Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
J Urol. 2013 Dec;190(6):2200-5. doi: 10.1016/j.juro.2013.06.010. Epub 2013 Jun 11.
The use of anabolic androgenic steroids has not been traditionally discussed in mainstream medicine. With the increased diagnosis of hypogonadism a heterogeneous population of men is now being evaluated. In this larger patient population the existence of anabolic steroid induced hypogonadism, whether transient or permanent, should now be considered.
We performed an initial retrospective database analysis of all 6,033 patients who sought treatment for hypogonadism from 2005 to 2010. An anonymous survey was subsequently distributed in 2012 to established patients undergoing testosterone replacement therapy.
Profound hypogonadism, defined as testosterone 50 ng/dl or less, was identified in 97 men (1.6%) in the large retrospective cohort initially reviewed. The most common etiology was prior anabolic androgenic steroid exposure, which was identified in 42 men (43%). Because of this surprising data, we performed an anonymous followup survey of our current hypogonadal population of 382 men with a mean±SD age of 49.2±13.0 years. This identified 80 patients (20.9%) with a mean age of 40.4±8.4 years who had prior anabolic androgenic steroid exposure. Hypogonadal men younger than 50 years were greater than 10 times more likely to have prior anabolic androgenic steroid exposure than men older than 50 years (OR 10.16, 95% CI 4.90-21.08). Prior anabolic androgenic steroid use significantly correlated negatively with education level (ρ=-0.160, p=0.002) and number of children (ρ=-0.281, p<0.0001).
Prior anabolic androgenic steroid use is common in young men who seek treatment for symptomatic hypogonadism and anabolic steroid induced hypogonadism is the most common etiology of profound hypogonadism. These findings suggest that it is necessary to refocus the approach to evaluation and treatment paradigms in young hypogonadal men.
在主流医学中，人们传统上并未讨论过使用合成代谢雄性激素类固醇。随着低促性腺激素血症诊断的增加，现在正在评估越来越多的男性人群。在这个更大的患者群体中，应该考虑到合成代谢类固醇引起的性腺功能减退症的存在，无论是暂时的还是永久性的。
我们对 2005 年至 2010 年间因性腺功能减退症寻求治疗的所有 6033 名患者进行了初始回顾性数据库分析。随后于 2012 年向正在接受睾丸激素替代治疗的既定患者分发了匿名调查。
在最初回顾的大回顾队列中，有 97 名男性（1.6%）被确定为严重性腺功能减退症，即睾丸酮<50ng/dl。最常见的病因是以前接触过合成代谢雄性激素类固醇，其中有 42 名男性（43%）。由于这一令人惊讶的数据，我们对目前 382 名年龄 49.2±13.0 岁的性腺功能减退男性进行了一项匿名随访调查。结果发现，80 名（20.9%）年龄 40.4±8.4 岁的患者以前接触过合成代谢雄性激素类固醇。年龄小于 50 岁的性腺功能减退男性比年龄大于 50 岁的男性有 10 多倍的可能性以前接触过合成代谢雄性激素类固醇（OR 10.16，95%CI 4.90-21.08）。以前使用过合成代谢雄性激素类固醇与受教育程度（ρ=-0.160，p=0.002）和子女数量（ρ=-0.281，p<0.0001）呈负相关。
在因症状性性腺功能减退症寻求治疗的年轻男性中，以前使用过合成代谢雄性激素类固醇很常见，而合成代谢类固醇引起的性腺功能减退症是严重性腺功能减退症的最常见病因。这些发现表明，有必要重新调整年轻性腺功能减退男性的评估和治疗模式。
