Livehealthy.ae is shining a spotlight on men’s health in the UAE throughout Movember (that explains the moustache on our social media logo). This article on the steroid-infertility paradox is one of a series of stories on the subject.
A growing number of men are using steroids out of social pressure to look good. But they are either unaware of or ignoring how it affects their fertility, experts warn.
A study conducted in Denmark and published in the Journal of Internal Medicine in March found that steroid use in men leads to a 90 percent chance of becoming sterile. Mortality was also found to be three times higher among steroid users, the study found.
According to Dr Francisco Ruiz, medical director at the IVI Fertility Clinic, in Muscat, Oman, if steroids were taken in larger doses for longer than a year, that damage to fertility can be irreversible.
“We need to raise awareness about the side effects of these steroids to facilitate an informed decision about taking these drugs,” said Dr Ruiz. “We strongly recommend discontinuation of anabolic steroids altogether to protect health and fertility of the users.”
Anabolic steroids should be prescribed only as a replacement therapy to patients who have deficiency in these hormones, according to established guidelines and under the supervision of a specialist physician.
In addition to infertility, there is a long list of side effects associated with non-medical steroid use: acne, hair loss, irritability, mood fluctuations, kidney and liver problems up to organ failure and disturbed blood cholesterol and triglycerides, predisposing younger men to greater risk of heart attacks and strokes.
Men may also experience sexual dysfunction, loss of libido, a weak or no erection and gynecomastia, or enlarged breasts.
Image-conscious teenagers who take steroids may suffer from stunted growth, while men over 50 expose themselves to a greater risk of prostate cancer.
Patrik Hedqvist, the Swedish head coach at Desert Barbell in Dubai, which promotes drug-free sport, says steroid use in the fitness and bodybuilding world has definitely increased over the years.
He sees it mostly in young people, many spurred on in their quest to be “insta-famous.” People seem to understand the impact steroid use can have, he says; but just forge ahead anyway.
“I believe people are aware of the side effects,” he says. “Generally, they just take a calculated risk. Most know the risks. Mainly, it’s among young people.”
Simon Pepper, an Abu Dhabi trainer and member of livehealthy.ae’s expert panel, says he has been offered steroids in the UAE.
“It’s pretty obvious from some of the guys — and girls — in various gyms that they are definitely not ‘au naturel’,” he says.
UAE law dictates that anabolic steroids should only be used if they have been prescribed by a licensed physician, but men can be tempted into illegal use by the prospect of fast results.
“Users of anabolic steroids are led to believe in fast results by the initial surge when they start consuming these hormones,” warns Dr Moharram. “They feel stronger, they rapidly grow bulkier muscles, their libido and sexual performance are at their best ever.”
Problems arise soon after, when the steroids begin to interfere with the body’s natural processes and spark a physiological response called “negative feedback.”
In healthy men, the pituitary gland ensures that the testes are producing the amount of testosterone they need. But if the level is low for any reason, the pituitary gland secretes a stimulating substance, ordering the testes to produce more testosterone to maintain a normal level. The negative feedback loop sparked by taking anabolic steroid comes when the additional testosterone levels in the blood are registered as too high by the pituitary gland.
“The pituitary is unable to recognise if this testosterone is from the testes or from outside,” Dr Moharram explains. “So it automatically orders the testes to ‘hold’ working in an attempt to keep a normal testosterone level in the blood.”
As testosterone is needed for sperm production, fertility is reduced soon after and, depending on how long the steroids were taken for and the quantity used, can be irreversible.
“During my career as a urologist and an andrologist, I have come across numerous young patients using anabolic steroids to build their muscles, but most of these patients have no idea about the damage that they are doing to their own body, especially in terms of long-term health and fertility,” Dr Muthanna Alrawi, a consultant in urology at the UAE’s Canadian Specialist Hospital.
Although no studies have been done comparing the impact of steroid use on fertility in the UAE with other countries, physicians know that we need to raise awareness about the detrimental effect of abusing anabolic steroids in the UAE.
“We need to make an effort to educate people about the side effects, especially infertility,” says Dr Alrawi.
Dr Ahmed Moharram, a specialist in urology at Bareen International Hospital in MBZ City, Abu Dhabi, says the problem is growing.
“I am regularly having an increasing number of patients, mostly 20 to 40 years old, who are used to taking anabolic steroids from their gym trainer without knowing any potential side effects that they may suffer,” he said. “This is simply because the gym trainer is not an authorized medical professional to subscribe medicine and most of them do not know how to handle the side effects such as overdose and so on.”