Peculiarity of recovery of the hypothalamic–pituitary–gonadal (HPG) axis, in men after using androgenic anabolic steroids

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  • Authors: Lykhonosov M.P.1, Babenko A.Y.2,3, Makarin V.A.4, Fedotov Y.N.4
  • Affiliations:
    1. Pavlov First Saint Petersburg State Medical University
    2. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
    3. Almazov National Medical Research Centre, St. Petersburg, Russia
    4. University hospital of Saint-Petersburg State University, St. Petersburg, Russia
  • Issue: Vol 66, No 1 (2020)
  • Pages: 104-112
  • Section: Reproductive Endocrinology
  • URL:
  • DOI:
  • Cite item
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BACKGROUND: Spontaneous recovery of the hypothalamic–pituitary–gonadal (HPG) axis after cessation of testosterone replacement therapy or after male contraception may take up to 24 months. There is insufficient data on the duration of recovery of HPG axis after abuse of androgenic anabolic steroids (AAS). AAS users use post-cycle therapy (PCT) to restore HPG axis, the effectiveness of which is unknown and needs further investigation.

AIMS: To evaluate the recovery of HPG axis in men, AAS users, after a 3-month of cessation of their use and after PCT.

METHODS: An observational, single-center, prospective, sampling, open, uncontrolled study was conducted among male AAS users. While using of AAS and 3 months after the refusal of their administration and PCT, the clinical symptoms of hypogonadism were evaluated, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (Tt), prolactin, estradiol, inhibin B, thyroid-stimulating hormone (TSH) were determined. The scheme of rehabilitation therapy was the same and did not change throughout the study. Recovery criteria: Tt >3.4 ng/ml and LH >1.24 mIU/ml. The study was conducted from January to August 2019. Fisher’s exact test, Mann-Whitney U-test, and Spearman’s rank correlation coefficient were used. The differences were considered statistically significant at p<0.05.

RESULTS: The study included 44 men, their age 29 years [27.75; 34], the duration of the use of AAS is 6 months [3.52; 7]. During the use of AAS: LH 0.2 mIU/ml [0.04; 0.47], Tt — 4.34 ng/ml [1.05; 8.81]. In this group, the number of men with a LH level <1.24 mIU / ml was 84% (n=37) and Tt <3.4 ng/ml was 47.7% (n=21). After 3 months, the LH level reached 4.12 mIU/ml [2.58; 5.84], Tt — 4.55 ng/ml [3.76; 6.24]. At the same time, the level of Tt <3.4 ng/ml remained in 20.5% (n=9), and LH <1.24 mIU/ml in 4.5% (n=2) men. According to the level of recovery of LH and Tt, patients were divided into two groups: with satisfying (n=35; 79.5%) and poor (n=9; 20.5%) recovery. A clear correlation was established between the duration of use (-0.857; p<0.0001), the amount (-0.443; p=0.003), the dose (-0.7825; p<0.0001), the type of AAS (-0.698; p<0.0001) and testosterone level recovery. A correlation between inhibin B and Tt (0.418; p=0.005) was revealed.

CONCLUSIONS: A three-month refusal to use AAS with PCT led to the restoration of HPG axis a in 79.5% of the volunteers. In 20.5% of cases, recovery did not occur. The negative effect of the duration of use, the number of simultaneously administered drugs, their dose and type of AAS on the restoration of HPG axis was established. The level of inhibin B may serve as a marker for the restoration of spermatogenic epithelium.

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About the authors

Mykola P. Lykhonosov

Pavlov First Saint Petersburg State
Medical University

Author for correspondence.
ORCID iD: 0000-0001-6460-5226
SPIN-code: 2102-5358

Russian Federation, 6/8 L’va Tolstogo street, St. Petersburg, 197022 Russian Federation

MD, PhD student Pavlov First Saint Petersburg State
Medical University

Alina Y. Babenko

Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia;
Almazov National Medical Research Centre, St. Petersburg, Russia

ORCID iD: 0000-0002-0559-697X
SPIN-code: 9388-1077

Russian Federation, 6/8 L’va Tolstogo street, St. Petersburg, 197022 Russian Federation; 2 Akkuratova street, St. Petersburg 197341

MD, associate professor of the faculty of therapy with a course of endocrinology, cardiology and functional diagnostics named after G.F. Langa with the clinic of the First St. Petersburg State Medical University named after Acad. I.P.Pavlova Ministry of Health of Russia

Viktor A. Makarin

University hospital of Saint-Petersburg State University, St. Petersburg, Russia

ORCID iD: 0000-0003-1710-8045
SPIN-code: 8885-2085

Russian Federation, Universitetskaya nab., 7/9, St. Petersburg, 199034

MD, PhD, Head of the medical and diagnostic complex for Korablestroitelej University hospital of Saint-Petersburg State University

Yury  N. Fedotov

University hospital of Saint-Petersburg State University, St. Petersburg, Russia

ORCID iD: 0000-0003-0445-9428

Russian Federation, Universitetskaya nab., 7/9, St. Petersburg, 199034

MD, PhD, Professor, First Vice-Rector for Medical Activities, Director of the N. I. Pirogov Clinic for High Medical Technologies


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