Public Enemy #1 for Male Fertility: Anabolic Steroids

Did you notice those guys with big muscles at the gym or on the beach? The muscles may be from "just plain old fashioned hard work in the gym" or they could be from using anabolic steroids or performing enhancing drugs (PED). Those that use anabolic steroids or PEDs to build and repair muscle are doing damage to their testicles. These testosterone-based hormones are very bad for men who eventually want to have children. They actually work almost like a contraceptive. When a man is taking anabolic steroids, it is virtually impossible for him to get his partner pregnant.

The use of anabolic steroids historically has been used by athletes in major sports, such as weight lifting, baseball and football. Because these so called "role models" use these drugs, anabolic steroid use or abuse has filtered down and is being used by recreational weight lifters, college and high school athletes, etc.

How do anabolic steroids affect male fertility? Sperm are formed in the body when brain hormones such as luteinizing hormone (LH) and follicle stimulating hormone (FSH) work directly on the testicles. In the testicle, cells called Leydig cells are turned on to produce the male hormone, testosterone. When this occurs, there are very high levels of testosterone that are present in the testicle, although there is a normal amount of testosterone in the blood stream. When men use anabolic steroids, they trick the body into thinking that the testicles DO NOT have to produce testosterone. When this happens, the amount of testosterone in the testicles is extremely low, despite normal or very high levels in the bloodstream. When this situation occurs, follicle stimulating hormone also is not released. This combination causes the testicles to shrink and to produce little if any sperm.

Although use of anabolic steroids can stop sperm production, the good news is that in many cases this problem is reversible. It appears that the longer one uses the steroids and the higher the dosage used, the more likely these become irreversible problems. Once performance enhancing drugs are stopped, sperm production may start again but will return in the ejaculate at the earliest three months after stopping the drugs. In fact, in patients who have used steroids for years, this sometimes may take one to two years before one may see a return in sperm production. After a period of time after stopping the PEDs, sometimes medical therapy can enhance the ability of the body to restart sperm production. This is usually done with human chorionic gonadotropin, or hCG. In certain cases, if hCG alone does not stimulate sperm production, a form of FSH called human menopausal gonadotropin may be added to improve the chances of return of sperm.

Anabolic steroids can cause other health problems that sometimes can be irreversible. These include aggressive behavior, acne, baldness, prominent breasts, liver disease, high blood pressure, heart attack and stroke. In adolescents, it may result in stunted growth and accelerated puberty changes.

PEDs can also cause sexual dysfunction. When the anabolic steroids are stopped, the "sexual rush" is gone and this will cause testosterone levels to crash to virtually zero. This may cause symptoms such as tiredness, loss of energy and loss of sex drive. Testosterone production may return in a few months, however, in certain situations, it may be a permanent problem. Luckily, there is medical treatment for this problem to raise testosterone levels back to the normal range.

So there are lessons to be learned from the abuse of anabolic steroids. The most important point here is if you want to have children at some point in your life, DON'T USE ANABOLIC STEROIDS!!! In addition, stopping anabolic steroids may result in the "crashing of testosterone levels" with associated bad problems related to general health and sexuality.

HMG: The Miracle Fertility Med?

When we administer certain hormones into our bodies, various cells and organs have the ability to sense this. Your body 'sees' this increase in testosterone or similar molecules and as a result it can sense that it is in a higher concentration than what would be normal in the blood. As a result, it will shut down its own testosterone production. There are various mechanisms involved in this, but an important one is the cessation in production of luteinizing hormone (LH) and follicle stimulating hormone (FSH), produced by the pituitary gland. These hormones are required for the testes to be stimulated to produce testosterone but also play a role in sperm production.

From a blood-testosterone aspect this all seems okay to us, sure we have shut down natural testosterone production, but we still have testosterone in us; right? Well, one of the big problems with regards to fertility is that the testes do not work like that. The Leydig cells in the testes produce testosterone when stimulated by LH. Testosterone is released from these cells which are in close proximity to the Sertoli cells. When Sertoli cells see a high concentration of testosterone, they are stimulated to produce and mature sperm by the process of spermatogenesis. A high blood concentration of testosterone will not do this job. Thus administering anabolic androgenic steroids (AAS) will shut down natural testosterone production which will in turn slow down (and eventually near turn off) the proper formation and maturation of sperm. Thus infertility is a serious issue with use of anabolic steroids.

