.6 mIU per mL, luteinizing hormone level of 1.9 mIU per mL and a free testosterone level of 7.1 pg per mL). Treatment was initiated with a double dose of clomiphene (100 mg per day). Potency and libido were restored within one month. Three weeks later, serum gonadotropin and free testosterone levels returned to normal.
Most synthetic anabolic steroids have some androgenic effects that inhibit release of gonadotropin-releasing hormone (GnRH) from the hypothalamus and release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. A hypogonadotropic state and, eventually, testicular atrophy with reduced serum testosterone results, followed by reduced libido and impotence. This process is usually reversible within four months after cessation of anabolic steroid use. Rarely, as in this example, the suppression of the hypothalamic-pituitary-testicular axis lasts longer than four months.
The authors conclude that clomiphene produces an antiestrogenic effect on the hypothalamus that results in increased GnRH release, while producing an estrogen-like effect on the pituitary, increasing sensitivity to GnRH. Pituitary-gonadal failure induced by recreational use of steroids can be resolved by halting steroid use and administering clomiphene. (Western Journal of Medicine, February 1995, vol. 162, p. 158.)
COPYRIGHT 1995 American Academy of Family Physicians
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