Background

Anabolic-androgenic steroids (AAS) are manufactured testosterone medications intended for use in testosterone-deficient men and to stimulate muscle growth in certain cases. However, AAS are often associated with athletes and bodybuilders because some may misuse them to enhance their physical appearance and performance. Around 6% of non-athletes with normal testosterone levels may also use AAS at least once in their lifetime.

Previous research has linked  AAS use to reduced natural testosterone production, continuing for years after withdrawing from use. Former AAS users have also reported symptoms associated with testosterone deficiency, such as erectile dysfunction (ED).

Study Objective

• Researchers investigated long-term  ED medication prescription filling among men who used or had used AAS within the previous 15 years.

Methods

• Data were collected from Anti-Doping Denmark’s national control program for public fitness centers between 2006 and 2018.
  • Information is included from 1,189 AAS users and 50,490 controls.
  • The average age was around 27.
• For this study, researchers identified the presence of ED through ED medication prescriptions n filled at a pharmacy, based on data from the Danish National Prescription Register.
  • Secondary outcomes included the cumulative number of prescriptions filled during the follow-up period.
• The follow-up period was an average of 11 years, depending on how long the men’s records were with the doping program.

Key Results/Analysis

• Men who used AAS were more likely to fill at least one ED medication prescription than the controls.
  • 24% of AAS users filled at least one ED medication prescription
  • 8% of controls filled at least one ED medication prescription
• Men who used AAS also filled more r ED medication prescriptions over the entire study period than the controls.
  • Average of 72 ED medication prescriptions for each AAS user.
  • Average of 36 ED medication prescriptions for each control.
• These results are in line with previous research that links AAS use to long-term testosterone deficiency.

Limitations

• This study identified differences in ED treatment between the cohorts but could not establish that AAS use caused those differences.
  • Although AAS users filled more ED medication prescriptions, researchers could not determine whether AAS use was the reason.
    • Patient history information, such as smoking, alcohol use, weight, presence of diabetes, etc., was not included.
• Researchers also could not determine whether the medications were actually used, only that the prescriptions were filled.

Key Takeaways

• AAS have been linked to testosterone deficiency and ED through mechanisms that slow testosterone production.
• Men with a history of AAS use were more likely to fill ED medication prescriptions during long-term follow-up compared with controls.
• AAS users also filled a greater number of ED medication prescriptions over the study period.
• Future research should include medical history variables and ED diagnoses to further clarify this correlation.

Resources

• Handelsman, D. J. (2021). Androgen misuse and abuse. Endocrine Reviews, 42(4), 457–501. Oxford Academic. https://doi.org/10.1210/endrev/bnab001 
• Levinsen, A. K. G., Tolver, A., Kjaer, T. K., Thygesen, L. C., Wohlfahrt, J., Rosthøj, S., Tolstrup, L. K., Hansen, M. N., Oerlemans, S., Miaskowski, C., Christiansen, P., Christensen, P., Johansen, C., Zachariae, R., Saltbæk, L., & Dalton, S. O. (2026). A structural equation modeling framework for estimating symptom burden based on symptom clusters in cancer survivors. Scientific Reports, 16(1). https://doi.org/10.1038/s41598-026-55933-8
• Middelboe, M., Heerfordt, I. M., Windfenld-Mathiasen, J., Dalhoff, K. P., Andersen, J. T., & Horwitz, H. (2026). Anabolic-androgenic steroid use and erectile dysfunction. The Journal of Sexual Medicine, 23(8). Oxford Academic. https://doi.org/10.1093/jsxmed/qdag223
• Rasmussen, J. J., Selmer, C., Østergren, P. B., Pedersen, K. B., Schou, M., Gustafsson, F., Faber, J., Juul, A., & Kistorp, C. (2016). Former abusers of anabolic androgenic steroids exhibit decreased testosterone levels and hypogonadal symptoms years after cessation: A case-control study. PLOS ONE, 11(8), e0161208. PLOS. https://doi.org/10.1371/journal.pone.0161208

Background

Low testosterone and testosterone deficiency are usually treated with testosterone therapy. But for those who wish to preserve their fertility or may not tolerate testosterone therapy, SERMs are available. Selective estrogen receptor modulators (SERMs), including clomiphene citrate (CC), can increase gonadotropin and testosterone levels in men and have been in use as early as the 1960s.

Background

Premature ejaculation (PE) is one of the more common male sexual dysfunctions, with an average prevalence of around 14.9% worldwide. The International Society for Sexual Medicine (ISSM) characterizes PE by a short intravaginal latency time, a consistent inability to delay ejaculation, and personal complications or distress.

Background

Postorgasmic illness syndrome (POIS) is a poorly defined clinical condition that presents primarily in men with a host of flu-like, somatic, and cognitive symptoms shortly after ejaculation. These symptoms may last for up to a week after ejaculation, significantly impacting quality of life and potentially deterring people from wanting to have sex.

Background

Peyronie’s disease (PD) is a connective tissue disorder that involves the buildup of fibrotic plaque in the penis, which can lead to penile curvature, deformities like indentations or an hourglass shape, and a loss of elasticity. As a result, many men with PD experience painful erections or erectile dysfunction (ED).

Background

Male sexual dysfunction, including erectile dysfunction (ED), premature ejaculation (PE), and Peyronie’s disease (PD), is highly prevalent and tends to have a significant impact on men’s health globally. The normal courses of treatment for these include pharmacological routes, like phosphodiesterase 5 inhibitors (PDE5-is) for ED, physiotherapeutic routes, like the stop-start method for PE, and surgical routes for PD and ED. However, even the most standard options have their drawbacks, sometimes leading to frustration and further distress among patients.