Classically, HCG has been seen to rectify this problem in males. HCG is an LH analogue – it 'looks' like LH to the body and so it can stimulate the Leydig cells to produce testosterone and in turn, hopefully, restore fertility. In some cases this will occur, and many people have had success from HCG therapy relating to infertility. However, the response is not robust and certainly with longer shut-down periods, many often find the use of HCG (even in combination with other post cycle therapy (PCT) medicines such as clomifene (aka clomid) and tamoxifen (aka nolvadex), etc) to not be effective at restoring fertility.

Furthermore, what HCG lacks is to produce the important effects that FSH inflicts upon fertility. FSH, despite its name, is important in male fertility in two main pathways. The first thing it does is to enhance the action of LH, by increasing the amount of protein that will 'see' testosterone in the Sertoli cells. The more easily these cells can see testosterone, the more likely spermatogenesis will occur. Secondly, FSH enhances the maturation of sperm by effects on their primary division. These are two important aspects of the role of FSH in the male testes that HCG is not optimal in promoting.

HMG, or its full name Human Menopausal Gonadotropin, bears similarities to HCG in that while HCG is similar to human LH, HMG contains actual LH. Additionally (and crucially) though, HMG also contains purified FSH. The combination of these two hormones perform the effects described above: induction of natural testosterone production by Leydig cells, and subsequent formation and maturation of sperm cells. The result is improved and potentially recovered fertility for the male concerned.

Does HMG really work?
So often we hear about various different drugs and the science for them is sound, but real world evidence is lacking. There are a few studies performed on HMG over the last 25 years, and I would like to draw your attention to two of these studies, pointing out a few key details. The first goes back to 1985 by Ley & Leonard and is an important study as it looks at males who had previously encountered anabolic steroids treatment (treatment for low hormone levels including mainly testosterone). This study is available online and I encourage you to read it in more detail than the brief summary I will provide here.

They looked at 13 hypogonadotropic men all of who had undetectable levels of LH/FSH, lower than normal levels of testosterone and azoospermia, thus were unable to currently conceive. Obviously with the low hormonal levels there were issues with libido as well. Furthermore, there were instances where upon testis biopsies, Leydig cells were completely absent. Despite this, all 13 men responded to treatment with HCG with increasing testosterone levels. However, upon addition of HMG treatment, most men saw a further increase in testosterone, sometimes very large. HCG was able to increase sperm counts in most men slightly; however, only upon addition of HMG were sperm counts above 'normal' fertility levels (i.e. 20 million per ml) observed. The study indicates that the addition of HMG therapy surpasses any level that HCG treatment could achieve alone. Admittedly this is a particular subset of men who have medical conditions and abnormal hormone issues, but the results are interesting nonetheless.

The second is more recent by Buchter et al in 1998. This is even more interesting from the point of view that it looks at three times the number of cases as the previous study and in a different manner. Again, this study can be found online and I encourage you to read it. The most interesting result you could take away from this study is that in the group of men treated who suffered from hypopituitarism, all 21 treated with HCG/HMG achieved spermatogenesis and a large proportion (81%) was able to successfully achieve pregnancies. The discussion of this article is most interesting as it raises the points from its own study and the literature that many in the field believe that to achieve spermatogenesis and pregnancy in a gonadotropin-compromised individual requires combinational therapy of HCG and HMG. The important point to note is that HCG is not sufficient alone in many cases.

Given the fact that other studies point to HMG increasing endogenous testosterone further than HCG can, as those who have relatively 'normal' pituitaries but have compromised their function due to AAS use, it would be wise to consider the use of HMG. This would not only be for purposes of fertility, but to induce natural testosterone levels back to normal values when they have been suppressed. Treatment in this latest study was the use of HCG twice per week at 1000-2500IU per dose (Mon-Fri) and HMG three times per week at 75-150IU (Mon-Wed-Fri). Thus for bodybuilders seeking to regain fertility, spermatogenesis and restore natural testosterone levels but wishing to keep costs down, a weekly dose of the lower ends should be employed for at least one month.

A schedule would involve:
Monday: 1000-1500IU HCG + 75IU HMG
Wednesday: 75IU HMG
Friday: 1000-1500IU HCG + 75IU HMG

Depending on the amount of suppression this cycle may need to be lengthened for a further period.

