Non-medical use of exogenous testosterone and anabolic–androgenic substances in young men: health, psychological, and fertility consequences

The non-medical use of exogenous testosterone and other anabolic-androgenic steroids (AAS) has increased substantially in recent years, particularly among young men engaged in recreational strength training. Although often perceived as a means of enhancing muscle mass and physical performance, this practice represents a growing public-health concern due to its wide-ranging endocrine, reproductive, and multisystem adverse effects. This narrative review synthesizes current international evidence on the non-medical use of testosterone and AAS in non-professional athletic settings, with a primary focus on endocrine disruption and reproductive health. The review outlines the classification of commonly used anabolic-androgenic compounds, discusses their pharmacological mechanisms of action, and integrates clinical, experimental, and epidemiological data on associated adverse outcomes. Particular attention is given to suppression of the hypothalamic-pituitary-gonadal axis, impaired spermatogenesis, fertility disturbances, and the potential for long-term or persistent endocrine sequelae. In addition, psychological and behavioural factors contributing to AAS use-including muscle dysmorphia, social pressure, and body-image concerns-are discussed as important modulators of risk. The review also addresses current clinical approaches to the management of AAS-related complications, including strategies aimed at hormonal recovery and restoration of reproductive function. By presenting a comprehensive, mechanistic, and clinically oriented overview, this article highlights the need for increased awareness among clinicians and underscores priorities for future research and preventive interventions in endocrine and reproductive health.