Supervisors info:
Τίγκας Στυλιανός, Επίκουρος Καθηγητής, Ενδοκρινολογική Κλινική, Πανεπιστημιακό Γενικό Νοσοκομείο Ιωαννίνων
Μαστοράκος Γεώργιος, Καθηγητής, Ενδοκρινολογική Κλινική, Αρεταίειο Νοσοκομείο, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Τσατσούλης Αγαθοκλής, Καθηγητής Ενδοκρινολογίας, Ενδοκρινολογική Κλινική, Πανεπιστημιακό Γενικό Νοσοκομείο Ιωαννίνων
Summary:
Background Anabolic androgenic steroids (AAS) are testosterone derivatives used by athletes and recreational users, in order to improve athletic performance and/or enhance appearance. AAS use may have serious and potentially irreversible adverse effects on different organs and systems, including the reproductive system.
Objective This systematic review and meta-analysis aimed to critically assess the impact of AAS use on the reproductive system of athletes.
Methods An electronic literature search was conducted using the databases MEDLINE, CENTRAL and Google Scholar. Studies were included when the following criteria were fulfilled: participants were athletes or recreational users of any age, gender, level or type of sport; subjects used any type, dose, form or duration of AAS; AAS effects on the reproductive system of athletes, were assessed as stated by medical history, clinical examination, hormone and/or semen analysis. Random-effects meta-analysis was performed to assess the weighted mean difference of serum gonadotropin (LH, FSH) and testosterone levels compared to baseline, during the period of AAS use, as well as following AAS discontinuation.
Results Thirty-three studies (3 randomized clinical trials, 11 cohort, 18 cross-sectional and 1 non-randomized parallel clinical trial) were included in the systematic review (3,879 participants; 1,766 AAS users and 2,113 non-AAS users).The majority of the participants were men; only 6 studies provided data for female athletes. A meta-analysis (11 studies) was conducted, of studies evaluating serum gonadotropin and testosterone levels in male subjects: (1) prior to, and during AAS use (6 studies, n=65 AAS users; 7 studies, n=59, evaluating gonadotropin and testosterone levels respectively), (2) during AAS use and following AAS discontinuation (4 studies, n=35; 6 studies, n=39, respectively), as well as (3) prior to AAS use and following AAS discontinuation (3 studies, n=17; 5 studies, n=27, respectively). During AAS intake, significant reductions in LH (WMD: -3.37 IU/l, 95%CI: -5.05 to -1.70, p <0.001), FSH (WMD: -1.73 IU/l, 95%CI: -2.67 to -0.79, p <0.001) and endogenous testosterone levels (WMD: -10.75 nmol/L, 95% CI: -15.01 to -6.49, p<0.001) were reported. Following AAS discontinuation, serum gonadotropin levels gradually returned to baseline values within 13-24 weeks, whereas serum testosterone levels remained lower as compared to baseline (WMD: -9.40 nmol/L, 95% CI: -14.38 to -4.42, p<0.001). Serum testosterone remains reduced up to 16 weeks following discontinuation of AAS. In addition, AAS abuse resulted in structural and functional sperm changes, reduction of testicular volume, gynecomastia, as well as clitoromegaly, menstrual irregularities and subfertility.
Conclusion The majority of AAS users demonstrated hypogonadism with persistently low gonadotropin and testosterone levels, lasting for several weeks to months after AAS withdrawal. AAS use results in profound and prolonged effects on the reproductive system of athletes and potentially on fertility.
