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Five of the former users were currently receiving treatment with physiological testosterone replacement, leaving 19 untreated users for the numerical comparisons below.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The Structured Clinical Interview for DSM\u2010IV, questions regarding history of AAS use, physical examination, serum hormone determinations and the International Index of Erectile Function (IIEF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Compared with the 36 non\u2010AAS\u2010using weightlifters, the 19 untreated former AAS users displayed significantly smaller testicular volumes [estimated difference, 95% confidence interval (CI)\u2009=\u20092.3 (0.1, 4.5) ml;<jats:italic>P<\/jats:italic>\u2009=\u20090.042] and lower serum testosterone levels [estimated difference: 95% CI\u2009=\u2009131 (25, 227) dl;<jats:italic>P<\/jats:italic>\u2009=\u20090.009], with five users showing testosterone levels below 200\u2009ng\/dl despite abstinence from AAS for 3\u201326 months. Untreated former users also displayed significantly lower scores on the IIEF sexual desire subscale [estimated difference: 95% CI\u2009=\u20092.4 (1.3, 3.4) points on a 10\u2010point scale;<jats:italic>P<\/jats:italic>&lt; 0.001]. In the overall group of 24 treated plus untreated former users, seven (29%) had experienced major depressive episodes during AAS withdrawal; four of these had not experienced major depressive episodes at any other time. Two men (8%) had failed to regain normal libidinal or erectile function despite adequate replacement testosterone treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among long\u2010term anabolic\u2013androgenic steroid misusers, anabolic\u2013androgenic steroid\u2010withdrawal hypogonadism appears to be common, frequently prolonged and associated with substantial morbidity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.12850","type":"journal-article","created":{"date-parts":[[2015,1,19]],"date-time":"2015-01-19T13:28:24Z","timestamp":1421674104000},"page":"823-831","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":121,"title":["Prolonged hypogonadism in males following withdrawal from anabolic\u2013androgenic steroids: an under\u2010recognized problem"],"prefix":"10.1111","volume":"110","author":[{"given":"Gen","family":"Kanayama","sequence":"first","affiliation":[{"name":"Biological Psychiatry 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