TRT (Testorone Replacement Therapy) very high in ex-steroid users

One of several maladies facing steroid users is depression resulting from the hypogonadism that follows the use of anabolic androgenic steroids.  This hypogondism sends these ex-steroid users to TRT centers at 10x the rate of men that have not used steroids.


The [VERY HIGH] Prevalence Of Prior Use Of Anabolic Androgenic Steroids In Young Hypogonadal Men  [Abstract: 1395]

 Introduction and Objectives – Testosterone replacement therapy (TRT) for hypogonadism has increased significantly in the past decade. In 2011, 1.3% of all 19-30 year olds reported prior use of anabolic androgenic steroids (AAS) (Johnson, 2012). This trend has led to a heightened sense of awareness surrounding AAS use and the potential for transient or permanent hypogonadotropic hypogonadism. The prevalence and attitudes of men with a history of prior AAS use presenting with symptomatic hypogonadism requiring TRT has never been reported.

 Methods – An anonymous, prospective, IRB-approved survey was distributed to men with symptomatic hypogonadism over a 6-month period in 2012. Basic demographic information and choice of TRT was documented as was the nature and attitudes regarding prior AAS use. Statistical analysis was performed with student’s t-test and Fisher’s exact test with p<0.05 considered significant.

 Results – A total of 138 men (mean age 45.7 ±11.7) currently receiving TRT for hypogonadism participated, and 31% (n=43; mean age 39.4 ±7.4) reported a history of prior AAS use. Among hypogonadal men ≤ 50 years old, 43.6% (n=41) used AAS in the past compared to 4.5% (n=2) in those >50 years old (p<0.001). Men with previous AAS use were 9.1 years younger on presentation than men without an AAS history (p<0.0001). The mean reported age of first AAS use was 24.6 ±6.8, and 21% started using AAS in their teens. Less than half understood the effects of AAS on natural testosterone production (49%) and fertility (47%), yet only 16% regretted using them.

 In men with an AAS history, moving forward, treatment for hypogonadism via testosterone injections was preferred by 93%, while 46% without a history of AAS use preferred injections (p<0.0001). AAS users were more likely to experiment with their prescribed dose of TRT without notifying their physician (26%) and to use additional, non-prescribed substances like growth hormone (40%). 

 Conclusions – Prior AAS use is relatively common in men seeking treatment for symptomatic hypogonadism. Although this only represents one center, the prevalence was approximately ten times higher in hypogonadal men under age 50 years than those over. This information was not known prior to treatment and highlights the need to be cautious about prescribing TRT to younger patients. Perhaps prescription of alternative medications with lower likelihood for abuse (e.g. selective estrogen receptor modulators or aromatase inhibitors) would be more prudent in younger patients with symptomatic hypogonadism.

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