Can Steroids Cause Erectile Dysfunction?
Can Steroids Cause Erectile Dysfunction?
Understanding the Complex Relationship Between Anabolic Steroids, Hormonal Health, and Sexual Function
Medically Reviewed by Courtney LaSumner Bass, NP | Board-Certified Nurse Practitioner, Men's Health Specialist
KEY CLINICAL TAKEAWAYS
Yes, anabolic steroid use can cause erectile dysfunction through HPG axis suppression and hormonal imbalances
Research shows up to 38% of AAS users experience ED, with symptoms often worsening after discontinuation
Recovery can take 3-12+ months and may require medical intervention in some cases
Effective treatments exist, including PDE5 inhibitors, hormone optimization, and lifestyle modifications
Introduction
For men who have used anabolic-androgenic steroids (AAS) to enhance physique or athletic performance, concerns about sexual health are increasingly common. What many don't realize is that the very substances designed to enhance masculinity can paradoxically undermine one of its most fundamental aspects: erectile function.
The relationship between steroid use and erectile dysfunction (ED) is well-documented in peer-reviewed medical literature, yet remains poorly understood by many users. A comprehensive meta-analysis published in 2022, which included 24 studies and 2,411 participants, found that up to 44% reported reduced testicular volume, 31% experienced decreased libido, and 19% reported erectile dysfunction as a direct consequence of AAS abuse.
At Arsenal Men's Health, we encounter men daily who are navigating the aftermath of steroid use on their hormonal health and sexual function. This comprehensive guide will explain the science behind steroid-induced erectile dysfunction, provide evidence-based insights into prevention and treatment, and offer a clear path toward restored sexual health.
Understanding Anabolic-Androgenic Steroids
What Are Anabolic Steroids?
Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone, the primary male sex hormone. These compounds were originally developed for legitimate medical purposes, including treatment of hypogonadism (low testosterone), delayed puberty, and muscle-wasting conditions associated with chronic diseases.
The term "anabolic" refers to muscle-building properties, while "androgenic" describes masculinizing effects. When used illicitly for performance enhancement or physique development, these substances are typically taken at doses far exceeding therapeutic levels—often 10 to 100 times higher than what would be medically prescribed.
Common Types of Anabolic Steroids
Steroid Class
Examples
ED Risk Profile
Testosterone Esters
Cypionate, Enanthate, Propionate
Moderate (post-cycle)
DHT Derivatives
Stanozolol, Masteron, Anavar
High (severe HPG suppression)
19-Nortestosterone
Nandrolone (Deca), Trenbolone
Very High ("Deca Dick")
Oral 17α-alkylated
Dianabol, Anadrol, Winstrol
High (hepatotoxic + hormonal)
Table 1: Classification of common anabolic steroids and their relative impact on erectile function based on clinical observations and pharmacological profiles.
The Science: How Steroids Cause Erectile Dysfunction
The Hypothalamic-Pituitary-Gonadal (HPG) Axis
To understand steroid-induced ED, we must first understand the body's natural hormone regulation system: the Hypothalamic-Pituitary-Gonadal (HPG) axis. This intricate feedback loop controls testosterone production and maintains hormonal homeostasis.
Normal HPG Axis Function:
Hypothalamus releases GnRH (Gonadotropin-Releasing Hormone) in pulsatile fashion
Pituitary gland responds by secreting LH and FSH (Luteinizing Hormone and Follicle-Stimulating Hormone)
LH stimulates Leydig cells in the testes to produce testosterone
Testosterone provides negative feedback to regulate GnRH and LH release
HPG Axis Suppression from Exogenous Steroids
When exogenous (external) testosterone or other anabolic steroids are introduced, the body's natural feedback mechanisms detect the elevated hormone levels and respond by dramatically reducing or completely shutting down endogenous production. This suppression can occur within days of steroid initiation.
Research published in PLOS One found that ongoing AAS abuse causes dramatic increases in plasma androgen levels that ultimately facilitate severe HPG axis suppression due to negative feedback mechanisms. This inhibition may cause long-lasting spermatogenesis inhibition and reductions in biomarkers of Sertoli-cell function.
CLINICAL EVIDENCE: LONG-TERM HPG SUPPRESSION
A landmark study published in PLOS One (Rasmussen et al., 2016) compared former AAS abusers with control participants:
Former AAS abusers exhibited significantly lower total testosterone levels (14.4 vs 18.8 nmol/L)
27.2% of former abusers had testosterone below the clinical reference limit
Gonadotropins remained significantly suppressed even after cessation
These effects persisted years after AAS cessation in many subjects
Mechanisms of Steroid-Induced Erectile Dysfunction
The development of erectile dysfunction in steroid users involves multiple interconnected pathways:
1. Testosterone Deficiency Post-Cycle
When AAS use is discontinued, the suppressed HPG axis does not immediately recover. During this period—which can last months to over a year—endogenous testosterone production remains low or absent, leading to hypogonadal symptoms including erectile dysfunction, decreased libido, fatigue, and depression.
