Management of non-medical androgen use: a position statement by the Society for Endocrinology

Abstract

Non-medical androgen use, commonly involving anabolic–androgenic steroids, represents an increasing public health concern. Non-medical androgen use is associated with significant morbidity and mortality, including cardiovascular disease, erythrocytosis, dyslipidaemia, infertility, sexual dysfunction, psychiatric manifestations and suppression of the hypothalamic–pituitary–gonadal axis. Men with current or previous non-medical androgen use are increasingly presenting to endocrine and reproductive medicine services, often with hypogonadal symptoms, infertility or concerns regarding recovery following cessation. However, both patients and clinicians frequently report mistrust, uncertainty and limited confidence in management approaches. This Society for Endocrinology position statement summarises the currently available evidence relating to non-medical androgen use, associated health consequences, biochemical recovery following cessation and potential management strategies. Current evidence suggests that most men will experience biochemical recovery of the HPG axis within approximately 12 months of androgen cessation, although recovery timelines vary substantially and some individuals may develop persistent hypogonadism. Symptoms such as low mood, fatigue, anxiety and sexual dysfunction may persist despite biochemical recovery and are likely influenced by psychological factors in addition to serum testosterone concentrations. Existing evidence supporting pharmacological interventions, including human chorionic gonadotrophin, selective oestrogen receptor modulators, aromatase inhibitors or testosterone therapy, remains limited and of low quality, with no robust evidence demonstrating improved long-term recovery or symptom outcomes. Clinicians should approach individuals who misuse androgens with compassion, professionalism and a non-judgemental attitude while remaining alert to undisclosed androgen use. Further longitudinal and interventional studies are required to better characterise recovery trajectories, identify predictors of persistent morbidity and inform evidence-based management strategies.