Steroid misuse and the inevitable decline in fertility

Anabolic steroids are no longer a fringe issue confined to elite sport or tabloid scandals. They’ve slipped into everyday life, used by men who want to feel leaner, stronger, and more in control of their bodies in a culture that prizes visible results.

What’s harder to see, and far less discussed, are the repercussions of steroid misuse. Reproductive specialists are seeing more men in their twenties and thirties, otherwise healthy, turning up with infertility. And, despite having stopped their steroids months ago, they find that some things don’t quite reset.¹

From enhancement to dependence

Estimates suggest that around 4% of men will use anabolic-androgenic steroids (AAS) at some point in their lives, with prevalence rising to as high as 30% among gym-going men. Crucially, around 80% of use is for body enhancement, not competitive sport.¹

What’s driving this shift isn’t competition, but comparison. A constant exposure to curated, enhanced bodies has normalised the idea that looking exceptional should be achievable, and if it isn’t, the problem must be you.

But this misinformation rarely comes from doctors. It comes from blogs, YouTube channels, Reddit threads, and word of mouth. Information spreads easily, presented as science, but often without clinical context or safeguards.^2,3 Add to that a poorly regulated supplement market where up to 15% of supplements have been found to be contaminated with anabolic agents, and the line between “natural” and pharmaceutical blurs quickly.⁴

What steroids actually do to fertility

Sperm production depends on very high levels of testosterone inside the testes - far higher than what circulates in the bloodstream. That local testosterone production is driven by signals from the brain: luteinising hormone (LH) and follicle-stimulating hormone (FSH).⁵

When someone injects or takes anabolic steroids, the brain senses excess androgen and shuts those signals down, causing LH and FSH to fall, collapsing testicular testosterone production.⁶ Clinically, this shows up as oligozoospermia (very low sperm count) or azoospermia (no sperm). It’s known as anabolic-steroid-induced hypogonadotropic hypogonadism (ASIH).⁶

In many cases, stopping steroids allows sperm production to recover. Studies suggest most men regain their ability to produce sperm within 4-12 months. But that’s far from guaranteed.⁷ Heavy dosing, long cycles, and stacking multiple compounds make recovery slower and less predictable.

The pressure to rush fertility treatment

Because recovery is slow and poorly understood, couples often move quickly to assisted reproductive technologies like IVF, sometimes before natural recovery has had time to occur.¹

This can be emotionally and financially exhausting, and in hindsight, unnecessary. Recovery timelines from a controlled testosterone study (used historically as male contraceptives) showed that nearly all men regained sperm production within 15 months after stopping, even after prolonged suppression.⁸ But steroid abuse rarely resembles those controlled conditions, oftentimes because doses are higher, compounds are mixed, and quality is uncertain.

Medicine doesn’t yet have perfect data for these scenarios, partly because studying illicit drug use ethically is almost impossible.

Why “just stopping” isn’t always enough

Stopping steroids can also trigger withdrawal, which can show up as:⁹

• Depression

• Fatigue

• Loss of libido

• Insomnia

• A strong urge to restart

This is where many men fall into a gap in care. Some clinicians are hesitant to treat steroid-induced hypogonadism, worried about enabling dependency.¹⁰ Others recognise the reality that these men aren’t looking to abuse hormones, but are dealing with the consequences of having already done so.

The path to regulated testosterone care

Unregulated steroid use and medically supervised testosterone treatment are not the same thing. One floods the system with doses higher than what the human body needs, and the other aims to restore balance, monitor effects, and plan for fertility.

In men whose natural hormone production has been suppressed, clinicians may use structured testosterone treatment alongside fertility-preserving strategies, or avoid testosterone altogether in favour of agents that stimulate the body’s own production.¹¹

Evidence suggests that with proper medical oversight, fertility can often be restored even years after steroid use.¹¹ But it requires patience, monitoring, and a willingness to step away from the black-market logic of cycles and quick fixes.

The numan take

The rise in steroid misuse reflects a culture that rewards physical optimisation while leaving little room for limits or long-term health. In chasing strength, many men are unknowingly disrupting their hormone balance and fertility, often without realising the consequences until years later.

The good news is that much of this harm is preventable, and in many cases reversible. Stepping away from illicit steroids and working with a clinician to assess hormones and, where appropriate, transition to regulated testosterone treatment can help restore balance without further compromising fertility.

References

1. Nangia AK. Anabolic steroid abuse: a paradox of manliness. Fertil Steril. 2014;101(5):1247.

2. Chan GJ, Fung M, Warrington J, Nowak SA. Understanding health-related discussions on Reddit: Development of a topic assignment method and exploratory analysis. JMIR Form Res. 2025;9:e55309.

3. Dubin JM, Aguiar JA, Lin JS, Greenberg DR, Keeter MK, Fantus RJ, et al. The broad reach and inaccuracy of men’s health information on social media: analysis of TikTok and Instagram. Int J Impot Res. 2024;36(3):256–60.

4. Geyer H, Parr MK, Koehler K, Mareck U, Schänzer W, Thevis M. Nutritional supplements cross-contaminated and faked with doping substances. J Mass Spectrom. 2008;43(7):892–902. 

5. Nishimura H, L’Hernault SW. Spermatogenesis. Curr Biol. 2017;27(18):R988–94. 

6. Solanki P, Eu B, Smith J, Allan C, Lee K. Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review. Endocr Connect. 2023;12(12). 

7. Injac R. Spermatogenesis recovery treatment in less than four months from zero to almost 16 million sperms per milliliter after several cycles of steroids in 44-year-old healthy man. Clin Case Rep. 2023;11(11):e8159.

8. Gu Y, Liang X, Wu W, Liu M, Song S, Cheng L, et al. Multicenter contraceptive efficacy trial of injectable testosterone undecanoate in Chinese men. J Clin Endocrinol Metab. 2009;94(6):1910–5.

9. Sharma A, Grant B, Islam H, Kapoor A, Pradeep A, Jayasena CN. Common symptoms associated with usage and cessation of anabolic androgenic steroids in men. Best Pract Res Clin Endocrinol Metab. 2022;36(5):101691.

10. Park HJ. Anabolic steroid-induced hypogonadism: a challenge for clinicians. J Exerc Rehabil. 2018;14(1):2–3.

11. Rajmil O, Moreno-Sepulveda J. Recovery of spermatogenesis after androgenic anabolic steroids abuse in men. A systematic review of the literature. Actas Urol Esp (Engl Ed). 2024;48(2):116–24.