Hypogonadism is a disturbance of HPTA homeostasis. Hypogonadism is inadequate gonadal function, as manifested by deficiencies in spermatogenesis and/or the secretion of testosterone. AAS, including testosterone, licit and illicit, administration induce a state of hypogonadism that continues after their cessation. This state is present during their administration but typically becomes symptomatic or manifest after AAS cessation. To date, all compounds classified as androgens or anabolic steroids prescribed clinically cause a negative feedback inhibition of the hypothalamic pituitary testicular axis, suppress endogenous gonadotropin secretion, and as a consequence serum testosterone.

Anabolic steroid induced hypogonadism (ASIH) is the functional incompetence of the testes with subnormal or impaired production of testosterone or spermatozoa due to administration of androgens or anabolic steroids. ASIH results from an abnormality in the normal functioning of the hypothalamic-pituitary-testicular axis (HPTA), from a negative feedback inhibition of one of the hormone secreting glands, causing a cascading unbalance in the rest of the axis.

Anabolic steroid induced hypogonadism (ASIH) occurs in one-hundred percent of individuals upon AAS cessation. There is not a single study within the peer-reviewed literature demonstrating an immediate return of HPTA homeostasis upon AAS cessation. AAS, licit and illicit, induce a state of hypogonadism that continues after their cessation. The only variable is the duration and severity of ASIH. ASIH, as a form of hypogonadism, is a real disease with potentially serious consequences.

Declining, or suppressed, circulating testosterone levels because of either pathophysiological or induced hypogonadal conditions can have many negative consequences in males. There is a direct association between hypogonadism (decreased levels of testosterone) and a number of signs and symptoms, most notably body composition changes (decrease in muscle mass and increase in fat mass), decreased muscle strength, bone loss, increased cardiovascular risk, sexual dysfunction (decreased libido, decreased spontaneous erections, decreased ejaculate, erection dysfunction, decreased sexual fantasies, and anorgasmia), decreased cognitive abilities (memory and concentration), sleep disturbances, adverse psychological effects (depression, low self esteem, guilt, increased stress, and anhedonia), sleep disturbances, and constitutional symptoms (general fatigue, agitation/motor dyskinesia, and decreased appetite). Reports of symptoms following use of illicit androgens also include suicidal ideation and suicide.

“The discovery of truth is prevented more effectively, not by the false appearance things present and which mislead into error, not directly by weakness of the reasoning powers, but by preconceived opinion, by prejudice.” Arthur Schopenhauer (1788–1860), German philosopher.

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” Schopenhauer.

A challenge for the physician investigator willing to expose the use of unsound scientific design and methodology found in anabolic steroid research is an unheralded opportunity. It will not be possible [read impossible] to repeat the findings of the studies demonstrating positive anabolic improvements and increased muscle strength during AAS administration but now include the period after anabolic steroid cessation, hypogonadism, with the end-point being the study groups return to their baseline values. The studies completely and entirely dismiss and ignore the significance of sex hormone measurements. Further, they ignore a basic tenet of life’s characteristics, homeostasis. Even more significantly and disturbing is that these very studies in already compromised individuals, the elderly, HIV+, chronic obstructive pulmonary disease (COPD), chronic kidney disease (hemodialysis), chronic glucocorticoid use, will now face an additional comorbid condition, hypogonadism, with its own attendant problems.  

Historically, the difference in the beliefs held by the athletic and the medical communities on AAS are contradictory and irreconcilable. The development of AAS compounds originally were for treatment of hypogonadal dysfunction and commencement of delayed puberty in men and for growth promotion. AAS have, however, not always been used for pure medical purposes. Due to their anabolic effects, AAS became vastly popular among athletes, bodybuilders, and power lifters. Controversy raged for decades over the effectiveness of AAS in promoting muscle mass and muscle strength.

Despite the admitted illicit use of AAS by athletes, the record breaking in Olympic events, the obvious appearance in musculature enhancement, and more the medical and research community disputed and denied the AAS effects. Moreover, scientific and official court documents, including secret doctoral theses and scientific reports, demonstrate the positive effects of these and other hormonal drugs on muscle strength and performance in elite sports were common knowledge and had been in practice since the early 1960s. After a period of scientific controversy, it is now clear that anabolic-androgenic steroid hormones are effective in increasing both muscle mass and muscle strength as well as enhancing performance in sports.