Metabolic & Cardiometabolic
anabolic-androgenic steroids causes testicular atrophy and impaired fertility
In plain terms: Do anabolic steroids cause testicular shrinkage and reduced fertility?
Strong support Metabolic & Cardiometabolic 🔬 Includes disconfirming
Part of: 💊 anabolic-androgenic steroids
RefutedContestedStrong support
consensus score 0.92
Yes — steroids suppress the body's own testosterone and sperm production, shrinking the testes and often causing infertility; it usually recovers over months after stopping but sometimes incompletely.
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
25 support 0 contradict 1 tested null 1 mixed · 27 sources, 25 independent groups · 1 superseded — pooled inside a review, counted once
The evidence (28)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Vorona 2018 · Minerva Endocrinol | observational | supports | moderate | Review states AAS cause reversible suppression of spermatogenesis up to azoospermia via HPG-axis negative feedback. |
| Hashimi 2025 · Asian J Androl | observational | supports | high | Review documents exogenous testosterone/AAS as a well-established cause of HPG-axis suppression, impaired spermatogenesis and azoospermia. |
| Ding JB et al 2021 · study_type: mechanism | observational | supports | moderate | Review of AAS misuse mechanisms/patterns/user typology states AAS are associated with infertility among other adverse effects (cardiac death, neuropsychiatric), citing ~6% lifetime male prevalence. |
| Mulawkar PM et al 2023 · study_type: meta-analysis | meta-analysis | supports | high | Systematic review/meta-analysis of 32 studies (9,371 individuals, 2,671 AAS users): AAS users had lower FSH/LH than controls, persisting 3-6 months post-cessation but normalizing by 1 year; testicular size and sperm motility were lower in u |
| ElShebiney S et al 2025 · study_type: animal | animal | supports | moderate | In rats, Stanozolol (5 mg/kg/wk) alone or combined with cannabis for 2 months caused testicular tissue injury, reduced free testosterone/FSH/LH, increased oxidative stress (MDA up, GSH down) and histopathological damage; exercise partially |
| Bocu K et al 2025 · study_type: mechanism | observational | supports | low | Narrative review of lifestyle factors and male fertility lists substance use (including steroids) among factors impairing spermatogenesis and sperm quality via oxidative stress and hormonal disruption, but calls for more rigorous research o |
| Sukegawa 2020 · Acta Urol Jpn | observational | supports | low | Exogenous testosterone suppressed gonadotropins producing azoospermia to severe oligospermia, with variable recovery time after cessation. |
| Szabó A et al 2025 · study_type: mechanism | observational | supports | low | Review of lifestyle/environmental fertility factors states drug use, particularly steroids, cannabis, and opioids, may suppress fertility, alongside HPG-axis disruption from other exposures; frames many risks as 'often reversible.' |
| Di Girolamo FG et al 2024 · study_type: observational | observational | tested-null | low | Cross-sectional study of 92 male bodybuilders (43% hormone abusers, 95% of those using AAS) found lower HDL-cholesterol and higher ALT/AST in hormone abusers vs controls; endpoints measured were metabolic/lipid/liver doping-detection marker |
| Christou 2017 · Sports Med | observational | supports | high | Systematic review and meta-analysis found AAS use markedly suppresses gonadotropins and spermatogenesis, reducing sperm concentration and testicular volume. |
| Bond P et al 2022 · study_type: mechanism | observational | supports | moderate | Comprehensive review of AAS pharmacology/receptor binding lists testosterone deficiency and erectile dysfunction among documented side effects, with treatment/self-medication options discussed. |
| Kamali Hosseinzadeh F et al 2024 · study_type: animal | animal | supports | moderate | In rats, Sustanon (10/20/30 mg/kg, 8 weeks) significantly reduced testicular length, diameter, and weight, sperm count, and LH/FSH concentrations versus control, with histological damage; BCL2 expression fell in treated groups. |
| Hohl A et al 2026 · study_type: mechanism | observational | supports | moderate | Multidisciplinary consensus statement noting AAS use has increased frequency of functional male hypogonadism, and recommends fertility-preserving strategies (SERMs, hCG, aromatase inhibitors) when treating hypogonadism. |
