Is there anything worse than getting into the heat of the moment and finding you can’t perform? It feels embarrassing and awkward — though it doesn’t have to be. With this in mind, there are 2 things we want you to know.
The first is that occasional erectile problems are normal. If it was caused by stress, alcohol or tiredness, it should go away again when those symptoms do too.
The second is that persistent erectile dysfunction (ED) is treatable. There are lots of reasons it might happen and there are lots of ways you and your doctor can improve it. One potential cause is anabolic-androgenic steroids, which we’re taking a deep dive into for this article.
We’ll start with the lowdown on anabolic steroids — what they are, what they do and the side effects to be aware of. Then, we’ll get into the nitty gritty of how anabolic steroid misuse can cause erectile dysfunction, plus the treatment options out there.
What are anabolic steroids?
Anabolic steroids are synthetic drugs that act in a similar way to the male hormone testosterone. Their full name is anabolic-androgenic steroids (AAS), but they’re more often referred to as anabolic steroids or simply, steroids .
Anabolic steroids can be swallowed as tablets, applied as a gel or injected directly into muscles. While they do have legitimate medical uses, they are more commonly used by athletes, bodybuilders and people who need strength for their work (think people in the military or police force)  .
Both men and women have been known to take steroids as they can help build lean muscle, improve strength and endurance, and reduce recovery time after an injury. Anabolic steroids are legal in Australia when prescribed by a doctor, but otherwise, they are not. They are also banned in competitive sports .
How do steroids work?
Anabolic steroids imitate your body’s natural hormones, namely testosterone and activate your body’s hormone receptors. The drugs tell these receptors to get to work on all the things that testosterone would usually do .
The name anabolic-androgenic steroids came from the 2 different ways that testosterone works in your body. The anabolic effects include speeding up recovery, supporting muscle growth and maintaining bone density. The androgenic effects take care of physical male characteristics; from penis and testicle function to increased muscle mass, a deeper voice and facial hair .
Anabolic steroids are not the only substance to have these effects. Another example is human growth hormone, which can also increase muscle mass and speed up recovery . But, research tells us that anabolic steroid misuse is more common .
What are the long-term effects of steroid use?
There are some good reasons that steroids are illegal without a prescription as they can be dangerous to manage on your own.
Male anabolic steroid abusers are more likely to suffer side effects because they take higher doses than those recommended by medical professionals . People can also become addicted to steroids when they rely on them for body confidence and self-esteem .
The short-term effects include :
- Mood swings or aggression
- Changes in sex drive
- Male pattern baldness
- Low sperm count and infertility
- Breast development (Gynecomastia)
- Involuntary erections that won’t go away (Priapism).
The longer you keep up steroid misuse, the more serious the consequences can become. Long-term effects from extended duration AAS supplementation can include:
- High blood pressure
- High cholesterol
- Heart attack and stroke
- Kidney or prostate cancer
- Paranoia and mood swings, including deep depression
- ‘Roid Rage’ — having uncontrollable outbursts of psychotic aggression
- Severe acne which causes scarring
- Stunted growth .
Another potential side effect of taking anabolic steroids is erectile dysfunction.
What are the symptoms of erectile dysfunction?
To keep us all on the same page, here’s a quick recap of what health professionals classify as erectile dysfunction.
Erectile dysfunction (ED), or impotence, is the inability to get or maintain an erection that will allow for sexual intercourse. It’s not a disease, but it can be a symptom of another physical or psychological condition .
Lifestyle factors like drinking too much, stress or anxiety can cause occasional erectile problems and in general, this is considered normal. But, if the symptoms remain persistent, you need to look deeper. Persistent ED should be investigated with the help of your doctor .
Erectile dysfunction is more common than you might think. It’s estimated that 1 in 10 men have issues with maintaining an erection during sex and the problem increases in frequency as you get older. For men over 40, that statistic jumps to 1 in 5 men having erection problems .
The first thing you need to know is it’s nothing to be ashamed of. Sometimes our bodies have trouble performing at their best and it’s our job to find out why and seek treatment. When your body isn't doing things the way it should, take the time to investigate with your doctor.
Can steroids cause erectile dysfunction?
The simple answer is yes — anabolic steroids can cause erectile dysfunction. But, for most people, the problems start when they stop using them.
