{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:19:26Z","timestamp":1792498766423,"version":"4.5.0"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T00:00:00Z","timestamp":1713744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Toxicol."],"abstract":"<jats:p>The evolving prevalence of anabolic androgenic steroids (AAS) abuse among nonathletes is alarming because of the known harm to an individual\u2019s health. Among the adverse effects of AAS abuse, male infertility and sexual dysfunction have been often reported in the literature, but little is known regarding its actual prevalence, possible underpinning mechanisms, and potential treatments either during or post-AAS usage. Thus, the current narrative review summarizes the state-of-art regarding the effects of AAS on male fertility and sexual function. Evidence was gathered from the latest reviews and recent original studies, specifically from prospective cohorts and clinical trials, ultimately resulting in five main topics of discussion. First, AAS usage is briefly characterized by its historical background, main physiological mechanisms, and the most frequently used AAS substances. Second, data on the prevalence of AAS-induced male infertility and sexual dysfunction are described. Third, some new insights on possible underpinning mechanisms of AAS-induced male infertility and sexual dysfunction are thoroughly discussed, with particular attention to histological data derived from animal models and the latest insights from prospective cohorts in humans. Fourth, the potential treatments during and after the AAS usage are presented, highlighting the odds of resolving male infertility and sexual dysfunction. Fifth, future directions on this topic are discussed, focusing on the methodological robustness of scientific studies.<\/jats:p>","DOI":"10.3389\/ftox.2024.1379272","type":"journal-article","created":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T04:30:10Z","timestamp":1713760210000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Abusive use of anabolic androgenic steroids, male sexual dysfunction and infertility: an updated review"],"prefix":"10.3389","volume":"6","author":[{"given":"Rafael\u00a0de Almeida","family":"Azevedo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Gualano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Afonso","family":"Teixeira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno C. G.","family":"Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Hallak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.3109\/10826084.2014.903750","article-title":"Prevalence of the use of anabolic-androgenic steroids in Brazil: a systematic review","volume":"49","author":"Abrahin","year":"2014","journal-title":"Subst. Use Misuse"},{"key":"B2","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12958-015-0032-1","article-title":"A unique view on male infertility around the globe","volume":"13","author":"Agarwal","year":"2015","journal-title":"Reproductive Biol. Endocrinol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e14576","DOI":"10.1111\/and.14576","article-title":"The deleterious effects of anabolic androgenic steroid abuse on sexual and reproductive health and comparison of recovery between treated and untreated patients: single\u2010center prospective randomized study","volume":"54","author":"Al Hashimi","year":"2022","journal-title":"Andrologia"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2490","DOI":"10.1210\/jc.2018-01882","article-title":"Diagnosis and management of anabolic androgenic steroid use","volume":"104","author":"Anawalt","year":"2019","journal-title":"J. Clin. Endocrinol. Metabolism"},{"key":"B5","doi-asserted-by":"publisher","first-page":"613","DOI":"10.2164\/jandrol.106.001966","article-title":"Development of normal reference values for seminal reactive oxygen species and their correlation with leukocytes and semen parameters in a fertile population","volume":"28","author":"Athayde","year":"2007","journal-title":"J. Androl."},{"key":"B6","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3238\/arztebl.m2021.0014","article-title":"Motivational interviewing: an evidence-based approach for use in medical practice","volume":"118","author":"Bischof","year":"2021","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1059473","DOI":"10.3389\/fendo.2022.1059473","article-title":"Anabolic\u2013androgenic steroids: how do they work and what are the risks?","volume":"13","author":"Bond","year":"2022","journal-title":"Front. Endocrinol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2055","DOI":"10.1007\/s11606-021-06751-3","article-title":"Harm reduction in male patients actively using anabolic androgenic steroids (AAS) and performance-enhancing drugs (PEDs): a review","volume":"36","author":"Bonnecaze","year":"2021","journal-title":"J. General Intern. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"52","DOI":"10.4103\/aja.aja_9_20","article-title":"Serum vitamin D content is associated with semen parameters and serum testosterone levels in men","volume":"23","author":"Ciccone","year":"2021","journal-title":"Asian J. Androl."