Armstrong Joseph Matthew, Avant Ross A, Charchenko Cameron M, Westerman Mary E, Ziegelmann Matthew J, Miest Tanner S, Trost Landon W
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
Transl Androl Urol. 2018 Jun;7(3):483-489. doi: 10.21037/tau.2018.04.23.
To describe the impact of supra-physiologic anabolic-androgenic steroid (AAS) use, including agent, dosage, and duration of therapy, on sexual function.
We reviewed data from an online survey of AAS users to evaluate their sexual function on and off AAS. The online survey consisted of questions addressing demographics, anabolic steroid use and patterns, ancillary medications, testosterone (T)-related symptoms while on and off of therapy, as well as sexual function which was assessed using the 5-item, International Index of Erectile Function (IIEF-5).
A total of 321 men responded to the survey, of which 90 failed to meet inclusion criteria, for a final cohort of 231 AAS users. The majority of men were Caucasian (85%), employed (62%), and younger than 35 years (58%), while an equal mix were single (47%) or married (46%). The mean IIEF-5 was 22.5, with higher scores associated with increased T dosages (>600 mg/week), use of 17-alpha alkylated hormones and anti-estrogens, and absence of concurrent medical conditions. Lower mean IIEF scores were associated with current and pre-AAS low T symptoms, self-reported angry or violent tendencies, self-reported erectile dysfunction (ED), decreased libido, decreased energy, and depression. After controlling for age, low T symptoms and decreased energy remained significantly associated with lower IIEF scores. Among 127 men reporting decreased libido when not taking AAS, several factors were significantly associated including frequency and duration of T and use of adjunctive therapies, while post-cycle therapies were protective. Men who reported any other symptom (decreased energy, libido, muscle mass or depression) after discontinuing T were also more likely to report ED, as well as those using >10 years or for >40 weeks per year.
The long-term impact of high dose AAS use on sexual function remains poorly defined. Although high T dosages appeared to be protective of erectile function during use, symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. Given the importance of these findings, long-term studies evaluating the impacts of discontinuing T on sexual dysfunction are indicated.
描述超生理剂量的合成代谢雄激素类固醇（AAS）使用，包括药物、剂量和治疗持续时间，对性功能的影响。
我们回顾了一项针对AAS使用者的在线调查数据，以评估他们在使用和停用AAS时的性功能。在线调查包括有关人口统计学、合成代谢类固醇使用情况和模式、辅助药物、治疗期间和治疗后与睾酮（T）相关的症状，以及使用5项国际勃起功能指数（IIEF-5）评估的性功能等问题。
共有321名男性回复了调查，其中90人不符合纳入标准，最终队列中有231名AAS使用者。大多数男性为白种人（85%），有工作（62%），年龄小于35岁（58%），单身（47%）或已婚（46%）的比例相当。IIEF-5的平均分为22.5，较高的分数与较高的T剂量（>600毫克/周）、使用17-α烷基化激素和抗雌激素以及无并发疾病相关。较低的IIEF平均得分与当前和使用AAS前的低T症状、自我报告的愤怒或暴力倾向、自我报告的勃起功能障碍（ED）、性欲减退、精力下降和抑郁相关。在控制年龄后，低T症状和精力下降仍与较低的IIEF得分显著相关。在127名报告停用AAS时性欲减退的男性中，几个因素与之显著相关，包括T的使用频率和持续时间以及辅助治疗的使用，而周期后治疗具有保护作用。停用T后报告有任何其他症状（精力下降、性欲减退、肌肉量减少或抑郁）的男性也更有可能报告ED，以及那些使用超过10年或每年使用超过40周的男性。
高剂量AAS使用对性功能的长期影响仍不明确。虽然高T剂量在使用期间似乎对勃起功能有保护作用，但性欲减退和ED等症状在停用T后更频繁出现，尤其是在使用更频繁和持续时间更长的人群中。鉴于这些发现的重要性，需要进行长期研究来评估停用T对性功能障碍的影响。
