(257) RAPID RECOVERY OF SPERMATOGENESIS IN LONG-TERM ANABOLIC STEROID ABUSER FOLLOWING CLOMIPHENE CITRATE ADMINISTRATION
Authors: Freire M , Camara L , Souza L , Silva L , Rizzuti A , Araujo F , Machado F , Almeida F , Missaglia P , Ferreira L , Andrade R 
Published: December 2024

Abstract

Introduction
The misuse of anabolic-androgenic steroids (AAS) raises concerns regarding their impact on male fertility. High levels of intratesticular testosterone are essential for spermatogenesis. Infertility often results from the misuse of AAS due to the negative feedback effect of androgens on the hypothalamic–pituitary-testicular axis. Elevated serum testosterone levels can suppress the release of gonadotropin-releasing hormone which in turn reduces or even completely inhibits the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). After discontinuing AAS use, reversing male infertility becomes challenging, depending on the amount of AAS used, the duration of the AAS cycle, and the individual’s age. Treatment often requires various drugs, including Clomiphene Citrate (CC), Human Chorionic Gonadotropin, Selective Estrogen Receptor Modulators (SERMs), Recombinant Luteinizing Hormone, Recombinant Follicle-Stimulating Hormone, and Human Menopausal Gonadotropin.

Objective
To describe the case of a patient who abused steroids for 15 uninterrupted years, starting at age 16, but exhibited an unusually rapid recovery pattern given the duration of abuse and therapeutic intervention with CC alone.

Methods
A 31-year-old male patient, with a history of 15 years of AAS abuse starting at the age of 16, underwent treatment for male infertility with CC at a dosage of 50 mg every other day for 72 consecutive days, starting seven days after discontinuing anabolic steroid use (counting from the last Testosterone Enanthate injection). Laboratory test levels before treatment: Total Testosterone (TT) greater than 1500 ng/dL; LH: less than 0.1 mIU/mL; FSH: less than 0.1 mIU/mL; Estradiol (E2): 307 pg/mL. The baseline spermogram revealed a Semen Volume:1.5 mL, Sperm Concentration: 0.75 million/mL, Total Sperm Count: 1.13 million, 71% immotile sperm and 60% dead sperm. Morphology could not be assessed. Other sperm parameters were within the normal range.

Results
On the 72nd day of CC therapy, laboratory tests and semen analysis were again performed, showing a return of testosterone levels to physiological values and normalization of the semen analysis. Thus, during the clinical follow-up consultation, the results of the tests conducted were as follows: TT: 778 ng/dL, LH: 1,67 mUI/mL, FSH: 1.27 mIU/mL, Estradiol (E2): 24 pg/mL. Semen analysis results included: Semen volume: 4 mL, Sperm concentration: 22 million/mL, Total sperm count: 88 million, Immotile sperm: 23%, Live sperm: 76%, Morphology: 6%, Progressive motility: 60%. Other sperm parameters were within the normal range. One week later, the patient reported that his wife had become pregnant. Furthermore, the patient did not present any clinical complaints after discontinuing anabolic-androgenic steroid (AAS) use (such as acne, hair loss, low libido, depressive mood, anxiety, or sexual function impairment) or during the use of CC.

Conclusions
The exponential increase in the misuse and abuse of anabolic-androgenic steroids (AAS) raises concerns about their impact on male fertility. This case report suggests that clomiphene citrate (CC) is a viable approach to restoring fertility in men with a history of AAS abuse, and some individuals may respond quickly. However, the efficacy of the treatment varies depending on the amount of AAS used, the duration of the AAS cycle, the individual’s age, and personal responses.

Disclosure
No.