The use of testosterone therapy among young men has also dramatically risen during the last decade. Reproductive endocrinologists are seeing increasing numbers of men who are infertile due to anabolic steroid use.

“The diagnosis of secondary hypogonadism is being missed and treated as primary hypogonadism,” said Dr Turek. “While spontaneous recovery of spermatogenesis may occur following the use of anabolic steroids, studies have shown that treatments, which include SERMs, human chorionic gonadotropin, and aromatase inhibitors, may speed that recovery.”

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In 2014, the Endocrine Society issued a scientific statement on the use of anabolic steroids and adverse health outcomes to highlight what it sees as an education gap.5 The society stated that media attention has been mostly focused on the high prevalence of performance-enhancing drug use by elite athletes and not on the overall health risks. Subsequently, there appears to be a widespread misperception that performance-enhancing drug use is safe and that adverse effects are manageable.

“There is indeed an increase in anabolic steroid use, and because exogenous testosterone suppresses the hypothalamic‐pituitary-testicular axis (HPT), this results in drug-induced HH. That is a different entity than pathologic HH,” said Rebecca Sokol, MD, MPH, professor of medicine and obstetrics and gynecology at the Keck School of Medicine at the University of Southern California in Los Angeles.

“Another cause of drug-induced HH is the increasing use of heroin, naltrexone, and codeine and codeine-like derivatives. Opiates suppress the hypothalamic-pituitary system, dramatically dropping testosterone levels.”

Peter Kolettis, MD, professor of urology at the University of Alabama at Birmingham, said the rise in HH due to steroid and testosterone use is a growing problem.

According to Dr Kolettis, studies have shown that replacement testosterone has a strong negative effect on sperm production, and anabolic steroids can harm male fertility in a similar manner.

“More research could be helpful to better understand this problem. It is important to educate men and care providers about the risks these drugs pose to fertility. It is important for men of reproductive age to know that there are risks to their fertility if they use steroids or testosterone,” Dr Kolettis told Endocrinology Advisor.

Kenan Omurtag, MD, assistant professor of reproductive endocrinology and infertility at Washington University School of Medicine in Saint Louis, Missouri, said endocrinologists need to speak out on this issue. Not only do endocrinologists need to educate their patients, but they should also discuss the effects of what many may view as harmless supplementation.

“You can listen to any sports radio ads and they are just inundating men about testosterone replacement therapy,” Dr Omurtag told Endocrinology Advisor. “They are targeting 30- to 40-year-old men, and many of these men are trying to have a child or a second or third child. There is a misconception that it does not affect their sperm count and some mistakenly think it improves their sperm count.”


  1. Moskovic DJ, Katz DJ, Akhavan A, Park K, Mulhall JP. Clomiphene citrate is safe and effective for long-term management of hypogonadism. BJU Int. 2012;110(10):1524-1528.
  2. Lawall C, Ezeh U, Turek P. How semen quality changes in hypogonadal men on clomiphene citrate. Fertil Steril. 2004;82(Suppl 2):S21.
  3. CANCELLED: November 3, 2015: Meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee Meeting Announcement. U.S. Food and Drug Administration website., 2015. Accessed January 14, 2016.
  4. Repros Therapeutics Announces Cancellation of FDA Advisory Committee Meeting to Review Enclomiphene for the Treatment of Secondary Hypogonadism [press release]. The Woodlands, Texas: Repros Therapeutics Inc; October 29, 2015. Accessed January 14, 2016.
  5. Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Endocr Rev. 2014;35(3):341-375.