Health Consequences of Anabolic Steroids: A Sexual-Medicine Perspective

Nonmedical use of anabolic-androgenic steroids (AAS) is increasingly seen in sexual medicine, often presenting with sexual or fertility issues. AAS abuse can suppress the hypothalamo-pituitary-gonadal axis, causing hypogonadism, reduced libido, erectile dysfunction, gynecomastia, and impaired spermatogenesis. Recovery after stopping AAS varies, with hormonal balance often returning before semen quality, and prolonged/high-dose use can delay or hinder recovery. AAS use also raises cardiovascular, hepatic, hematologic, tendon, neuropsychiatric, and dermatologic risks, influenced by dose and duration. Without robust trials, management should focus on stopping AAS use, preventing relapse, and tailoring follow-up based on individual needs, with pharmacological recovery induction used selectively.