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