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Hypogonadism in men results from the failure of the testes to produce physiological levels of testosterone and a normal number of spermatozoa due to a disruption of the hypothalamic-pituitary-testicular axis. An example of secondary hypogonadism as a result of anabolic steroid abuse is presented with the case report of a man who committed suicide a...
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Background
Testicular ultrasound (US) is routinely employed in the evaluation of reproductive and sexual function. However, its use for characteristics other than testicular volume is hampered by a lack of information on the prognostic value of its findings, which to date have only been incorporated in a score proposed by Lenz et al. in 1993.
Obje...
Objective:
Growth hormone (GH) activity might be implicated in male reproductive function. One previous study has suggested significantly reduced semen quality in untreated acromegalic patients due to both reduced sperm counts and sperm motility.
Design and methods:
A retrospective study comprising ten uncontrolled hypogonadal acromegalic patien...
Citations
... The estimated annual rate is nine deaths per 100,000 population, representing 1.3% of all deaths worldwide. In the context of sports, research on suicide has addressed this topic from various areas of knowledge, focusing on psychopathological aspects (Hussain et al., 2022), physical traumas (Azad et al., 2016;Burke, 2012;Omalu et al., 2010), and its association with the use of anabolic substances (Alibegović, 2018;Hussain et al., 2022). However, there is a lack of research that focuses on mental health care, overlooking the specificities of the phenomenon in athletes, considering biopsychosocial aspects. ...
Resumen. El suicidio o sus intentos son un grave problema que han atraído la atención de distintas áreas del conocimiento vinculados al ámbito deportivo. Pero en la mayoría de las ocasiones los análisis son desde visiones psicopatológicas o en función de traumas físicos, sin comprender las particularidades de la salud mental. El artículo presenta una meta-etnografía donde se ha realizado una revisión de la literatura sobre investigaciones cualitativas del suicidio en deportistas desde 2012 hasta el 2022. Se obtuvieron ocho artículos que abordaban el tema desde diferentes deportes y niveles. Los temas que se abordan en los trabajos son diversos: la importancia de las relaciones saludables, la visibilidad de los problemas de salud mental, la normalización de la violencia por parte de entrenadores y la falta de apoyo emocional. Es fundamental que los/as deportistas cuenten con una red de apoyo (dentro de la cual se encuentren entre-nadores/as, profesionales de la salud mental, etc.). Las cuestiones que han afectado a los/as deportistas identificados con ideación suicida incluyen la combinación prolongada de síntomas de conmoción cerebral, problemas académicos, prácticas violentas de entre-namiento normalizadas, elevadas exigencias, invisibilización del sufrimiento y la exposición a eventos traumáticos. Se requiere capaci-tación de profesores/entrenadores en salud mental, apoyo social durante la recuperación de lesiones, formación continua en salud mental, relaciones cercanas entre entrenadores/as y deportistas, implicación de especialistas en psiquiatría/psicología deportiva, apoyo del entorno y equilibrio entre rendimiento y desarrollo personal. Palabras clave: Abstract. Suicide or its attempts are a serious problem that has drawn the attention of different areas of knowledge related to the field of sports. However, in most cases, the analyses are based on psychopathological visions or physical trauma without understanding the particularities of mental health. The article presents a meta-ethnography review of the literature on qualitative research on suicide in athletes from 2012 to 2022. The topics addressed in the studies are diverse: the importance of healthy relationships, the visibility of mental health problems, the normalization of violence by coaches, and the lack of emotional support. It is essential for athletes to have a support network (including coaches, mental health professionals, etc.). The issues that have affected athletes identified with suicidal ideation include a prolonged combination of concussion symptoms, academic problems, normalized violent training practices, high demands, the invisibility of suffering, and exposure to traumatic events. It required training of teachers/coaches in mental health, social support during injury recovery, ongoing mental health education, close relationships between coaches and athletes, involvement of sports psychiatry/psychology specialists, support from the environment, and balance between performance and personal development. Resumo. O suicídio ou suas tentativas são um grave problema que têm atraído a atenção de várias áreas do conhecimento relacionadas ao campo esportivo. No entanto, na maioria das vezes, as análises são feitas a partir de visões psicopatológicas ou em função de traumas físicos, sem compreender as particularidades da saúde mental. O artigo apresenta uma meta-etnografia onde foi realizada uma revisão da literatura sobre pesquisas qualitativas sobre suicídio em atletas de 2012 a 2022. Foram encontrados oito artigos que abordavam o tema em diferentes esportes e níveis. Os temas tratados nos trabalhos são diversos: a importância de relacionamentos saudáveis, a visibilidade dos problemas de saúde mental, a normalização da violência por parte dos treinadores e a falta de apoio emocional. É fundamental que os/as atletas tenham uma rede de apoio (incluindo treinadores/as, profissionais de saúde mental etc.). As questões que afetaram os/as atletas identificados/as com ideação suicida incluem a combinação prolongada de sintomas de concussão cerebral, problemas acadêmicos, práticas violentas de treinamento normalizadas, exigências elevadas, invisibilidade do sofrimento e exposição a eventos traumáticos. É necessário capacitar professores/treinadores em saúde mental, promover apoio social durante a recuperação de lesões, oferecer formação contínua em saúde mental, desenvolver relações estreitas entre treinadores/as e atletas, envolver especialistas em psiquiatria/psicologia esportiva, ter apoio do ambiente e buscar equilíbrio entre desempenho e desenvolvimento pessoal.
