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Clinical Opal - Androgen abuse recovery in a younger male

28 September 2023 - Professor Robert McLachlan AM, FRACP, PhD

Jeremy is a 22-year-old who presents with low energy, fatigue, weaker erections and decreasing libido. He plays football and works out at the gym a few times a week.

Jeremy’s physical examination shows a moderate reduction in testes size of approximately 10ml. Jeremy’s blood tests return with total testosterone extremely low at 1.2nmol/L, and LH 1IU/L, indicating secondary hypogonadism along with a high creatinine (124umol/L) and haematocrit (55%) and upper normal haemoglobin (178g/L).

What do these results suggest?

 

 

In this case Jeremy’s symptoms and clinical findings are consistent with withdrawal from androgenic steroids used for muscle and performance enhancement. Other diagnoses have been excluded. This presents as transient hypogonadotropic hypogonadism. His pituitary function will recover over time.

Jeremy’s recovery may take many months depending mainly on the time since cessation. The outlook for recovery of fertility and testosterone production is generally good but prolonged. The support of an interdisciplinary team including the general practitioner, endocrinologist and psychologist can help to support Jeremy.

Learn more in our Androgen use, misuse and abuse online learning modules.


References:

Handelsman DJ. Androgen Physiology, Pharmacology, Use and Misuse. In: Feingold et al., editors. Endotext available from: https://www.ncbi.nlm.nih.gov/books/NBK279000/

Anawalt, 2019. Diagnosis and Management of Anabolic Androgenic Steroid Use. The Journal of Clinical Endocrinology & Metabolism

Christou & Tigas, 2018. Recovery of reproductive function following androgen abuse. Current Opinion in Endocrinology, Diabetes and Obesity

Professor Robert McLachlan AM, FRACP, PhD
Professor Robert McLachlan AM, FRACP, PhD
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