suppression of spermatogenesis and gynecomastia are frequent consequences of androgen use
high doses of anabolic androgenic steroids (AAS) suppress the hypothalamic-pituitary-gonadal axis due to negative feedback, and it may take weeks or months (sometimes longer) for the axis to recover
atrophy of the seminiferous tubules during this time may result in subfertility/infertility
even after discontinuation of AAS, subjects may continue to encounter symptoms of hypogonadism (low libido, erectile dysfunction, and low vitality) until the axis recovers
although no randomized trials exist, anecdotal reports suggest that use of clomiphene citrate may hasten the recovery of the gonadal axis
gynecomastia is also seen in athletes using AAS, specifically aromatizable androgens e.g. testosterone
a proportion of testosterone is converted by aromatization to oestradiol (an endogenous oestrogen) in males - however with supraphysiological amounts of testosterone then the levels of oestradiol are also increased to supraphysiological levels
many athletes resort to off-label use of tamoxifen (oestrogen receptor antagonist) and aromatase inhibitors to circumvent this side effect
women using AAS experience the usual adverse effects of hyperandrogenism such as breast atrophy, irregular menses, hirsutism, male-pattern baldness, hoarse voice, and clitoromegaly
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