2. Estrogen Imbalance
Many anabolic steroids convert to estrogen through aromatization. While physiological estrogen levels are necessary for male sexual function, elevated estrogen or an abnormal testosterone-to-estrogen ratio can cause sexual dysfunction, including difficulty achieving erections, reduced libido, and mood changes that further impact performance.
3. Testicular Atrophy
Chronic HPG suppression leads to testicular shrinkage (atrophy) as the Leydig cells responsible for testosterone production become dormant. A prospective cohort study found that 71% of AAS users experienced testicular atrophy, which was strongly associated with other sexual side effects.
4. Cardiovascular Effects
Anabolic steroids can cause blood vessel constriction, reducing blood flow to the penis—a critical factor in achieving and maintaining erections. Additionally, AAS use is associated with adverse cardiovascular profiles including increased LDL cholesterol, decreased HDL cholesterol, and elevated blood pressure, all of which contribute to vascular-based erectile dysfunction.
5. Psychological Factors
Steroid use is associated with mood disturbances including aggression, anxiety, and depression. These psychological effects can create secondary erectile dysfunction through performance anxiety, relationship stress, and the neurochemical changes that affect sexual arousal and response.
Research Findings: Prevalence of Sexual Dysfunction in Steroid Users
The scientific literature provides compelling evidence regarding the scope of sexual dysfunction among AAS users:
Sexual Side Effect
Prevalence in AAS Users
Testicular Atrophy
44-71%
Decreased Libido
31-58%
Erectile Dysfunction
19-38%
Reduced Sperm Count/Infertility
Up to 90%
Table 2: Compiled from Corona et al. 2022 meta-analysis, Rasmussen et al. 2016, and multiple prospective cohort studies.
When Does Steroid-Related ED Typically Occur?
Understanding the timing of ED onset helps contextualize the problem and guide treatment approaches:
During Active Steroid Use
Some men experience sexual dysfunction while actively using steroids, particularly with certain compounds. Nandrolone (Deca-Durabolin) is notorious for causing "Deca Dick"—a term used in bodybuilding communities to describe the erectile difficulties associated with this steroid. This occurs due to nandrolone's unique metabolite profile and its effects on neurological pathways involved in sexual arousal.
Post-Cycle (Most Common)
Research from the Translational Andrology and Urology journal indicates that the negative effects on sexual function are most pronounced after discontinuing AAS use. This is when the HPG axis remains suppressed while exogenous hormones clear the system, creating a profound hypogonadal state.
Long-Term and Permanent Effects
A systematic review published in Andrologia (Vilar Neto et al., 2021) analyzed 179 cases of AAS users with diagnosed hypogonadism. Among cases with fully known outcomes, only 4 showed complete HPG axis recovery, suggesting that for many men, the effects may be long-lasting or permanent.
Recovery and Treatment Options
The good news is that effective treatments exist for steroid-induced erectile dysfunction. The approach depends on the underlying cause and severity of the condition.
Natural Recovery Timeline
For many men, HPG axis function will gradually recover after cessation of steroid use. A meta-analysis of 33 eligible studies including nearly 3,900 subjects found that while gonadotropin levels may return to normal range within 13-24 weeks, serum testosterone levels often remain suppressed for more than 4 months. Complete recovery can take 3-12 months or longer, depending on duration and intensity of prior use.
Medical Interventions
1. PDE5 Inhibitors (First-Line Treatment)
Phosphodiesterase type 5 (PDE5) inhibitors—including sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—are the first-line treatment for ED regardless of etiology. These medications work by enhancing the nitric oxide pathway to increase blood flow to the penis, helping achieve and maintain erections during the recovery period.
Research confirms that PDE5 inhibitors are effective in 60-70% of men with ED, though efficacy may be lower in men with severe hormonal deficiency who may require concurrent testosterone optimization.
2. Hormone Optimization Therapy
For men with persistent low testosterone after AAS cessation, several approaches may help restore hormonal balance:
Clomiphene Citrate (Clomid): A selective estrogen receptor modulator (SERM) that blocks estrogen feedback at the pituitary, stimulating increased LH and FSH release to drive natural testosterone production
Human Chorionic Gonadotropin (HCG): Mimics LH to directly stimulate testicular testosterone production, often used to prevent or reverse testicular atrophy
Testosterone Replacement Therapy: For men with confirmed, persistent hypogonadism who are not seeking fertility, medically supervised TRT may be appropriate
3. Lifestyle Optimization
Evidence-based lifestyle modifications can significantly support hormonal recovery and erectile function:
Resistance training (without AAS) naturally elevates testosterone levels
Sleep optimization (7-9 hours) supports healthy testosterone production
Weight management: Excess adipose tissue increases aromatization of testosterone to estrogen
Stress reduction: Chronic stress elevates cortisol, which antagonizes testosterone
Limit alcohol consumption: Alcohol impairs testosterone production and liver function
Prevention: Harm Reduction for Current Users
While the safest approach is to avoid non-medical steroid use entirely, for those who choose to use AAS, certain strategies may help minimize sexual health impacts. It's important to note that these approaches do not eliminate risks and are not a substitute for medical supervision.