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1016\/j.fertnstert.2007.07.1377","article-title":"Impact of clinical varicocele and testis size on seminal reactive oxygen species levels in a fertile population: a prospective controlled study","volume":"90","author":"Cocuzza","year":"2008","journal-title":"Fertil. Steril."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1517\/14656566.2014.944896","article-title":"Injectable testosterone undecanoate for the treatment of hypogonadism","volume":"15","author":"Corona","year":"2014","journal-title":"Expert Opin. Pharmacother."},{"key":"B12","doi-asserted-by":"publisher","first-page":"165","DOI":"10.5534\/wjmh.210021","article-title":"Consequences of anabolic-androgenic steroid abuse in males; sexual and reproductive perspective","volume":"40","author":"Corona","year":"2022","journal-title":"World J. Men\u2019s Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s40279-014-0247-x","article-title":"Prevalence of doping use in elite sports: a review of numbers and methods","volume":"45","author":"de Hon","year":"2015","journal-title":"Sports Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1111\/j.1464-410X.2011.10131.x","article-title":"Anabolic steroids and male infertility: a comprehensive review","volume":"108","author":"de Souza","year":"2011","journal-title":"BJU Int."},{"key":"B15","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1089\/ars.2021.0235","article-title":"Reactive oxygen species and their consequences on the structure and function of mammalian spermatozoa","volume":"37","author":"Drevet","year":"2022","journal-title":"Antioxidants Redox Signal."},{"key":"B16","doi-asserted-by":"publisher","first-page":"197","DOI":"10.31128\/AJGP-04-22-6402","article-title":"Impact of harm reduction practice on the use of non-prescribed performance and image-enhancing drugs: the PUSH! Audit","volume":"52","author":"Eu","year":"2023","journal-title":"Aust. J. General Pract."},{"key":"B17","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S0031-9384(97)00105-4","article-title":"The effect of anabolic-androgenic steroids on sexual behavior and reproductive tissues in male rats","volume":"62","author":"Feinberg","year":"1997","journal-title":"Physiology Behav."},{"key":"B18","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1136\/sti.77.2.84","article-title":"Measuring sexual behaviour: methodological challenges in survey research","volume":"77","author":"Fenton","year":"2001","journal-title":"Sex. Transm. Infect."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1056\/NEJMoa1206168","article-title":"Gonadal steroids and body composition, strength, and sexual function in men","volume":"369","author":"Finkelstein","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"846983","DOI":"10.3389\/fpsyt.2022.846983","article-title":"Toxicological characterization of GHB as a performance-enhancing drug","volume":"13","author":"Giorgetti","year":"2022","journal-title":"Front. Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13011-023-00573-8","article-title":"The use of post-cycle therapy is associated with reduced withdrawal symptoms from anabolic-androgenic steroid use: a survey of 470 men","volume":"18","author":"Grant","year":"2023","journal-title":"Subst. Abuse Treat. Prev. Policy"},{"key":"B22","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/S0899-3467(07)60142-6","article-title":"Writing narrative literature reviews for peer-reviewed journals: secrets of the trade","volume":"5","author":"Green","year":"2006","journal-title":"J. Chiropr. Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1210\/jc.2008-1846","article-title":"Multicenter contraceptive efficacy trial of injectable testosterone undecanoate in Chinese men","volume":"94","author":"Gu","year":"2009","journal-title":"J. Clin. Endocrinol. Metabolism"},{"key":"B24","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1210\/jc.2002-020447","article-title":"A multicenter contraceptive efficacy study of injectable testosterone undecanoate in healthy Chinese men","volume":"88","author":"Gu","year":"2003","journal-title":"J. Clin. Endocrinol. Metabolism"},{"key":"B25","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1210\/mend-4-2-349","article-title":"Follicle-stimulating hormone regulation of androgen-binding protein messenger RNA in sertoli cell cultures","volume":"4","author":"Hall","year":"1990","journal-title":"Mol. Endocrinol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"S509-S512","DOI":"10.21037\/tau.2017.06.29","article-title":"Utility of sperm DNA fragmentation testing in different clinical scenarios of male reproductive abnormalities and its influence in natural and assisted reproduction","volume":"6","author":"Hallak","year":"2017","journal-title":"Transl. Androl. Urology"},{"key":"B27","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.fertnstert.2020.05.019","article-title":"Protein supplements for physical enhancement and male reproductive health: are there potential reasons for concern in an uncontrolled, unregulated, and widespread abuse scenario?","volume":"114","author":"Hallak","year":"2020","journal-title":"Fertil. Steril."},{"key":"B28","first-page":"38","article-title":"Cryopreservation of human spermatozoa: comparison of TEST-yolk buffer and glycerol","volume":"45","author":"Hallak","year":"2000","journal-title":"Int. J. Fertil. Women\u2019s Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"111965","DOI":"10.1016\/j.forsciint.2024.111965","article-title":"Detection of anabolic-androgenic steroids in e-cigarettes seized from prisons: a case study","volume":"356","author":"Harries","year":"2024","journal-title":"Forensic Sci. Int."