Factors predicting normalisation of reproductive hormones after cessation of anabolic-androgenic steroids in men: a single centre retrospective study

Grant, Bonnie, Campbell, John, Pradeep, Anjali, Burns, Angela, Bassett, Paul, Abbara, Ali, Saket, Priyadarshi, Minhas, Sukhbinder, Dhillo, Waljit, McVeigh, James ORCID: https://orcid.org/0000-0001-5319-6885, Bhasin, Shalender and Jayasena, Channa (2023) Factors predicting normalisation of reproductive hormones after cessation of anabolic-androgenic steroids in men: a single centre retrospective study. European Journal of Endocrinology, 189 (6). pp. 601-610. ISSN 0804-4643

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Abstract

Objective: Symptomatic hypogonadism discourages men from stopping anabolic-androgenic steroids (AAS). Some men illicitly take drugs temporarily stimulating endogenous testosterone following AAS cessation (post-cycle therapy; PCT) to lessen hypogonadal symptoms. We investigated whether prior PCT use was associated with normalisation of reproductive hormones following AAS cessation. Methods: Retrospective analysis of 641 men attending a clinic between 2015-2022 for a single, non-fasting, random blood test <36 months following AAS cessation, with or without PCT. Normalised reproductive hormones (i.e., combination of reference range serum luteinising hormone, follicle-stimulating hormone, and total testosterone levels) was the surrogate marker of biochemical recovery. Results: Normalisation of reproductive hormones was achieved in 48.2% of men. PCT use was associated with faster biochemical recovery (13.0 (IQR8.0 – 19.0) weeks, PCT; 26.0 (IQR10.5 – 52) weeks, no-PCT; P<0.001). Odds of biochemical recovery during multivariable analysis were: (1) higher with PCT (OR3.80) versus no-PCT (P=0.001), in men stopping AAS ≤3 months previously; (2) reduced when two (OR0.55), three (OR0.46) or four (OR0.25) AAS were administered versus one drug (P=0.009); (3) lower with AAS >6 versus ≤3 months previously (OR0.34, P=0.01); (4) higher with last reported AAS >3 months (OR 5.68) versus ≤3 months (P=0.001). PCT use was not associated with biochemical recovery in men stopping AAS >3 months previously. Conclusion: Without evidence-based withdrawal protocols, men commonly try avoiding post-AAS hypogonadism with PCT, which is illicit, ill-defined, and not recommended. Only half of men had complete biochemical testicular recovery after stopping AAS. The surprising association of self-reported PCT use with short-term biochemical recovery from AAS-induced hypogonadism warrants further investigation.