Lesson of the Week: Anabolic steroid abuse by body builders and male subfertility

doi:10.1136/bmj.313.7049.100

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F H Lloyd, research registrar in obstetrics and gynaecologya,
P Powell, consultant urologistb,
A P Murdoch, consultant and senior lecturer in reproductive medicinea

^a Centre for Reproductive Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
^b Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN

Correspondence to: Dr Murdoch.

Accepted 10 May 1996

Steroid abuse by a minority of top class athletes is well recognised. Abuse by competitive body builders is thought to be common but has caused less public concern. Recreational body builders attending gymnasiums also abuse steroids1 but the frequency and patterns of use and the associated problems are less well known.

Among other side effects androgenic steroids induce hypogonadotrophic hypogonadism with subsequent azoospermia.2 Over the past year we have noted an increased number of men attending the infertility clinic who have been using anabolic steroids for body building. This has been associated with an apparent substantial increase in body building as a recreational pastime in the north east.

We are concerned about the lack of understanding of the consequences of steroid use by users and providers and the ease with which the diagnosis can be missed. The following five cases illustrate the problems.

Case reports

Case 1—A couple (husband aged 29) requested in vitro fertilisation after primary subfertility for three years. Results of two semen analyses arranged by the general practitioner in early 1994 were normal (sperm densities 80x10⁹ and 150x10⁹/l). At presentation the husband was severely oligospermic (sperm densities nil and <100x10⁶/l). His hobby was weightlifting and he admitted to taking oral steroids for two weeks 12 months earlier. Examination showed a normal muscular male physique with normal secondary sexual characteristics. However, follicle stimulating hormone and testosterone concentrations were very low, confirming steroid use. He admitted to taking a “protein health drink” which was made up by …