Dados do Trabalho

Title

The influence of anabolic androgenic steroid abuse on male infertility

Objective

Analyze the correlation between anabolic androgenic steroid abuse to male infertility.

Methods

This is an integrative review of articles published in PubMed, Cochrane and SciELO databases in the last five years, using the following descriptors: "Infertility, Male", "testosterone congeners" and "Anabolic Androgenic Steroids". The inclusion criteria were articles written in Portuguese and English, with full text available electronically. Paid studies, performed on animals, duplicates and those that are not related to the theme were excluded.

Results

Two review articles were selected for analysis, according to the inclusion and exclusion criteria, and the first of them indicated that exogenous testosterone suppress the pituitary secretion of LH and FSH, which results in a decrease in testosterone concentrations within of the testis, promoting abnormal spermatogenesis. However, a pooled analysis of 30 studies revealed that the recovery of spermatogenesis after the cessation of exogenous testosterone use is uncertain. The probability of recovering a sperm density of at least 20 million/mL is 67% at 6 months after discontinuation, increasing to 90% at 12 months and reaching 100% at 24 months. Additionally, short-acting testosterone has been shown to have minimal impact on the pituitary axis and preserve spermatogenesis. Thus, testosterone gel is presented as a viable option to raise testosterone levels while maintaining fertility. A study observed that, in a group of 60 men who used 4.5% testosterone, administered at a dose of 125 μL, three times a day, through an intranasal pump, only 1 individual became azoospermic after 3 months of use, and three developed severe oligospermia (sperm density < 1 million/mL). In the second article, it was observed that users of Anabolic Androgenic Steroids (AAS) had a reduction in the baseline levels of LH and FSH, in addition to an increase in testosterone and estradiol, which led them to develop side effects such as acne, hair loss, gynecomastia, sexual dysfunction and reduced testicular volume. It was also observed, in users, the reduction of total sperm count and sperm morphology. The recovery of gonadotropin levels was seen from 13 to 24 weeks after AAS withdrawal, while endogenous testosterone serum levels are still reduced at 16 weeks. The time of exposure to AAS, as well as the dosages used and the type of preparations taken, can specifically affect the hypothalamic-pituitary-testicular axis recovery, and the substance may remain concentrated in the sperm for up to 24 months.

Conclusion

The abuse of these substances has a notorious negative influence on male fertility, mainly through the mechanism of testicular atrophy and azoospermia, which are not always reversible in the short term. For this reason, it is necessary to have a greater role in public health policies that reinforce, for the population, the harm caused by this indiscriminate use.

Keywords

Infertility, Male; testosterone congeners; Anabolic Androgenic Steroids