The Effects Of Steroids On Fertility And Reproductive Organs

The use of steroids may have a severe side effect on the reproductive system of both males and females and may affect fertility permanently ...
The synthetic form of the male sex hormone testosterone is called steroid. Consequently, use of steroids may have a severe side effect on the reproductive system of both males and females and may affect fertility permanently. The use of any steroid can lead to anabolic (tissue building) and androgenic (masculinizing) effects.
More than 70 side effects of use of steroids have been identified so far. These side effects may range from liver cancer to acne. The areas of the human body most affected by steroids are the liver, the cardiovascular and the reproductive systems. Some side effects like heart attacks or strokes may not be recognized for a long time. On the other hand, side effects like stunted growth may even remain unnoticed.
Steroid is used either in tablet form or by injection. However, the use of injection forms of steroids involves the risk of infection in a case the needles are shared. Thus, it carries the risk of contracting AIDS.
Often steroids are taken by sports people to increase their performance or by occupational users like bouncers, security personnel etc. to increase their muscle size and strength.
 
Effect of Steroids Use on Male Fertility

Steroid use in men leads to enlargement of the prostrate gland and may increase the chances of prostrate cancer. Besides these, it may lead to accelerated male pattern hair loss. Since steroids are a synthetic form of testosterone, their effect on the reproductive system is obvious. Supra physiological elevations of testosterone are also the result of use of steroids.
Long time use of steroids in high doses results in hypogonadotrophic hypogonadism, along with reduced serum elevations of LH and FSH and testosterone.
Atrophy of the testes and decreased sperm cell production are caused by a moderate reduction in gonadotropin secretion. It has been reported that oligo, azoospermia and increased sperm cells have been identified in athletes, thus resulting in a decreased fertility.
Steroids cessation will make gonadal functions normal within few months. Also, changes in fertility that occur due to steroids use usually can be reversed within a few months. However, it may take some more time than usual in some cases.

Effects of Steroids Use in Female Fertility

In a normal female body, testosterones are produced in a small amount. Similar to males, synthetically elevated testosterones due to anabolic steroids use can affect the hypothalamic-pituitary-gonadal axis. The production and release of LH and FSH gets hampered due to increase in circulating androgens.
Consequently, serum levels of LH, FSH, estrogens and progesterone are reduced. It may lead to follicle formation, ovulation and an irregular menstrual cycle. Other side effects of steroids use in females include increased sexual desire and clitoral hypertrophy.
However, steroids used by pregnant women may result in the slow growth of the female fetus. More adversely, it may even lead to fetal death.
Besides all these, if steroids are used during adolescence, then it may lead to stunted growth. The condition of acne gets worse with the use of steroids. Also, prolonged use may have long-term undesirable effects on fertility.

Anabolic Steroids and Fertility

There are a number of side effects users will experience when taking Anabolic Steroids. Some are short term and others may have long term side effects. Unfortunately any side effects will in most cases also effect the male fertility health. Some of these side effects can include:

Short term effects

    Puffiness and swelling in the face and neck due to increased water retention.
    Development of breast tissue in males.
    Increased risk of injury to muscles and joints.
    Increase in muscle mass.
    Heightened aggression, sleeping disorders, anxiety and irritability.
    Stunted growth if taken during adolescent growth spurts due to skeletal maturation and accelerated puberty changes.
    

Long term effects

    Growth of breasts due to the high level of testosterone some of which the body converts to oestrogen.
    Increased erectile dysfunction and shrinking testicles.
    Heart and liver disease - some steroids are toxic to the liver.
     Kidney disease due to the increase in toxins to be broken down.
    Aggressive behaviour and depression.
    Jaundice from high levels of steroids - affects liver function.
    Increased blood pressure.
    Prostate enlargement.


Anabolic Steroids and male infertility are often linked due to the effects on the body as mentioned here.  Any increased toxins in the body have the potential to affect the sperm being produced.

A semen analysis will give a good indication of the health of the sperm if a male has used steroids previously and is now having difficulty with infertility. A low sperm count will also be detected by going for a semen analysis.

Fortunately medical technology and advancement in procedures such as sperm washing as well as ICSI - Intra-Cytoplasmic Sperm Injection could assist men whose fertility may have been affected by the usage of Steroids.

Your doctor will be able to advise you on using an Assisted Reproductive Technology (ART) procedure in the event of being diagnosed with infertility due to this usage.

Natural remedies for infertility

In order to get rid of the toxins and increase your health status and hormonal balance, changing your infertility diet and considering the alkaline diet may assist in correcting your sperm problems.

Many of the side effects mentioned can be corrected by immediately stopping the usage of these substances, as well as considering lifestyle changes and partaking in moderate exercise such as walking and swimming or yoga.