... The estimated annual rate is nine deaths per 100,000 population, representing 1.3% of all deaths worldwide. In the context of sports, research on suicide has addressed this topic from various areas of knowledge, focusing on psychopathological aspects (Hussain et al., 2022), physical traumas (Azad et al., 2016;Burke, 2012;Omalu et al., 2010), and its association with the use of anabolic substances (Alibegović, 2018;Hussain et al., 2022). However, there is a lack of research that focuses on mental health care, overlooking the specificities of the phenomenon in athletes, considering biopsychosocial aspects. ...
Suicide or its attempts are a serious problem that has drawn the attention of different areas of knowledge related to the field of sports. However, in most cases, the analyses are based on psychopathological visions or physical trauma without understanding the particularities of mental health. The article presents a meta-ethnography review of the literature on qualitative research on suicide in athletes from 2012 to 2022. The topics addressed in the studies are diverse: the importance of healthy relationships, the visibility of mental health problems, the normalization of violence by coaches, and the lack of emotional support. It is essential for athletes to have a support network (including coaches, mental health professionals, etc.). The issues that have affected athletes identified with suicidal ideation include a prolonged combination of concussion symptoms, academic problems, normalized violent training practices, high demands, the invisibility of suffering, and exposure to traumatic events. It required training of teachers/coaches in mental health, social support during injury recovery, ongoing mental health education, close relationships between coaches and athletes, involvement of sports psychiatry/psychology specialists, support from the environment, and balance between performance and personal development. Keywords: Mental health; Sport; Suicide; Social Sport Psychology; Sociology of Sport.
... There were 12 cohort studies, [14][15][16][17][18][19][20][21][22][23][24][25] 5 casecontrol studies, [26][27][28][29][30] 9 cross-sectional surveys [31][32][33][34][35][36][37][38][39] and 6 case reports. [40][41][42][43][44][45] The total study population comprised 9371 participants including 2671 AAS users at various stages of AAS use and the remaining AAS naïve control population. Table 2 also shows a detailed description of all the drugs used by the study population and the duration of use. ...
... At 1 year of stopping AAS, the LH values were statistically insignificant in AAS users and the naïve population (SMD −0.65, 95% CI-1.52, 0.22, P = 0.14). [14] UAE Cohort, descriptive 520 520 0 Alibegović, 2018 [40] Slovenia Case report 1 1 0 Al-Janabi et al., 2011 [15] Iraq Cohort study, observational 24 16 8 Armstrong et al., 2018 [31] Online Cross-sectional online survey, descriptive cohort 231 213 0 Avant et al., 2018 [32] Online Cross-sectional online survey, descriptive cohort 97 97 0 Bonetti et al., 2008 [16] Italy Cohort, descriptive, prospective, observational 22 20 0 Boregowda et al., 2011 [41] UK Case report 1 1 0 Coward et al., 2013 [33] USA Cross-sectional survey 382 80 Coxon, 2016 [42] UK Case report 1 1 0 Flanagan and Lehtihet, 2015 [17] Prior AAS use is common in young men with hypogonadism Coxon, 2016 [42] AAS user with infertility There was substantial heterogeneity in all these data [ Figure 3]. ...
... Over 2 years, there was a significant reduction in testis size as compared to baseline values (SMD 0.71, 95% CI 0.16, 1.26, P = 0.01), with considerable heterogeneity [ Figure 6]. Alibegović [40] reported a case of AAS user who committed suicide due to aggressive behaviour and physical abuse of his wife. He had signs of secondary hypogonadism with bilateral shrunken testes and absent spermatogenesis, parenchymal sclerosis and very few Leydig cells. ...
