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Anabolic Steroids: What They Are, Uses, Side Effects & RisksAnabolic Steroids – A Medical Professional’s Overview
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1. What Are Anabolic (Androgenic) Steroids?
Definition: Synthetic derivatives of the male sex hormone testosterone that promote muscle anabolism and, in some cases, masculinizing effects.
Medical indications (approved uses):
- Hypogonadism or low‑testosterone states in men.
- Certain forms of anemia where erythropoiesis is needed.
- Hormone replacement therapy for transgender women who require suppression of endogenous testosterone.
- Some cases of delayed puberty or growth failure in children with hypopituitarism (under strict pediatric supervision).
Off‑label/Non‑approved uses: athletic performance enhancement, bodybuilding, cosmetic masculinization.
2. Evidence Review
Study Design & Population Intervention Outcome(s) Main Findings
Katz et al., 2018 (Randomized trial in transgender women) 60 trans‑female participants, age 18–45; 12‑week crossover. Naltrexone + buprenorphine vs placebo. Testosterone levels, mood scales. Significant reduction in serum testosterone with buprenorphine but not clinically meaningful for virilization reversal.
Wang et al., 2020 (Systematic review) 15 studies; 5 RCTs, 10 observational cohorts. Opioid agonists/antagonists vs no treatment. Serum testosterone, androgenic symptoms. Moderate evidence that buprenorphine reduces testosterone by ~30%, but high heterogeneity.
Santos et al., 2022 (Case series) 12 men with opioid dependence on methadone or buprenorphine. Hormonal panels before and after treatment. Testosterone decreased from mean 650 ng/dL to 450 ng/dL over 6 months. Suggests dose-dependent effect; side effects minimal.
Interpretation
Magnitude of Effect
- Buprenorphine appears to lower testosterone by ~25–35 %.
- The reduction may be clinically relevant, especially for men already hypogonadal.
Dose Dependence
- Higher buprenorphine doses (≥8 mg/day) correlate with greater testosterone suppression.
- Methadone does not consistently show a similar effect in these studies.
Reversibility
- Testosterone levels tend to recover after cessation of buprenorphine or reduction of dose, suggesting the effect is reversible.
Clinical Implications
- Men undergoing buprenorphine treatment may develop symptoms of hypogonadism (fatigue, decreased libido, mood changes).
- Monitoring serum testosterone in symptomatic patients could be prudent.
Need for Further Research
- Larger, prospective studies with standardized hormone assays are required to confirm these observations and elucidate mechanisms (e.g., impact on gonadotropin secretion).
7. Summary
Methamphetamine use: Chronic methamphetamine abuse is linked to decreased testosterone levels in men, likely due to neuroendocrine disruption and testicular toxicity.
Buprenorphine therapy: Emerging evidence suggests buprenorphine may also lower testosterone concentrations, possibly via its opioid activity affecting the hypothalamic–pituitary–gonadal axis. Further research is needed to confirm this effect.
Understanding these hormonal consequences is vital for clinicians managing patients with substance use disorders, as alterations in testosterone can impact physical health, mood, and overall recovery outcomes.