Health consequences of anabolic steroids: a sexual-medicine perspective

Abstract Nonmedical anabolic–androgenic steroid (AAS) use is increasingly encountered in sexual medicine practice, often presenting through sexual symptoms or fertility concerns rather than overt systemic illness. This review summarizes the major health consequences of AAS abuse with emphasis on sexual and reproductive sequelae and provides a pragmatic approach to evaluation and recovery after cessation. AAS exposure commonly suppresses the hypothalamo–pituitary–gonadal axis, leading to hypogonadism and hormonal imbalance that may manifest as reduced libido, erectile dysfunction, gynecomastia, and impaired spermatogenesis ranging from severe oligozoospermia to azoospermia. Recovery after discontinuation is heterogeneous: endocrine parameters frequently normalize earlier than semen parameters, and prolonged/high-dose exposure is associated with delayed or incomplete recovery in a clinically meaningful subset. Beyond sexual and reproductive harm, convergent observational evidence supports increased cardiovascular risk (remodeling, dysfunction, and adverse events), hepatic injury (particularly with 17α-alkylated agents), hematologic/prothrombotic changes, tendon pathology, neuropsychiatric symptoms, and dermatologic complications, with risk shaped by dose, duration, and polypharmacy. In the absence of robust randomized trials, management should prioritize AAS cessation and relapse prevention. Clinicians should actively screen for organ-specific sequelae and individualize follow-up based on symptom burden, hormonal status, fertility goals, and time since last exposure, with selective use of pharmacological induction of recovery when clinically appropriate.