Risk factors

Cardiac effects of androgen abuse are reversible

The adverse effects of androgen abuse on cardiac function in young men appear to be fully but slowly reversible on cessation of testosterone use, Australian research shows.

A Sydney University study of 41 current and 31 past users of illicit androgens found that reproductive and cardiac recovery time varied from 7-14 months.

Impairment in cardiac function was restored to normal levels in former users of androgens, though there was some residual deficit in functional echocardiographic parameters  (global myocardial strain) of LV function.

But testicular volume was halved in current users compared to a control group of non users (14 vs 28ml) and remained lower than normal (19ml) in former users after an average of 2.5 years since stopping use of androgens.

The findings came from a cohort of young men who started using androgens at an average age of 25 and who used anabolic steroids for a median of 2.4 years. Most of them reported using injectable agents such as DHEA.

The analysis by researchers at the Concord Repatriation General Hospital and ANZAC Research Institute, showed that all current androgen abusers had significant suppression of reproductive function, impaired cardiac systolic function and lipoprotein parameters compared with non or past users. Nevertheless, recovery of suppressed reproductive and cardiac functions was seen after ceasing androgen abuse, with past users not differing from non-users in almost all parameters except for testicular volume.

Left ventricular interventricular septum thickness and posterior wall thickness were were significantly greater in current androgen users than in non-user controls, but still within the normal range. Past users did not differ from non-user controls in both variables.

LV mass was increased in current androgen users compared to non-user controls, but former users showed no difference to non users.

LV ejection fraction was within the normal range in all groups. However, global longitudinal strain, a more sensitive marker of LV function, was reduced amongst current users compared with non-user controls. Again, past users did not differ from non-user controls.

Early LV relaxation velocity (E’), a marker of diastolic function, was reduced in current users relative to non-user controls for both septal and lateral E’. Again, past users did not differ from non-user controls in each of these variables.

Coronary artery calcification was not different between groups with a median score of 0 in all groups.

The adverse effects of androgen use on lipids (serum HDL, triglycerides) and systolic function (LV mass) showed reversibility after cessation but slower rates of recovery of some cardiac parameters such as LV global longitudinal strain were observed and may convey long term adverse prognostic cardiovascular risk.

The study authors said the small amount of previous research had suggested incomplete recovery of reproductive function after androgen abuse, but the current findings showed that the negative feedback of exogenous testosterone on the HP axis was mostly reversible.

“Overall, these findings are most consistent with a reversible effect on testicular hormone secretion but an additional cumulative, detrimental effect on sperm production with prolonged androgen-induced suppression of spermatogenesis as evident in the residual effect on testis volume.

However they cautioned that the findings could not be generalised to older men or longer durations of androgen misuse.

The findings are published in the Journal of Clinical Endocrinology and Metabolism.

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