Men who illicitly used anabolic-androgenic steroids to bulk up and then turned to illegal, web-based regimens for treating their steroid withdrawal complications have provided important clues for new approaches to treating a growing worldwide population of men who abuse steroids.
A retrospective, observational study at one steroid addiction center in Glasgow, Scotland, UK, examined 641 men who had stopped using steroids within the prior 3 years in 2015-2022 and who had self-administered certain agents, collectively known as post-cycle therapy (PCT) — within 3 months of stopping steroids.
They had a significant 3.8-fold increased rate of normalization of their levels of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) compared with men who either never used PCT or began it more than 3 months after stopping steroids, Channa N. Jayasena, PhD, MRCP, FRCPath, reported at ENDO 2023, The Endocrine Society Annual Meeting.
These testosterone, LH, and FSH levels served as a “surrogate marker of biochemical recovery from hypogonadism,” he explained. Normalization also occurred “slightly sooner” in men who began using PCT early after steroid cessation, added Jayasena, a reproductive endocrinologist at Imperial College, London, UK.
When men recovered their endogenous testosterone-producing capacity, it occurred after an average of about 13 weeks on PCT and after an average of about 19 weeks without PCT, a significant difference.
“There is a vacuum of medical advice on what to do” when men stop taking steroids, said Jayasena during a press briefing at the meeting. “We can’t recommend anything yet because [our studies] have not proven causality” between the post-cycle therapy that many men start after stopping steroids and any symptom improvement they experience.”
The next step is to test the PCT agents in a prospective, controlled study, an investigation Jayasena and colleagues are eager to launch. The goal is to determine whether PCT is truly effective, the optimal doses, and whether the treatments are safe.
“Incredibly Sophisticated“ Online Community
The agents that constitute PCT include human chorionic gonadotropin (hCG; the “pregnancy hormone”), selective estrogen receptor modulators (SERMs), and aromatase inhibitors (AIs). SERMs and AIs are licensed only for use in women, the former for osteoporosis and breast cancer and the latter for breast cancer.
All of these agents, as well as others, are advertised by various illegal websites as treatments that can restore endogenous testosterone production in men whose native testosterone shut down during their steroid self-medication.
Restored testosterone resolves many of the adverse effects of steroid withdrawal such as diminished libido and erections, and depressed mood and energy.
Men buy PCT agents illegally from various websites. “There is an enormous, incredibly sophisticated community online that influences” PCT, and an “incredibly refined worldwide distribution network,” Jayasena explained.
His study included 410 men who turned to PCT after steroid cessation and 170 who did not.
Largest Study of Hormone Recovery When Men Stop Taking Steroids
In a further multivariate analysis of the observational data, men who had used four or more different steroid treatments fared worse — with a significant 75% reduced rate of testosterone normalization with PCT — compared with men who had used a single steroid agent.
And men who had been on a steroid regimen for more than 6 months also fared badly — with a significant 66% reduced rate of testosterone normalization with PCT compared with men on a steroid regimen for 3 months or less.
“This is the largest study of hormone recovery when men stop taking steroids,” Jayasena noted.
And the data “require corroboration within an interventional study to determine causality.”
“We need further studies to help doctors and other healthcare professionals advise men about the risks of anabolic steroid use and support those who are motivated to stop,” Jayasena said.
He cautioned that the study has several limitations: biases were potentially introduced based on recruitment and on recall by participants; clinicians drew blood specimens used to measure hormone levels at random times; and participants may have engaged in concealed drug use and used steroid and PCT agents that did not contain the substances advertised.
Nevertheless, “Our data provide primary evidence that self-administered PCT drugs may be associated with improved biochemical recovery” from steroid-induced hypogonadism, [and they] “may have important therapeutic implications for the future treatment of men who are motivated to stop” steroids.
The study received no commercial funding. Jayasena has received research funding from Logixx Pharma.
ENDO 2023. Abstract OR25-05. Presented June 15, 2023.
Mitchel L. Zoler is a reporter for Medscape and MDedge based in the Philadelphia area. @mitchelzoler
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