What is ASIH?

Anabolic Steroid Induced Hypogonadism (ASIH) is a condition where the body's natural testosterone production shuts down after prolonged use of anabolic-androgenic steroids (AAS). The testicles shrink, sperm production stops, and testosterone levels remain suppressed even after stopping steroids.

Why does it happen?

When external testosterone or anabolic steroids are introduced:

• The brain (hypothalamus and pituitary) senses high testosterone levels
• It stops producing LH and FSH (hormones that signal the testicles to make testosterone and sperm)
• The testicles shut down and atrophy (shrink)
• After stopping steroids, it can take months to years for the body's natural testosterone production to recover—sometimes it never fully recovers

Symptoms of ASIH:

• Fatigue, low energy
• Depression, irritability, mood swings
• Loss of libido (sex drive)
• Erectile dysfunction
• Loss of muscle mass and strength
• Increased body fat
• Gynecomastia (breast tissue development)
• Hot flashes
• Infertility (no sperm production)
• Testicular atrophy (shrunken testicles)

Diagnosis:

Clinical History: Past or current anabolic steroid use

Labs (drawn in the morning, fasting):

• Total Testosterone: Low (<300 ng/dL)
• LH and FSH: Low or inappropriately normal (secondary hypogonadism)
• Estradiol: May be elevated (from aromatization of residual testosterone)
• Semen Analysis: Azoospermia (no sperm) or severe oligospermia
• Prolactin: May be mildly elevated

Recovery Timeline (Variable):

• Short-term use (weeks-months): Recovery typically within 3-6 months
• Long-term use (years): May take 1-2 years or longer; some never fully recover
• High doses or multiple cycles: Worse prognosis for recovery

Treatment Options:

1. Watchful Waiting (Natural Recovery):

• May work if steroid use was brief
• Can take 6-12+ months
• Involves enduring low testosterone symptoms

2. Post-Cycle Therapy (PCT):

• Clomiphene (Clomid): Increases LH/FSH to stimulate testicular testosterone production
• Tamoxifen (Nolvadex): Another SERM (selective estrogen receptor modulator)
• hCG (Human Chorionic Gonadotropin): Directly stimulates testes to produce testosterone
• Typical Protocol: hCG 500-1000 IU 3x/week for 2-3 weeks, then transition to Clomiphene 50 mg daily for 4-6 weeks
• Goal: "Jump-start" natural testosterone production

3. Long-Term Management with Clomiphene or Enclomiphene:

• Continuous treatment to maintain testosterone while preserving fertility
• Alternative to lifelong TRT

4. Testosterone Replacement Therapy (TRT):

• If recovery doesn't occur or symptoms are unbearable
• WARNING: TRT will permanently suppress natural testosterone and sperm production
• Only appropriate if fertility is not desired or if recovery attempts have failed

Fertility Recovery:

• Sperm production can recover, but it takes time (6 months to 2+ years)
• hCG + FSH injections can help restore sperm production
• Do NOT use TRT if trying to conceive—it will shut down sperm production

Can ASIH be permanent?

Yes. Some men never fully recover their natural testosterone production, especially after:

• Years of continuous steroid use
• High doses or "stacks" (multiple steroids)
• Use without proper PCT
• Underlying testicular damage

Prevention:

• Avoid anabolic steroids unless medically prescribed and monitored
• Understand the risks: Dependency, infertility, cardiovascular disease, liver damage, psychiatric effects
• If using, implement proper PCT to minimize damage