You may be a professional athlete, bodybuilder or a weight lifter who is currently using anabolic steroids with the purpose of building up muscle bulk or you may be a non-professional ordinary guy who is using these anabolic steroids to make yourself look more ‘manly’. In this article you will find the relationship of anabolic steroids with endogenous testosterone , and how anabolic steroids cause infertility in men.
Do you know that long term use of these anabolic steroids can lead to infertility in men? Anabolic steroid use is one of the main preventable causes of male infertility.
Earlier these anabolic steroids were restricted to professional bodybuilders only, but with time its use among recreational athletes and normal teenagers has increased.
Well, let’s see what these anabolic steroids are.
What are Anabolic steroids?
Anabolic steroids, also known as anabolic-androgenic steroids (AAS) are substances that have similarities to a natural androgenic hormone produced in the body. This natural hormone, which is known as testosterone is produced by the Leydig cells in the testis. I think it might be helpful for you to know what testosterone does in your body to understand the effect of anabolic steroids.
Ok. Let’s briefly look at what they are.
Effects of testosterone in your body
- Androgenic property of testosterone is most evident during the pubertal period. It is the hormone that,
- Gives secondary male sexual characteristics
- Determine male hair growth pattern
- Decides activity of sweat-producing glands
- Helps sperm maturation
- Determines the desire for sexual activities.
- Anabolic effects.
- Testosterone stimulates collagen and other protein syntheses of the body. Also, it reduces the breakdown of proteins. I’m sure you already know that protein synthesis is essential for muscle growth. After all, two proteins Actin and myosin are the major constituents of muscle cells after water. Because of these effects, testosterone acts as a growth promoter by increasing the size of the muscles of your body.
Now that you know the effects of testosterone, it is time to know about the effects of anabolic steroids.
Anabolic steroids
You may know it as gear, juice, roids, stackers, Arnolds, gym candy, pumpers or weight trainers. These are the common street names used by people for anabolic steroids.
I already mentioned that these anabolic steroids are similar to testosterone hormone. Actually, it has been made by changing the molecular structure of testosterone. Earlier I told you that testosterone has its androgenic and anabolic effects. Similarly, anabolic androgenic hormones also have these similar effects. But the difference is anabolic steroids have been optimized to have more anabolic effects overpowering the androgenic effects. Simply because people use anabolic steroids to build up more muscles in their bodies.
What are the routes of anabolic steroid administration?
Most commonly, anabolic steroid users take them by mouth. Other popular methods of administration of anabolic steroids are,
- By injections
- As pallets implanted under the skin
- Asa a skin cream or gel
What is this ‘STACKING’, ‘CYCLING’, ‘PYRAMIDING’ and ‘PLATEAUING’?
By the way, if you are an anabolic steroid user or previously have used anabolic steroids you may be familiar with those words. In fact, they are anabolic steroid administration patterns used by some people to minimize the possible side effects of anabolic steroids, rather than using them continuously.
The most popular patterns among the steroid users are stacking and cycling.
- Stacking-in this pattern, users combine two or more different steroids and mix oral and/ or injectable types, in order to maximize the effectiveness of the steroids.
- Cycling- anabolic steroid user takes multiple doses for a time period, usually 6-12 weeks, known as “on” period. Then the user stops taking the drug for a time period about 4 weeks to several months, known as the “off” period. Then he restarts taking the drug.
Other patterns of use are pyramiding and plateauing.
- Pyramiding– slowly increasing the dose of steroid use, reaching a peak amount – as in a pyramid, and then gradually lowering the dose to zero.
- Plateauing– Alternating or substituting with another steroid to tolerance development.
The impact of anabolic steroids on male infertility
Infertility is defined by WHO as the inability to conceive a child after one year of regular unprotected sex.
Let’s see how these anabolic steroids can block your path to become a fertile person.
Sperm cells are produced by Sertoli cells in the seminiferous tubules of the testis. For the production of sperms GnRH, FSH, LH and Testosterone hormones act as promotors.
Hypothalamus, a hormone-producing gland in the brain produces GnRH. GnRH is the head-hormone, whose action on pituitary promotes the production of LH and FSH hormones, LH hormone in-turn acts on the Leydig cells of the testes to produce Testosterone.
