Clinical features of androgen abuse withdrawal in men during the first year of cessation: a community dwelling study

CONTEXT: Androgen abuse is an increasing public health concern, particularly among young men seeking muscular or image enhancement. Although most achieve biochemical recovery within 12 months of cessation, mood disturbances, sexual dysfunction, and fatigue are widely reported for years afterward. OBJECTIVE: To examine symptom severity the relationship to biochemical recovery during the first year after androgen abuse cessation. METHODS: We conducted a cross-sectional study of community-dwelling men grouped as nonusers, current users, or past users who had ceased within the last 12 months. Participants completed questionnaires on androgen and substance use and 4 validated instruments assessing mood (Beck Depression Inventory-II), anxiety (Generalized Anxiety Disorder-7), sexual function (International Index of Erectile Function-15), and quality-of-life (36-item Short Form). Morning fasted serum hormonal analysis and screening to exclude undisclosed androgen use were performed. RESULTS: Two hundred forty-seven men were included: 50 nonusers, 125 current users, and 72 past users. Self-reported psychiatric diagnoses were 2.5-fold higher among current and past users than nonusers. Total testosterone (TT) was highest in current users (P < .001) with no difference between past and nonusers. Past users reported significantly worse mood, anxiety, sexual function, and quality of life vs nonusers. Multivariable analyses showed psychiatric comorbidity was independently associated with depression (P = .001), anxiety (P < .001), and poorer quality-of-life (P < .05). Older age and higher luteinizing hormone were associated with reduced sexual function (P < .05), while lower testosterone showed only a modest association with depressive symptoms (P = .03). CONCLUSION: Among men in the first year after stopping androgen abuse, psychological symptoms and reduced quality-of-life were most strongly associated with psychiatric comorbidity than biochemical recovery. These findings challenge the assumption that androgen withdrawal symptoms are predominantly driven by hypogonadism and supports developing psychological and behavioral interventions, rather than pharmacological, to support androgen withdrawal in men.