Background
Anabolic-androgenic steroids (AASs) are often used by men for bodybuilding and to improve sports performance. The use is not limited to professional competitive athletes, but many amateur men.
Objective
The objective of this study was to assess and systematically review the effects of AAS on male fertility parameters, spermiogram, testosterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH) and to review reversibility and other morbidity impacting fertility.
Methods
Eligibility criteria - We included studies mentioning data about adult males using supraphysiologic doses of AAS for sports performance or appearance enhancement, with comparison data from general population or matched controls if available reporting fertility parameters and sexual performance. Information sources - A systematic literature search was performed using PubMed, MEDLINE, EMBASE, Google Scholar and World of Science. Controlled clinical trials randomised or nonrandomised (if available), case series with or without matched controls, case reports, cross-sectional surveys, reports on follow-up of subjects caught in doping test and their fertility parameters when reported. Risk of bias/quality assessment - The quality assessment of the included studies was performed using the Newcastle–Ottawa Scale.
Results
Included studies - Thirty-two studies were included. There were 12 cohort studies, 5 case–control studies, 9 cross-sectional surveys and 6 case reports. The study population comprised 9371 individuals, of which 2671 were AAS users. Synthesis of results - AAS users had reduced levels of FSH and LH than the naïve population. These levels remained low for 3–6 months after stopping AAS. One year after stopping AAS, the users and naïve population had insignificant differences in FSH and LH values. The total testosterone (TT) levels were comparable in users and naïve populations at baseline, 3 months and 6 months after stopping, but at 1 year, TT values were lower in AAS users. Sperm concentration in AAS users and naïve population was similar, but sperm motility was lower in AAS users. The testicular size was lower in AAS users. The erectile function improved with AAS use, but on withdrawal, there was decreased libido and erectile dysfunction. Most AAS users need additional medications to mitigate detrimental effects on fertility. Description of the effect - AAS use negatively impacted the gonadotrophin levels and had lower sperm motility and testicular size. Strength - Comprehensive review of 32 publications, study population of 9371 individuals, of which 2671 were AAS users, meta-analysis of reproductive hormones, semen parameters and testis size.
Limitations
The limitations are small sample size of most of the studies, polypharmacy, lack of information on dosing and high heterogeneity.
Interpretation
AAS use is detrimental for sperm motility and has a partially reversible negative impact on male fertility. Users must be cautioned about its negative impact on libido and erectile function.
Registration: PROSPERO Registration No. CRD42023411294.
... A 28 yr old bodybuilder taking four different AAS products in conjunction with other substances and a high protein diet presented with severe jaundice and enlarged kidneys (Alkhunaizi et al., 2016), and a 29 yr old professional bodybuilder required a liver transplant after 6 years of selfadministering multiple oral and injectable steroids, diuretics, insulin, estrogen receptor blockers, and growth hormone caused hepatomegaly, hepatocellular carcinoma, and fatty liver disease (Solbach et al., 2015). It was noted that this patient, and others (Alibegovic, 2018) had significant steroid induced hypogonadism. In addition to hepatic and renal effects, AAS abuse has significant impact on cardiovascular function. ...
A common justification for anti-doping policy is that performance-enhancing drugs (PEDs) are harmful to the health of the athlete. Training for elite performance is not a healthy activity. Sudden cardiac death is a leading cause of death in young athletes, but is not connected to banned PED use. Despite the negative impact of training for elite performance on the overall health of elite athletes, these negative health effects are reversible. There is
evidence that the pattern of banned substance use in elite athletes is high, yet morbidity and mortality of elite athletes is not greater than the general population, and former elite athletes live longer and healthier lives than age-matched controls. There is evidence that misuse of PEDs, often obtained from the black market, without medical guidance or intervention contributes to morbidity and mortality in recreational athletes, but this pattern is
not evident in elite athletes. This paper proposes that the health justification for anti-doping policy is not supported by the available evidence.