We have to focus on Testosterone, to understand the effect of anabolic steroids on male infertility. Testosterone promotes the maturation of spermatozoa. The testosterone hormone produced naturally in the body is known as endogenous testosterone. When more Endogenous testosterone is produced, it exerts a negative feedback effect on the Hypothalamus and Pituitary glands. This will decrease the secretion of GnRH, FSH and LH hormones. By lowering the LH hormone level, the body prevents the over-production of endogenous Testosterone.
The mechanism behind the use of anabolic steroids and infertility
So how do anabolic steroids cause infertility in men? lets find out.
What happens when people take high doses of anabolic steroids is that the body mistakes it for having more circulating endogenous testosterone levels. This exogenous testosterone exhibits a negative feedback action on the hypothalamus and pituitary gland and decreased the production of GnRH, FSH and LH hormones.
FSH is the hormone that stimulates the testes to produce sperms in Sertoli cells and LH is the hormone that stimulates testes to produce testosterone hormone in the Leydig cells. For normal sperm production and maturation, there should be adequate levels of intra-testicular testosterone hormone.
Because of the negative feedback effect on Hypothalamus and Pituitary by exogenous anabolic steroids GnRH, FSH and LH hormone levels are reduced. This will lead to low endogenous testosterone hormone production in the Leydig cells. Without adequate amounts of testosterone production and maturation of sperms will be impaired. Low intra-testicular testosterone leads to atrophy (wasting) of the germinal epithelium that produces sperms.
What the researchers have found?
Many researches have been conducted using animal models. Through these experiments, researchers have found anabolic steroids can cause alteration of Leydig cells, abnormalities of semen quality and abnormalities of sperms. Sperm abnormalities include,
- Oligozoospermia: Reduced sperm count
- Azoospermia: Absence of sperms
- Teratozoospermia: Abnormal sperm morphology
- Asthenozoospermia: Abnormal sperm motility
How to diagnose infertility due to anabolic steroid use
The best and easiest test to identify infertility in men is seminal fluid analysis. It provides the details about the amount, size, shape and movement of the sperms. You can get more details about seminal fluid analysis from the article Semen analysis preparation: Full Guide.
Other than seminal fluid analysis your testosterone, FSH, LH hormone levels can be checked. Also, genetic studies are also available to exclude other causes of infertility in men.
Prevention of infertility due to anabolic steroid use
The most important infertility preventive method is stopping the use of anabolic steroids.
Through several researchers, it has been found that it is possible to have spontaneous recovery of spermatogenesis after stopping anabolic steroids. But it may take some time from several months to several years. Having said this, I should also state here that there are reported cases of permanent infertility after using anabolic steroids.
Other methods to treat infertility in men with a history of anabolic steroids
- Use of Clomiphene citrate (CC) and tamoxifen- It has been found that the use of Clomiphene citrate and tamoxifen can elevate both gonadotropins (FSH, LH) and improve semen analysis parameters. It is the most commonly used drug to treat infertility.
- HCG (Human chorionic gonadotropin) – A recent study conducted on several men treated with HCG monotherapy reported that it increases the serum testosterone levels and it also improves their hypogonadal symptoms.
HCG is administrated through the subcutaneous or intramuscular route. It has a relatively short half-life and it is a very expensive treatment method. Therefore it is not very popular as primary therapy.
- Combination of HCG and SERM (Selective estrogen receptor modulators) therapy
- Cryopreservation- This method is offered for men with oligospermia.
- Recombinant FSH therapy-If pregnancy is not achieved with Clomiphene citrate, it should be discontinued. Recombinant FSH can be started after that.
- Testicular sperm retrieval with possible microdissection in conjunction with in-vitro fertilization-This is the last option for biological paternity.
Summary: How do Anabolic steroids cause infertility in men?
- Anabolic steroids have negative feedback on Hypothalamus and Pituitary glands.
- This decreases the production of GnRH, FSH and LH hormones by the Hypothalamus and Pituitary.
- Decreased levels of GnRH and LH hormones inversely affect the production of endogenous testosterone.
- Decreased FSH hormone and Testosterone secretion affect the sperm count, morphology and motility.
- These effects of anabolic steroids can lead to infertility in men.
- The effects of anabolic steroids on male fertility can be reversed by stopping the misuse.
- Other treatment options are available to aid the recovery.