Maintain a testosterone base: When using other AAS, including a testosterone base can help maintain adequate androgen levels for sexual function
Monitor hormone levels: Regular blood work (total/free testosterone, estradiol, LH, FSH) allows early detection of problems
Consider post-cycle therapy (PCT): SERMs and other agents may help accelerate HPG axis recovery after discontinuation
Use the shortest effective cycles: Longer cycles and higher doses increase the degree of HPG suppression
Seek medical guidance: Working with a knowledgeable provider allows for proper monitoring and intervention if problems arise
When to Seek Professional Help
If you're experiencing erectile dysfunction related to steroid use—whether current or past—consulting with a men's health specialist can help determine the best course of action. Seek professional evaluation if you experience:
Persistent erectile difficulties lasting more than 2-3 weeks
Significant decrease in libido or sexual desire
Symptoms of low testosterone: fatigue, depression, loss of muscle mass
Testicular pain, swelling, or noticeable size changes
Fertility concerns or difficulty conceiving
Psychological symptoms: depression, anxiety, mood swings
Ready to Restore Your Sexual Health?
At Arsenal Men's Health, we provide confidential, evidence-based treatment for erectile dysfunction and hormonal optimization. Our board-certified nurse practitioner specializes in helping men recover from the effects of steroid use.
Book Your Free Consultation
(385) 666-6292 | arsenalmenshealth.com
Conclusion
The connection between anabolic steroid use and erectile dysfunction is well-established in medical literature. Through suppression of the HPG axis, hormonal imbalances, testicular atrophy, and cardiovascular effects, AAS can significantly impair sexual function—sometimes temporarily, and in some cases, permanently.
However, effective treatments are available. Whether through PDE5 inhibitors, hormone optimization protocols, or comprehensive lifestyle interventions, most men can experience significant improvement in their sexual health with proper medical guidance.
At Arsenal Men's Health, we approach these sensitive issues with the clinical expertise and discretion that Utah men deserve. If you're experiencing sexual health concerns related to steroid use—past or present—we're here to help you restore your confidence and vitality.
Peer-Reviewed References
Corona G, et al. (2022). "Impact of AAS abuse on sexual parameters: A meta-analysis." Journal of Sexual Medicine. Analysis of 24 studies with 2,411 participants.
Rasmussen JJ, et al. (2016). "Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study." PLOS One. DOI: 10.1371/journal.pone.0161208
Vilar Neto J, et al. (2021). "Anabolic androgenic steroid-induced hypogonadism, a reversible condition in male individuals? A systematic review." Andrologia. DOI: 10.1111/and.14062
Armstrong JM, et al. (2018). "Impact of anabolic androgenic steroids on sexual function." Translational Andrology and Urology. PMC6043738
Hackett G. (2023). "Non-testosterone management of male hypogonadism: an examination of the existing literature." Translational Andrology and Urology. PMC7108991
Salonia A, et al. (2021). "EAU Guidelines on Sexual and Reproductive Health." European Association of Urology.
Huang SA, Lie JD. (2013). "Phosphodiesterase-5 (PDE5) Inhibitors In the Management of Erectile Dysfunction." Pharmacy and Therapeutics. PMC3776492
NCBI Bookshelf. (2023). "PDE5 Inhibitors - StatPearls." National Library of Medicine. NBK549843
Lee JW, et al. (2013). "Treatment Strategy for Non-Responders to PDE5 Inhibitors." The World Journal of Men's Health. PMC3640150
Corona G, et al. (2015). "Phosphodiesterase Type 5 (PDE5) Inhibitors in Erectile Dysfunction: The Proper Drug for the Proper Patient." Journal of Sexual Medicine. DOI: 10.1111/jsm.12026
Kim ED, Crosnoe L, et al. (2019). "Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility." World Journal of Men's Health. DOI: 10.5534/wjmh.180036
Sexual Medicine Society of North America (SMSNA). (2024). "The Effects of Anabolic Steroid Use on Sexual Health." Patient Education Resources.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. Treatment decisions should be made by a licensed medical provider based on individual patient evaluation. The use of anabolic steroids without a prescription is illegal in the United States. If you are experiencing health concerns related to steroid use, please consult with a qualified healthcare professional.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
ARSENAL MEN'S HEALTH
Premium Men's Health Telehealth | Utah's Leader in Male Optimization
489 South Jordan Parkway, Suite #254, South Jordan, UT 84095
Trusted by 1,200+ Utah Men
