Department of Endocrinology, Medical School, University of Ioannina, Ioannina, Greece.
Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece.
Sports Med. 2017 Sep;47(9):1869-1883. doi: 10.1007/s40279-017-0709-z.
Anabolic androgenic steroids (AAS) are testosterone derivatives used by athletes and recreational users to improve athletic performance and/or enhance appearance. Anabolic androgenic steroids use may have serious and potentially irreversible adverse effects on different organs and systems, including the reproductive system.
This systematic review and meta-analysis aimed to critically assess the impact of AAS use on the reproductive system of athletes and recreational users.
An electronic literature search was conducted using the databases MEDLINE, CENTRAL, and Google Scholar. Studies were included when the following criteria were fulfilled: participants were athletes or recreational users of any age, sex, level or type of sport; AAS use of any type, dose, form or duration; AAS effects on the reproductive system were assessed as stated by medical history, clinical examination, hormone and/or semen analysis. Random-effects meta-analysis was performed to assess the weighted mean difference (WMD) of serum gonadotropin (luteinizing hormone, follicle-stimulating hormone) and testosterone levels compared with baseline, during the period of AAS use, as well as following AAS discontinuation.
Thirty-three studies (three randomized clinical trials, 11 cohort, 18 cross-sectional, and one non-randomized parallel clinical trial) were included in the systematic review (3879 participants; 1766 AAS users and 2113 non-AAS users). The majority of the participants were men; only six studies provided data for female athletes. A meta-analysis (11 studies) was conducted of studies evaluating serum gonadotropin and testosterone levels in male subjects: (1) prior to, and during AAS use (six studies, n = 65 AAS users; seven studies, n = 59, evaluating gonadotropin and testosterone levels respectively); (2) during AAS use and following AAS discontinuation (four studies, n = 35; six studies, n = 39, respectively); as well as (3) prior to AAS use and following AAS discontinuation (three studies, n = 17; five studies, n = 27, respectively). During AAS intake, significant reductions in luteinizing hormone [weighted mean difference (WMD) -3.37 IU/L, 95% confidence interval (CI) -5.05 to -1.70, p < 0.001], follicle-stimulating hormone (WMD -1.73 IU/L, 95% CI -2.67 to -0.79, p < 0.001), and endogenous testosterone levels (WMD -10.75 nmol/L, 95% CI -15.01 to -6.49, p < 0.001) were reported. Following AAS discontinuation, serum gonadotropin levels gradually returned to baseline values within 13-24 weeks, whereas serum testosterone levels remained lower as compared with baseline (WMD -9.40 nmol/L, 95% CI -14.38 to -4.42, p < 0.001). Serum testosterone levels remained reduced at 16 weeks following discontinuation of AAS. In addition, AAS abuse resulted in structural and functional sperm changes, a reduction in testicular volume, gynecomastia, as well as clitoromegaly, menstrual irregularities, and subfertility.
The majority of AAS users demonstrated hypogonadism with persistently low gonadotropin and testosterone levels, lasting for several weeks to months after AAS withdrawal. Anabolic androgenic steroid use results in profound and prolonged effects on the reproductive system of athletes and recreational users and potentially on fertility.
合成代谢雄激素类固醇（AAS）是一种睾丸激素衍生物，被运动员和业余使用者用于提高运动表现和/或增强外貌。AAS 的使用可能对不同的器官和系统，包括生殖系统，产生严重且潜在不可逆转的不良影响。
本系统评价和荟萃分析旨在批判性地评估 AAS 使用对运动员和业余使用者生殖系统的影响。
使用 MEDLINE、CENTRAL 和 Google Scholar 数据库进行电子文献检索。当满足以下标准时，研究被纳入：参与者为任何年龄、性别、运动水平或类型的运动员或业余使用者；AAS 使用的任何类型、剂量、形式或持续时间；AAS 对生殖系统的影响如病史、临床检查、激素和/或精液分析所述。采用随机效应荟萃分析评估血清促性腺激素（黄体生成素、卵泡刺激素）和睾酮水平与基线相比的加权均数差（WMD），分别在 AAS 使用期间、AAS 停用期间。
33 项研究（3 项随机临床试验、11 项队列研究、18 项横断面研究和 1 项非随机平行临床试验）被纳入系统评价（3879 名参与者；1766 名 AAS 使用者和 2113 名非 AAS 使用者）。大多数参与者为男性；只有 6 项研究提供了女性运动员的数据。对评估男性受试者血清促性腺激素和睾酮水平的 11 项研究进行了荟萃分析：（1）在 AAS 使用之前和期间（6 项研究，n=65 名 AAS 使用者；7 项研究，n=59，分别评估促性腺激素和睾酮水平）；（2）在 AAS 使用期间和 AAS 停用后（4 项研究，n=35；6 项研究，n=39，分别）；以及（3）在 AAS 使用之前和 AAS 停用后（3 项研究，n=17；5 项研究，n=27，分别）。在 AAS 摄入期间，黄体生成素[加权均数差（WMD）-3.37 IU/L，95%置信区间（CI）-5.05 至-1.70，p<0.001]、卵泡刺激素（WMD-1.73 IU/L，95%CI-2.67 至-0.79，p<0.001）和内源性睾酮水平（WMD-10.75 nmol/L，95%CI-15.01 至-6.49，p<0.001）显著降低。在 AAS 停用后，血清促性腺激素水平在 13-24 周内逐渐恢复到基线值，而血清睾酮水平仍低于基线（WMD-9.40 nmol/L，95%CI-14.38 至-4.42，p<0.001）。AAS 停用后 16 周，血清睾酮水平仍较低。此外，AAS 滥用会导致精子结构和功能改变、睾丸体积缩小、男性乳房发育、阴蒂增大、月经不规律和生育力下降。
大多数 AAS 使用者表现出促性腺激素低下和持续低水平的促性腺激素和睾酮，在 AAS 停药后数周至数月内持续存在。AAS 使用对运动员和业余使用者的生殖系统产生深远而持久的影响，并可能对生育能力产生影响。