},{"key":"B30","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.eururo.2013.08.048","article-title":"A critical analysis of the role of testosterone in erectile function: from pathophysiology to treatment\u2014a systematic review","volume":"65","author":"Isidori","year":"2014","journal-title":"Eur. Urol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1038\/bjp.2008.118","article-title":"Cellular and molecular mechanisms responsible for the action of testosterone on human skeletal muscle. A basis for illegal performance enhancement","volume":"154","author":"Kadi","year":"2008","journal-title":"Br. J. Pharmacol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.mce.2017.02.039","article-title":"History and epidemiology of anabolic androgens in athletes and non-athletes","volume":"464","author":"Kanayama","year":"2018","journal-title":"Mol. Cell. Endocrinol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1016\/j.fertnstert.2023.09.016","article-title":"Fertility outcomes in men with prior history of anabolic steroid use","volume":"120","author":"Ledesma","year":"2023","journal-title":"Fertil. Steril."},{"key":"B34","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1210\/jcem-70-1-282","article-title":"Effects of chronic testosterone administration in normal men: safety and efficacy of high dosage testosterone and parallel dose-dependent suppression of luteinizing hormone, follicle-stimulating hormone, and sperm production","volume":"70","author":"Matsumoto","year":"1990","journal-title":"J. Clin. Endocrinol. Metabolism"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1210\/jcem-62-6-1184","article-title":"Chronic human chorionic gonadotropin administration in normal men: evidence that follicle-stimulating hormone is necessary for the maintenance of quantitatively normal spermatogenesis in man","volume":"62","author":"Matsumoto","year":"1986","journal-title":"J. Clin. Endocrinol. Metabolism"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1016\/j.forsciint.2011.10.032","article-title":"Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases","volume":"217","author":"Montisci","year":"2012","journal-title":"Forensic Sci. Int."},{"key":"B37","doi-asserted-by":"publisher","first-page":"R47","DOI":"10.1530\/EJE-15-0080","article-title":"MECHANISMS IN ENDOCRINOLOGY: medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions","volume":"173","author":"Nieschlag","year":"2015","journal-title":"Eur. J. Endocrinol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1001\/jama.1993.03510010089036","article-title":"Potence: NIH Consensus development panel on impotence","volume":"270","year":"1993","journal-title":"JAMA"},{"key":"B39","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/B978-0-12-801238-3.64783-9","article-title":"General endocrine therapy","volume-title":"Encyclopedia of reproduction","author":"Pagani","year":"2018"},{"key":"B40","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1111\/and.12538","article-title":"Effects of caffeine supplementation in post-thaw human semen over different incubation periods","volume":"48","author":"Pariz","year":"2016","journal-title":"Andrologia"},{"key":"B41","doi-asserted-by":"publisher","first-page":"3","DOI":"10.5935\/1518-0557.20190066","article-title":"Long-term sperm cryopreservation does not affect post-thaw survival rates","volume":"24","author":"Pariz","year":"2020","journal-title":"JBRA Assist. Reprod."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/6472945","article-title":"Melatonin and caffeine supplementation used, respectively, as protective and stimulating agents in the cryopreservation of human sperm improves survival, viability, and motility after thawing compared to traditional TEST-yolk buffer","volume":"2019","author":"Pariz","year":"2019","journal-title":"Oxidative Med. Cell. Longev."},{"key":"B43","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/j.fertnstert.2005.08.043","article-title":"Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update","volume":"85","author":"Pasqualotto","year":"2006","journal-title":"Fertil. Steril."},{"key":"B44","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/j.1521-0391.2013.12118.x","article-title":"The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates","volume":"23","author":"Pope","year":"2014","journal-title":"Am. J. Addict."},{"key":"B45","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1210\/er.2013-1058","article-title":"Adverse health consequences of performance-enhancing drugs: an endocrine society scientific statement","volume":"35","author":"Pope","year":"","journal-title":"Endocr. Rev."},{"key":"B46","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1210\/er.2013-1058","article-title":"Adverse health consequences of performance-enhancing drugs: an endocrine society scientific statement","volume":"35","author":"Pope","year":"","journal-title":"Endocr. Rev."