The effect of anabolic androgenic steroid abuse on male fertility: Review Study

Young people's interest in strength exercises has led to the high use of anabolic steroids (AAS) regardless of its long-term side effects. Therefore, this review study was conducted with aim to investigate the effect of AAS drugs on male fertility.

In line with the aim of the present review study, search was performed in the databases of Scopus, Pubmed, Proquest, Science Direct, ISC, Irandoc, Magiran and Google Scholar with the keywords of energy drugs, male fertility, spermatogenesis, androgenic anabolic steroid drugs and AAS without time restrictions. Among a total of 8453 articles extracted, after reviewing the title, abstract and inclusion and exclusion criteria, finally 33 articles were reviewed.

AAS drugs have long-term effects on the male reproductive system and disrupt spermatogenesis through four primary mechanisms including direct effects on gametes, hypothalamic axis change, pituitary and testis, erectile dysfunction or ejaculation, and decreased libido. It also reduces testosterone production and suppresses spermatogenesis by inhibiting negative feedback at LH and FSH levels. Most side effects are reversible after discontinuation, but long-term use during the reproductive ages and testicular developmental stages disrupts semen analysis and sperm function parameters, and there is no possibility of responding to alternative therapy. Not enough information has been reported about the time required to return male fertility after drug discontinuation.

Excessive use of AAS drugs has long-term adverse effects on male reproductive health, so, existence of various and unknown items of drugs in the market, advertising in clubs and cyberspace and high consumption of drugs regardless of its side effects, require management measures to solve this global health problem and maintain male reproductive health. Therefore, education is recommended to the community, athletes, coaches and health care providers.