Too Much Too Long: Steroids, Testosterone and Male Fertility

Posted on by Paul Turek, MD
The steroid free fall is not a pretty sight (Courtesy: Unsplash.com)

The “point-of-no-return” concept is everywhere in our lives. Innocence, virginity and aging are all great examples of the irreversibility of life. In the past it never occurred to me that steroid-induced male infertility followed the same laws of nature. But it does.

Steroid Freefall

I have taken care of men from around the globe who want to get off the juice. Bodybuilding or competitive sports days now over, they dream of families, kids and life without regular ’roid injections. But it’s not that simple. The hormonal cliff they face when they stop is a treacherous enough freefall to stop them in their tracks like deer in headlights.

Smooth Landing

I’ve had great success “landing the plane” with the vast majority of men who cannot break the steroid spell. I offer several levels of medical intervention depending on the extent and severity of anabolics used:

  • Low and slow: A gradual tapering off of steroid injections over several months to allow the return of normal hormonal signaling and natural testosterone production.
  • Medium push: A gradual tapering off of steroids accompanied by pituitary stimulation using clomiphene citrate to jump-start the recovery.
  • High and hard: A gradual tapering off of steroids along with aggressive replacement of the testicular stimulants LH (hCG) and FSH by injection.

Although these medical-grade regimens are workhorse formulas in getting the steroid-suppressed testicle to make both testosterone and sperm again, in some cases there is minimal recovery. All the stimulation in the world just can’t fire up the turned-off testicle to make enough testosterone or sperm to support quality of life or fertility.

Call the Code

Although the testicle usually recovers very well from most insults it receives — say from fevers, hot baths, medications, and severe physical stress — it may not fare as well after longstanding suppression from anabolic steroids. (I begin to worry about regaining testicular function after 5-10 years of steroid use.) A lot depends on the dose, duration and frequency of the steroids taken. Constant use of testosterone injections is more detrimental to testicular recovery than are classic cycling and stacking steroid regimens, as the latter give the testicle some opportunity to “catch its breath” before going under again. The honest truth is that the testicle is not as resilient as we once believed, so lend it respect when building your biceps.