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.