},{"key":"B47","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/19396368.2021.2004623","article-title":"Sperm motility in asthenozoospermic semen samples can be improved by incubation in a continuous single culture medium (CSCM\u00ae)","volume":"68","author":"Ran\u00e9a","year":"2022","journal-title":"Syst. Biol. Reproductive Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1002\/jand.2002.23.1.71","article-title":"Sperm cryopreservation for men with nonmalignant, systemic diseases: a descriptive study","volume":"23","author":"Ranganathan","year":"2002","journal-title":"J. Androl."},{"key":"B49","doi-asserted-by":"publisher","first-page":"e234","DOI":"10.1016\/j.clinthera.2023.09.003","article-title":"Early pharmacologic approaches to avert anabolic steroid-induced male infertility: a narrative review","volume":"45","author":"Rizzuti","year":"2023","journal-title":"Clin. Ther."},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1590\/1981-6723.20618","article-title":"Determination of adulterants in whey protein food supplements by liquid chromatography coupled to Orbitrap high resolution mass spectrometry","volume":"22","author":"Roiff\u00e9","year":"2019","journal-title":"Braz. J. Food Technol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.annepidem.2014.01.009","article-title":"The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis","volume":"24","author":"Sagoe","year":"2014","journal-title":"Ann. Epidemiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1016\/j.clinthera.2022.06.006","article-title":"Nonpharmacological interventions for the management of testosterone and sperm parameters: a scoping review","volume":"44","author":"Santos","year":"2022","journal-title":"Clin. Ther."},{"key":"B53","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/S0140-6736(12)60520-0","article-title":"Erectile dysfunction","volume":"381","author":"Shamloul","year":"2013","journal-title":"Lancet"},{"key":"B54","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1038\/s41443-021-00507-7","article-title":"An update on male infertility and intratesticular testosterone\u2014insight into novel serum biomarkers","volume":"34","author":"Sidhom","year":"2022","journal-title":"Int. J. Impot. Res."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1016\/S0140-6736(08)60801-6","article-title":"Use of doping agents, particularly anabolic steroids, in sports and society","volume":"371","author":"Sj\u00f6qvist","year":"2008","journal-title":"Lancet"},{"key":"B56","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1097\/MED.0000000000000759","article-title":"Health effects of androgen abuse: a review of the HAARLEM study","volume":"29","author":"Smit","year":"2022","journal-title":"Curr. Opin. Endocrinol. Diabetes & Obes."},{"key":"B57","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1093\/humrep\/deaa366","article-title":"Disruption and recovery of testicular function during and after androgen abuse: the HAARLEM study","volume":"36","author":"Smit","year":"2021","journal-title":"Hum. Reprod."},{"key":"B58","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1111\/sms.13592","article-title":"Baseline characteristics of the HAARLEM study: 100 male amateur athletes using anabolic androgenic steroids","volume":"30","author":"Smit","year":"2020","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"B59","doi-asserted-by":"publisher","first-page":"414","DOI":"10.4300\/JGME-D-22-00480.1","article-title":"Narrative reviews: flexible, rigorous, and practical","volume":"14","author":"Sukhera","year":"2022","journal-title":"J. Graduate Med. Educ."},{"key":"B60","unstructured":"GP guide to harm minimisation for patients using non-prescribed anabolic-androgenic steroids (AAS) and other performance and image enhancing drugs (PIEDs)\n            van de VenK.\n            EuB.\n            JacksonE.\n            HanE.\n            GoudaN.\n            SimmondsP.\n          2020"},{"key":"B61","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1210\/clinem\/dgaa837","article-title":"Male fertility before and after androgen abuse","volume":"106","author":"Windfeld-Mathiasen","year":"2021","journal-title":"J. Clin. Endocrinol. Metabolism"},{"key":"B62","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1001\/jama.2024.3180","article-title":"Mortality among users of anabolic steroids","volume":"331","author":"Windfeld-Mathiasen","year":"2024","journal-title":"JAMA"},{"key":"B63","unstructured":"UNODC report2023"},{"key":"B64","volume-title":"WHO laboratory manual for the examination and processing of human semen","year":"2021"},{"key":"B65","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/s0015-0282(16)58221-1","article-title":"Contraceptive efficacy of testosterone-induced azoospermia and oligozoospermia in normal men","volume":"65","year":"1996","journal-title":"Fertil. Steril."}],"container-title":["Frontiers in Toxicology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/ftox.2024.1379272\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T04:30:14Z","timestamp":1713760214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/ftox.2024.1379272\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,22]]},"references-count":65,"alternative-id":["10.3389\/ftox.2024.1379272"],"URL":"https:\/\/doi.org\/10.3389\/ftox.2024.1379272","relation":{},"ISSN":["2673-3080"],"issn-type":[{"value":"2673-3080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,22]]},"article-number":"1379272"}}