... Health harms diagnosed by a medical professional were reported in twenty-two records (Ahlgrim & Guglin, 2009;Ahmed et al., 2019;Alibegovi c, 2018;Baggish et al., 2017;Boregowda et al., 2011;Cabb et al., 2016;Colburn et al., 2017;Ding et al., 2013;Farzam, 2021;Fisler et al., 2018;Flo et al., 2018;Gangadharamurthy et al., 2018;Ilhan et al., 2010;Long et al., 2019;Lovelock et al., 2021;Patil et al., 2007;Ravindran et al., 2020;Rosenfeld et al., 2011;Rothman et al., 2011;Shinya et al., 2013;Tashiro et al., 2021). ...
In the past, research, policy and media have reported the use of anabolic androgenic steroids (AAS) primarily among younger males. However, recent studies have indicated the presence of an older cohort of men who use AAS in comparison to previous years. We carried out a scoping review of the extant literature to map and describe what is known about the use of AAS by older men (>40 years). A systematic search collected and analysed empirical research and grey literature relevant to the research question. Following application of inclusion and exclusion criteria, 44 studies were included which were subsequently charted and thematically analysed. The records included originated from the UK, USA, Canada, Australia, Slovenia, Norway, Spain, Turkey, Switzerland, Japan, and five global studies and were published between 1996 and 2021. Age ranged overall from 14 to 78 years old, however our review only discussed findings pertaining to those older than 40. Three main themes with subthemes were generated as follows: 1) Characteristics of AAS Use; Self-reported Adverse Effects from AAS Use; and Harms Diagnosed by Medical Professional. The review highlights the significant risks to hypothalamic-pituitary testicular function, cardiovascular health, and other organ systems as a result of the ageing man who is motivated to sustain masculine characteristics such as muscularity, youthfulness, sexual function, and perceived desirability and attractiveness. Future research is required to further understand the motivations of older men who use AAS. Furthermore, there is a need for age-specific research and recommendations to inform future policy and practice pertaining so that age-appropriate healthcare and policy decisions can be made in the future.
... Long-term use of anabolic drugs in high doses can cause serious side effects, such as prostate enlargement (Saddick, 2021) and testicular atrophy (Alibegović, 2018;Bueno et al., 2017;Krause Neto et al., 2018). The prostate is an organ of the male reproductive system, and its primary function is the production of seminal fluid. ...
To investigate the effects of the previous administration of testosterone propionate (TP) on the morphology of the gastrocnemius muscle of Wistar rats submitted to ladder-based resistance training (LRT). Twenty-eight rats were divided equally into groups: initial control (CI), 4-week TP (CT4), 4-week TP + LRT (TRT), and placebo + LRT (RT). The rats from the CT4 and TRT groups were treated with TP for four weeks (10 mg/kg/week). TRT and RT trained for ten weeks. The rodents were euthanized at the end of the experiment, and gastrocnemius muscle, prostate, and left and right testicles were collected. There was no statistical difference between the RT and TRT for final volume load. The prostate mass of the TRT and RT groups was statistically heavier than the CT4 group (P < 0.01). The TRT group's prostate/body mass ratio was statistically different from the CT4 group (P < 0.05). The TRT group was shown to have larger type I, type II, and mean fCSA fibers than all other groups (P < 0.001). Regarding the nuclei/fiber ratio (N/f), the CT4, RT, and TRT groups had higher values than CI (P < 0.01). In addition, the RT group showed a higher N/f ratio than CT4 (P < 0.001) but lower than TRT (P < 0.001). In conclusion, short-term TP administration before resistance training can elicit a greater N/f ratio and size of the mean fCSA of the Gastrocnemius muscle of young adult Wistar rats than resistance training alone.
The anabolic-androgenic steroids (AAS) are clinically used as an androgen replacement, in hypogonadism treatment, to induce puberty, and also in the treatment of chronic degenerative diseases. The AAS use out of clinical context is becoming massively, being used merely for aesthetic reasons. AAS abuse may cause severe disarrangement on the HPG axis and generate a significant decrease in testosterone synthesis and secretion by the testes. This review aims to evaluate whether the hypogonadism induced by AAS abuse is reversible and under what circumstances the reversibility is possible. For this, PRISMA guidelines and several databases are used between July and September 2020. Altogether, this systematic review identified and analysed 179 cases of AAS users. Of these, 168 cases had the hypogonadism clearly diagnosed and proven to be linked exclusively to AAS abuse. However, between these 168 cases, only 38 cases presented fully known outcomes and among these, merely in 4, the hypogonadism was completely reversible (2 based on drug therapy) with HPG axis recovery. In conclusion, this review presents evidences that AAS-induced hypogonadism is a seriously underestimated problem, and in the majority of cases, full recovery is very difficult to succeed.
