Pandemic of testosterone abuse: Considerations for male fertility

Testosterone is the primary male hormone, which is essential for sexual differentiation, spermatogenesis, and the development of male sexual characteristics. It has been recommended for therapeutic use for symptomatic hypogonadism as androgen replacement therapy. However, the misuse and abuse of testosterone and other anabolic androgenic steroids (AAS) are detrimental to cardiovascular and psychological health, with a serious risk to male reproductive health. Testosterone abuse adversely impacts male fertility by suppressing the hypothalamic-pituitary-gonadal axis, leading to reduced intratesticular testosterone levels, impaired spermatogenesis, testicular atrophy and azoospermia. Additionally, chronic testosterone abuse induces oxidative stress and DNA damage in sperm cells, and may lead to sexual dysfunction. Recovery for fertility parameters after cessation of abuse is often prolonged and may be incomplete in many cases. Diagnostic approaches include clinical profile, hormonal assessment, semen analysis, genetic testing, and imaging techniques. Management involves cessation of AAS use, pharmacological interventions such as human chorionic gonadotropin and selective estrogen receptor modulators, lifestyle modifications, and assisted reproductive techniques for refractory infertility. Prevention measures focus on public awareness campaigns targeting athletes and young individuals to raise awareness about the adverse effects of testosterone abuse on fertility as well as overall health. This article discusses the physiological functions of testosterone and its therapeutic applications. Also, the article explains the mechanisms through which testosterone abuse exerts its negative effect on reproductive and general health. Additionally, the article explores the effects of the current pandemic of testosterone on male fertility. Further, the latest advancements and future directions to tackle this menace of testosterone abuse and minimise its effects on spermatogenesis have been deliberated.