Issue: February 2021
Perspective from Tamara Wexler, MD, PhD
Disclosures: Horwitz reports he received a research grant from Anti-Doping Denmark; another author reports he is a board member of Anti-Doping Denmark.
November 30, 2020
3 min read
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Androgen abuse temporarily lowers fertility in male athletes

Issue: February 2021
Perspective from Tamara Wexler, MD, PhD
Disclosures: Horwitz reports he received a research grant from Anti-Doping Denmark; another author reports he is a board member of Anti-Doping Denmark.
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Male athletes who tested positive for androgen use experienced a 26% lower fertility rate in the years before a doping sanction vs. controls, but rates gradually caught up with the general population in the years after testing, data show.

Henrik Horwitz

“We found that androgen abuse was associated with a temporary decline in fertility and most androgen users obtained parenthood without any help from the health care system,” Henrik Horwitz, MD, PhD, associate professor in the department of clinical pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark, told Healio. “Overall, the fertility rate and the prevalence of assisted reproduction among androgen users were close to that in the background population.”

Men who tested positive for androgen use compared with controls had a 26% lower fertility rate prior to their sanction. The rate increased after the positive test.

Horwitz and colleagues analyzed data from 545 men who tested positive for androgen use in an anti-doping test program in Danish fitness centers between Jan. 3, 2006, and March 1, 2018 (mean age at time of doping sanction, 26 years). The confirmed users were matched by birth year with 5,450 men who served as controls. Researchers followed this cohort from 10 years prior to testing positive and until May 2018 (mean length of follow-up, 17 years). The findings were published in The Journal of Clinical Endocrinology & Metabolism.

Researchers found that during the 10-year period before testing positive, the group of androgen users experienced a 26% lower fertility rate vs. controls, with a rate ratio of 0.74 (95% CI, 0.6-0.9). However, in the years following the doping sanction, men who tested positive for androgen use had a total fertility rate that was only 7% lower than expected at follow-up, with an RR of 0.93 (95% CI, 0.84-1.03). The prevalence of assisted reproduction was similar among androgen users (5.69%) and controls (5.28%).

“On a population level, androgen abuse is not expected to have a great impact on the general fertility rate due to the relatively minor prevalence, but the results presented in this study is of importance in the counselling of the individual androgen abuser,” the researchers wrote. “Most of these men obtained fatherhood without any assistance from the health care system. Therefore, our data indicate that a ‘wait-and-see-strategy’ in combination with abstinence of androgen abuse may be a wise first step for the typical androgen user planning parenthood.”

For more information:

Henrik Horwitz, MD, PhD, can be reached at henrik.horwitz@regionh.dk.