Androgen-Induced Secondary Hypogonadism and Associated Erectile Dysfunction in Recreational Weightlifters: A Narrative Review

Alesia Kravets; Lizaveta Zhukava; Kateryna Bessmylna; Agata Chrobak; Abdulrahman Alansi; Kai-Chiun Weng; Joanna Katarzyna Żukowska; Darya Volkava; Volha Sakovich; Ewa Kacynel; Wiktoria Myślicka

doi:10.12775/QS.2026.56.72517

Authors

Alesia Kravets Medical University of Warsaw https://orcid.org/0009-0003-2532-4458
Lizaveta Zhukava Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0007-8328-2232
Kateryna Bessmylna Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0009-9220-9162
Agata Chrobak Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0004-3370-5290
Abdulrahman Alansi Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0000-0001-6544-2916
Kai-Chiun Weng Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0006-5519-537X
Joanna Katarzyna Żukowska Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0003-8597-5447
Darya Volkava Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0009-2811-146X
Volha Sakovich Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0009-1768-1512
Ewa Kacynel Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0002-8290-9818
Wiktoria Myślicka Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0005-5209-6504

DOI:

https://doi.org/10.12775/QS.2026.56.72517

Keywords

anabolic androgenic steroid, secondary hypogonadism, erectile dysfunction, bodybuilding, ASIH

Abstract

Background. Anabolic-androgenic steroid (AAS) abuse is extremely common among amateur athletes and bodybuilders seeking to improve their physical appearance and performance. Chronic use of these substances in supraphysiological doses leads to severe suppression of the hypothalamic-pituitary-testicular (HPT) axis, resulting in anabolic steroid-induced hypogonadism (ASIH).

Aim. This work aims to summarize the current knowledge and available scientific evidence regarding the effects of AAS abuse on the male reproductive system, with particular emphasis on the mechanisms of secondary hypogonadism and erectile dysfunction in amateur bodybuilders.

Material and Methods. A comprehensive review of the medical literature was conducted, including available clinical trials, observational studies, meta-analyses, and case reports of men using or abusing AAS. The analysis assessed hormonal parameters (FSH, LH, total testosterone), semen parameters, sexual function, and the patterns and time to reversal of these changes after steroid discontinuation.

Results. Chronic AAS abuse profoundly suppresses the secretion of endogenous gonadotropins (LH and FSH), leading to a drastic decrease in intratesticular testosterone and secondary hypogonadism. Men often report sexual dysfunction, particularly during the withdrawal period (so-called "post-cycle"), with erectile dysfunction and decreased sexual desire observed in between 10% and over 30% of them.

Conclusions. Secondary hypogonadism and erectile dysfunction are significant yet underestimated consequences of AAS abuse in amateur bodybuilding. Although hormonal parameters and sexual function return to normal in most patients after discontinuing doping, this process can be lengthy and often requires individualized medical intervention, such as the use of human chorionic gonadotropin (hCG) or selective estrogen receptor modulators (SERMs), to accelerate recovery of the HPG axis.

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Androgen-Induced Secondary Hypogonadism and Associated Erectile Dysfunction in Recreational Weightlifters: A Narrative Review

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