About 65% of men who stop anabolic steroids restart, likely due to withdrawal symptoms.
Worsened mental health and sexual function should be targeted during the first year of steroid cessation.

In the first year after discontinuing anabolic steroid misuse, men experienced worse sexual function, as well as increased depression and anxiety, compared to those who continued using the drugs or had never used them, according to a presentation at ENDO 2024.

Anabolic-androgenic steroids, drugs with effects similar to testosterone, are used by approximately 6.4% of men worldwide, often in gym settings for bodybuilding and aesthetic purposes, explained Bonnie Grant, MBBS, a clinical researcher at Imperial College London, during a press briefing. These steroids can lead to hypogonadism, adverse cardiometabolic effects, and infertility during use. Upon discontinuation, adverse effects include persistent hypogonadism, depression, suicidal ideation, low libido, erectile dysfunction, fatigue, and dependence syndrome.

“Many men—around 65%—restart using anabolic steroids within the first year, often due to difficult withdrawal symptoms,” Grant told Healio. “[Our study] highlights potentially treatable factors that could alleviate symptoms men face when they stop using anabolic steroids within the first year.”

To assess withdrawal symptoms, Grant and her colleagues conducted a cross-sectional, observational study with 245 men. Of these, 45 (mean age 38.6 years; 60% white; 11% Asian British) had never used anabolic-androgenic steroids, 116 (mean age 36.2 years; 75.8% white; 16.4% Asian British) were current users, and 84 (mean age 35.6 years; 75% white; 21.4% Asian British) had discontinued use within the past year. Among the never-users, 6.6% had a psychiatric diagnosis, and 17.7% reported illicit drug use. Among current users, 29% had a psychiatric diagnosis, and 47.4% reported illicit drug use. Among recent quitters, 25% had a current psychiatric diagnosis, and 40.5% reported illicit drug use.

The researchers used questionnaires to assess substance misuse, the Beck Depression Inventory-II (BDI-II) and General Anxiety Disorder-7 (GAD-7) scale for mental health (with higher scores indicating more severe depression or anxiety), the International Index Erectile Function-15 (IIEF-15) scale for sexual function (with lower scores indicating worse function), and fasting morning blood samples and urine toxicology to evaluate hormone levels.

As expected, current steroid users had higher testosterone and lower luteinizing hormone and follicle-stimulating hormone levels compared to those who had never used or had stopped using steroids.

Men who had recently stopped using steroids reported lower sexual function scores (IIEF-15 = 70; 95% CI, 67-71) compared to current users (IIEF-15 = 64; 95% CI, 60-67) and past users (IIEF-15 = 64; 95% CI, 60-67; P = .0009). Additionally, higher luteinizing hormone levels were associated with poorer sexual function (coefficient, –2.6; 95% CI, –4.9 to –0.7; P = .01).

Recent steroid cessation was linked to higher depression scores (BDI-II = 7; 95% CI, 4-11) compared to those who had never used steroids (BDI-II = 3; 95% CI, 1-6; P = .0079).

Quitting steroids appeared to worsen existing mental health conditions. Depression scores tripled for recent quitters with a psychiatric diagnosis compared to those without (OR = 3.04; 95% CI, 1.72-5.38; P < .001), while current steroid users with a psychiatric diagnosis had double the depression scores compared to those without (OR = 2.04; 95% CI, 1.34-3.09; P = .001).

Men who quit steroids within the past year also exhibited higher anxiety scores (GAD-7 = 2; 95% CI, 1-3) compared to never-users (GAD-7 = 1; 95% CI, 0-2; P = .035).

“We don’t yet know how long [men who stop using steroids] experience symptoms of depression and sexual dysfunction,” Grant told Healio. “Further studies are needed, but ultimately, support for men quitting steroids will likely involve addressing hormone loss and the psychiatric aspects, requiring a joint approach from physicians and psychiatrists.”