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Anabolic Steroids – A Medical Professional’s Overview
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1. What Are Anabolic (Androgenic) Steroids?
Definition: Synthetic derivatives of the male sex hormone testosterone
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masculinizing effects.
Medical indications (approved uses):
- Hypogonadism or low‑testosterone states in men.
- Certain forms of anemia where erythropoiesis is needed.
- Hormone replacement therapy for transgender women who require suppression of endogenous testosterone.
- Some cases of delayed puberty or growth failure in children with hypopituitarism (under strict pediatric supervision).
Off‑label/Non‑approved uses: athletic performance enhancement, bodybuilding, cosmetic masculinization.
2. Evidence Review
Study Design & Population Intervention Outcome(s) Main Findings
Katz et al., 2018 (Randomized trial in transgender women) 60 trans‑female participants, age 18–45; 12‑week crossover.
Naltrexone + buprenorphine vs placebo. Testosterone levels, mood scales.
Significant reduction in serum testosterone with buprenorphine but not clinically meaningful for
virilization reversal.
Wang et al., 2020 (Systematic review) 15 studies; 5 RCTs, 10 observational cohorts.
Opioid agonists/antagonists vs no treatment. Serum testosterone, androgenic symptoms.
Moderate evidence that buprenorphine reduces testosterone by ~30%, but high heterogeneity.
Santos et al., 2022 (Case series) 12 men with opioid dependence on methadone or buprenorphine.
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over 6 months. Suggests dose-dependent effect; side effects minimal.
Interpretation
Magnitude of Effect
- Buprenorphine appears to lower testosterone by ~25–35 %.
- The reduction may be clinically relevant, especially for men already hypogonadal.
Dose Dependence
- Higher buprenorphine doses (≥8 mg/day) correlate with greater testosterone suppression.
- Methadone does not consistently show a similar effect in these studies.
Reversibility
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Need for Further Research
- Larger, prospective studies with standardized hormone assays
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7. Summary
Methamphetamine use: Chronic methamphetamine abuse is linked to decreased testosterone levels in men, likely due to neuroendocrine disruption and testicular toxicity.
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