Clinical features of androgen abuse withdrawal in men during the first year of cessation: a community dwelling study.

Abstract

Androgen abuse is an increasing public health concern, particularly among young men seeking muscular or image enhancement. Although most achieve biochemical recovery within 12 months of cessation, mood disturbances, sexual dysfunction, and fatigue is widely reported for years afterward. To examine symptom severity the relationship to biochemical recovery during the first year after androgen abuse cessation. We conducted a cross-sectional study of community-dwelling men grouped as non-users, current users, or past users who had ceased within the last 12 months. Participants completed questionnaires on androgen and substance use and four validated instruments assessing mood (BDI-II), anxiety (GAD-7), sexual function (IIEF-15), and quality-of-life (SF-36). Morning fasted serum hormonal analysis and screening to exclude undisclosed androgen use were performed. 247 men were included: 50 non-users, 125 current users, 72 past users. Self-reported psychiatric diagnoses were 2.5-fold higher among current and past users than non-users. Total testosterone was highest in current users (p<0.001) with no difference between past and non-users. Past users reported significantly worse mood, anxiety, sexual function, and quality of life versus non-users. Multivariable analyses showed psychiatric comorbidity was independently associated with depression (p=0.001), anxiety (p<0.001), and poorer quality-of-life (p<0.05). Older age and higher LH were associated with reduced sexual function (p<0.05), while lower testosterone showed only a modest association with depressive symptoms (p=0.03). Among men in the first year after stopping androgen abuse, psychological symptoms and reduced quality-of-life were most strongly associated with psychiatric comorbidity than biochemical recovery. These findings challenge the assumption that androgen withdrawal symptoms are predominantly driven by hypogonadism, and supports developing psychological and behavioural interventions, rather than pharmacological, to support androgen withdrawal in men.