Getting Off the Juice

Posted on by Paul Turek, MD

The case of the month is a patient of The Turek Clinic. This week, it highlights my recent lecture to the Northern California Chapter of the American Association of Clinical Endocrinologists in San Francisco (view presentation at the bottom of this post or on Slideshare).

Addicted to Juice

This 30-year old man is guessing that he is sterile when he sees me. He is engaged to be married but shows up in the office alone. A very muscular man, he has been bodybuilding for years. When questioned, he admits to a 3-year history of stacking and cycling various anabolic steroids. He says that he stopped 6 months ago as he read that they can cause sterility and he eventually wants to have children. I checked his semen analysis and he is indeed azoospermic (sterile) but his testosterone is quite high at 1050 ng/mL (normal 300-800). When pushed further, he admits to still taking testosterone gels daily and that “I am scared that I will bottom out if I stop the juice. Please help me!”

De-Juicing

Anabolic steroid use is very common among professional, college and even high school athletes. Recreational use for bodybuilding is also rampant. Although it increases muscle mass, steroids also cause sterility. When trying to stop, another problem is that, similar to an addiction, men may have withdrawal symptoms or “bottom out” before suppressed natural testosterone levels rise to normal again. During this time, men feel terribly fatigued, with very low motivation and energy. The knee-jerk response to avoid this issue is to take testosterone at physiologic doses. However, this is also a male contraceptive. Despite the turmoil of withdrawal, I always encourage men to dump the juice entirely and I offer medical support during this difficult transition. I see it as landing a fighter jet as smoothly as possible.

Support for Stackers

There are several ways to prevent withdrawal symptoms after stopping steroids. Some work better than others. All are discussed with patients motivated to pitch pumpers:

  • Simply stop and wait. Natural testosterone levels should return over 1-3 months but this approach leaves the body wide open to hormonal collapse.
  • Oral clomiphene citrate. Off-label use of this female fertility pill in men increases pituitary hormone output that stimulates natural testosterone and sperm production. When given with a steroid taper, natural hormones are stimulated sooner, enabling a quicker recovery.
  • Injectable hCG. The gonadotropin LH (luteininzing hormone) in the form of human chorionic gonadotropin injections, is a more powerful stimulant of natural testosterone production than is clomiphene. It “wakes up” the hormonal system even faster than clomiphene. Unlike clomiphene, though, it does not support sperm production.

What to Expect

With medical help, virtually all men can achieve physiologic levels of testosterone within 3 to 4 months of treatment. However, the response varies with baseline hormone levels and duration and dose of steroid use. Sperm production normalizes in 90% of men by one year. When tackling this issue, I remind men that a year from now, you will wish that you did this today.