A decrease in sexual desire is one of the most common complaints after completing a course of anabolic steroids. It is she who scares men the most and pushes them to chaotic experiments with drugs. The editorial explains the hormonal and psychological mechanisms behind the problem, why blindly "raising estrogen" or "lowering estrogen" is a bad idea, and what research says about restoring libido.
Why libido drops after withdrawal
During the course, the level of androgens in the blood significantly exceeds the physiological level, and the libido often remains high. After withdrawal, exogenous hormones are gradually removed, and own production of testosterone is still suppressed. There is a window in which the body has less androgens than a person who has never used steroids.
This condition is anabolic steroid-induced hypogonadism. It is manifested by fatigue, a decrease in mood, muscle strength and, above all, sexual desire. The duration of the failure depends on how quickly the hypothalamus and pituitary gland will restore the secretion of LH and FSH.
Contrast exacerbates the problem. After several weeks or months of supraphysiological libido, even a normal level of desire can be perceived as a "fall". Some of the men complain after the tests have already been restored - then it is more about adaptation than about pathology.
However, in other cases, decreased libido reflects a true lingering testosterone deficiency, which has been described in former steroid users years after withdrawal. These situations can be distinguished only by analyzes and the clinical picture.
Hormones that control desire
Libido in men is regulated by several hormonal systems, and testosterone is only one of them, albeit a key one. An important role is played by estradiol, which is formed from testosterone under the action of the aromatase enzyme.
A study by Finkelstein et al. (NEJM, 2013) demonstrated this clearly: men were medicated to suppress their own hormones and then added different doses of testosterone with or without blocking aromatase. It turned out that the decrease in sexual desire largely depended on the deficiency of estrogens, and not only androgens.
| Hormone | Role in libido | What happens after the course |
|---|---|---|
| Testosterone | The main driver of desire | Reduced due to axle suppression |
| Estradiol | Necessary for normal libido and erectile function | It can be too low (especially after self-administration of aromatase inhibitors) and elevated |
| Prolactin | Excess suppresses libido and axis | Sometimes increased (stress, some drugs) |
| Thyroid hormones | Affect energy and mood | Need to be checked in case of persistent symptoms |
Hence the practical conclusion: self-administration of aromatase inhibitors "for prevention" may not help, but harm. Excessive suppression of estradiol provokes a drop in libido, pain in the joints and deterioration of the lipid profile.
Elevated prolactin is another common cause that is missed. It can be associated with stress, taking certain medications or a pituitary tumor, therefore, with a persistent decrease in libido, its determination is included in the basic examination.
Psychological component and withdrawal syndrome
Sexual desire is not only a hormonal function. It is closely related to mood, self-esteem, sleep quality and relationships. After the course, all these areas can be under attack at the same time.
Anabolic steroid withdrawal syndrome, including depressed mood, anhedonia, fatigue, and decreased libido, has been described in the literature. Pope and co-authors in the scientific statement of the Endocrine Society note that depression after withdrawal can be pronounced and in some cases accompanied by suicidal thoughts.
- loss of muscle volume after the course worsens self-esteem and body image;
- anxiety about a "broken" hormonal system in itself suppresses desire;
- lack of sleep and overtraining reduce energy and libido;
- relationship tension creates a vicious cycle of failure.
That is why psychological support is not a secondary point. If the decrease in libido is combined with long-term apathy, insomnia or hopelessness, you should consult a psychiatrist or psychotherapist in parallel with an endocrinologist.
Libido and erection are not the same thing
Men often call any sexual difficulties "libido problems". However, desire (libido) and erectile function are regulated differently, and so are the treatments.
Erection is a vascular-nervous process. Anabolic steroids can worsen the lipid profile and vascular function, and increase blood pressure. Therefore, erectile dysfunction after the course can have not only a hormonal, but also a vascular origin, especially in older men.
The guidelines of the European Association of Urology on male sexual dysfunction recommend evaluating cardiovascular risk factors in erectile dysfunction, and PDE-5 inhibitors are considered as the first line of treatment in the absence of contraindications. They help erection, but do not increase libido.
In the Testosterone Trials (TTrials), in older men with confirmed low testosterone, therapy modestly improved sexual desire and activity, while the effect on erectile function was smaller. This emphasizes: testosterone is not a universal remedy for all sexual problems.
What helps and what harms
The first and most important step is an examination. The baseline panel for persistently low libido includes morning total testosterone, LH, FSH, estradiol, prolactin, GH, TSH, complete blood count, and lipids. The results show in which direction to move.
- Helps: time and patience in the first months, enough sleep, moderate training without overloading, normalizing body weight, giving up alcohol and smoking.
- Helps: psychological support, open conversation with a partner, couples therapy if needed.
- Helps: treatment prescribed by a doctor based on tests.
- Harmful: independent aromatase inhibitors and "anti-estrogens" without tests.
- Harms: Going back to steroids to “boost libido” only delays and exacerbates the problem.
- Harms: untested "boosters" with questionable composition.
Regarding dietary supplements, the scientific basis for most "libido boosters" is weak. Some plant extracts have small studies, but none of them are able to compensate for a true hormone deficiency. Another thing is more dangerous: tests by independent laboratories periodically find undeclared prescription substances in such products.
If, despite time and lifestyle correction, libido does not return, and testosterone is consistently low, the endocrinologist considers options for pharmacological stimulation of the axis or, in the case of persistent hypogonadism, replacement therapy. The choice depends, in particular, on plans for children.
Editorial conclusion
A decrease in libido after the course is an expected consequence of the suppression of the hormonal axis, which for many passes over time. But if it lasts for months, this is a reason for examination, not for experiments.
Testosterone, estradiol, prolactin and psyche are involved in libido. Excessive suppression of estrogens is just as harmful as their excess, and psychological factors can be no less important than hormonal ones.
We also advise you to familiarize yourself with the materials "Mistakes in the restoration of the hormonal background", "Diagnosis of hypogonadism in men" and "Fertility after anabolics: chances and deadlines".
References
- Finkelstein JS, Lee H, Burnett-Bowie SA, et al. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013;369(11):1011â1022.
- Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341â375.
- Kanayama G, Hudson JI, DeLuca J, et al. Prolonged hypogonadism in males following withdrawal from anabolic-androgenic steroids: an under-recognized problem. Addiction. 2015;110(5):823â831.
- Cunningham GR, Stephens-Shields AJ, Rosen RC, et al. Testosterone treatment and sexual function in older men with low testosterone levels. J Clin Endocrinol Metab. 2016;101(8):3096â3104.
- Salonia A, Bettocchi C, Boeri L, et al. European Association of Urology guidelines on sexual and reproductive health â 2021 update: male sexual dysfunction. Eur Urol. 2021;80(3):333â357.
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715â1744.
- Rahnema CD, Lipshultz LI, Crosnoe LE, et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101(5):1271â1279.