| Kumar 2025 · Basic Clin Androl | observational | supports | moderate | Testosterone/AAS abuse suppresses intratesticular testosterone causing impaired spermatogenesis, testicular atrophy and azoospermia, with prolonged or incomplete recovery. |
| Kanayama 2015 · Addiction | observational | supports | moderate | Long-term AAS misusers frequently showed prolonged hypogonadism after discontinuation, an under-recognized reproductive consequence. ↩ SUPERSEDED — pooled in the review above, counted once |
| Bonnecaze AK et al 2021 · study_type: mechanism | mechanism | supports | moderate | Review of harm reduction in AAS/PED users notes prior studies reveal AAS association with infertility, polycythemia, dyslipidemia, hypertension, and left ventricular hypertrophy, plus a distinct AAS withdrawal syndrome complicating cessatio |
| Rasmussen 2016 · PLoS One | observational | supports | moderate | Current and former AAS abusers exhibited suppressed testosterone and hypogonadal symptoms, including reduced testicular function, persisting years after cessation. |
| Tatem AJ et al 2020 · study_type: mechanism | observational | supports | moderate | Review states exogenous testosterone/AAS use 'almost universally impairs spermatogenesis and can even completely eradicate it in some men,' and discusses novel fertility maintenance/recovery strategies for affected men. |
| Dos Santos JC et al 2024 · study_type: observational | observational | supports | low | Cross-sectional survey of Brazilian bodybuilders using AAS reported acute effects (acne, irritability, alopecia) and chronic effects (hypertension, liver disease, cancer); testicular atrophy/infertility endpoints were not among the specific |
| Al Hashimi M et al 2023 · study_type: observational | observational | supports | low | Cross-sectional survey of 151 clinicians managing AAS abusers: patients commonly presented with infertility (64%), abnormal semen analysis (77%), abnormal hormones (95%), and reduced testicular size (50%); recovery often required 6-12 month |
| Hammood MN et al 2026 · study_type: animal | animal | supports | moderate | In male rats, all Stanozolol doses (5/10/15 mg/kg, 60 days) significantly decreased testicular weight, sperm concentration, viability and motility, and increased sperm abnormalities (p<0.05); Johnsen score and tubule diameter fell significa |
| Easton J et al 2025 · study_type: observational | observational | mixed | low | Qualitative/digital ethnography of AAS forum discourse on post-cycle therapy (PCT); consumers reported concerns about hormonal imbalance and long-term damage as drivers for seeking PCT advice, with no clinical guidelines or prospective data |
| Solanki 2023 · Endocr Connect | observational | supports | moderate | Scoping review found testicular atrophy and suppressed spermatogenesis are expected after AAS abuse, recovering over months to years but sometimes incompletely. |
| Jafari H et al 2021 · study_type: observational | observational | supports | low | Systematic review of factors affecting male infertility in Iranian men (26,324 infertile males across 14 studies) lists anabolic steroids among established contributing factors alongside varicocele, smoking, obesity. |
| Magnolini R et al 2025 · study_type: in-vitro | observational | supports | low | Case report: 38-year-old bodybuilder with years of supraphysiologic AAS use presented with testicular atrophy, suppressed LH/FSH, and androgen-induced hypogonadism; hormonal recovery regimen (tamoxifen, hCG) attempted but he later developed |
| Skrzypiec-Spring M et al 2024 · study_type: observational | observational | supports | low | 50-year case-report analysis (1973-2022) of AAS-related clinical complications found endocrinological, hepatic, oncological, and cardiological adverse events increasing over decades; frames AAS as a significant lifestyle contributor to infe |
| Oduwole 2014 · FASEB J | animal | supports | moderate | Exogenous testosterone doses that suppressed gonadotropins consistently blocked spermatogenesis in a knockout mouse model, supporting the fertility-suppression mechanism. |
| Kowalik K et al 2026 · study_type: mechanism | observational | supports | low | Narrative review synthesizing clinical/experimental/epidemiological data on AAS-driven HPG-axis suppression, impaired spermatogenesis, and fertility disturbances, with clinical strategies for hormonal recovery discussed. |
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