Hypogonadism is a clinical condition that happens because the testes fail to produce high amounts of testosterone and sperm. It is usually diagnosed by checking testosterone (T) levels. Another option is to look for classic low T symptoms, such as decreased libido, erectile dysfunction, hot flushes or gynecomastia (developing breasts) .
Taking anabolic steroids can lead to hypogonadism, which in medical circles is known as AAS-induced hypogonadism. It’s considered a widespread phenomenon and sometimes, even a health crisis of our generation. The reason that steroids cause this condition is the effect they have on testosterone levels.
They suppress natural testosterone while keeping the synthetic levels high. When you stop using steroids, the levels drop overall — leading to low T symptoms and eventually, hypogonadism. In many cases, the condition clears up on its own — taking anywhere from a few weeks to a full year. This is likely due to the balancing out of natural testosterone levels .
None of this is to say that continued steroid use is better. We’ve already noted how it can be unsafe and lead to serious health conditions. The best option is to seek treatment for erectile dysfunction with the help of your doctor.
While hypogonadism is the main reason for AAS-induced erectile dysfunction, some of the long-term side effects of taking steroids crossover with the common causes of ED.
What else causes erectile dysfunction (ED)?
For a long time, doctors believed that erectile dysfunction was purely mental — caused by stress, anxiety or depression. While mental health can play a role, we’ve been able to debunk this myth. Research shows that only 1 in 10 persistent ED cases were caused by psychological problems .
Now, we have a better understanding of the physical factors that cause ED. Conditions that affect blood flow to the penis are often the underlying cause, such as :
- High cholesterol
- High blood pressure
- Heart disease
Certain medications can also cause or worsen ED — like those used to treat high blood pressure, high cholesterol, depression and prostate disease . We also know that an enzyme called PDE5 has a big impact on blood flow to the penis — both restricting blood flow coming in and speeding up the blood flow going out.
Both of these factors can make maintaining erectile function more difficult. In other words, it's harder to get or maintain an erection. PDE5 has been an important part of treatment options .
There are also lifestyle factors that can lead to erectile dysfunction. We’ve covered a number of ED causes in detail on Pilot's Health Hub including legitimate causes like smoking and vaping, ones that are loosely related (like condom use) and even myths like masturbation.
Can steroids cause permanent issues with ED?
There isn’t a definitive yes or no answer on this one and research is ongoing. The best we can say is that it’s possible (though unlikely) for steroid use to cause permanent issues with ED.
Abusing steroids has been found as the most frequent cause of hypogonadism for young men. AAS-induced hypogonadism usually resolves on its own within 6-12 months, but there are cases of it lasting longer. A growing number of studies are finding it can persist for years — which may mean it is a more permanent condition .
Do bodybuilders have erectile dysfunction?
Honestly, this one comes down to perception. There’s no evidence that all bodybuilders have erectile dysfunction, but there are a few reasons why the stereotype may keep coming up.
First, there’s the fact that anabolic steroids are the most used drugs by athletes, amateur sportsmen and bodybuilders around the world . They also happen to be banned substances, known as performance-enhancing drugs .
When you combine these factors, you get a whole lot of bodybuilders potentially using steroids and a higher likelihood it will become public knowledge — since it’s not allowed. Once you connect the dots on how steroids can cause erectile dysfunction, you may end up forming a perception that bodybuilders have ED.
Second, researchers often recruit bodybuilders to study anabolic steroid use and erectile dysfunction. One such study used bodybuilding forums to recruit participants for a study on steroid use and sexual function .
It found that using steroids frequently or for a long time could cause de novo erectile dysfunction — meaning ED that has returned. This de novo ED appeared after they stopped using steroids. The study also found that men with de novo sexual dysfunctions were more likely to report low T-related symptoms including decreased libido, depression and reductions in muscle mass .
Because researchers know anabolic steroid use is high in sports, they recruit from these areas for their studies. The amount of research on bodybuilding, steroid use and erectile dysfunction probably adds to the perception that bodybuilders have ED.
We can help break the perception by sharing that steroid use is actually pretty common for men in their 30s . Reasons for non-medical use vary — from wanting a leg up in your sports career, to wanting increased strength at work or having body image concerns.
This means that steroid users come from all different walks of life — from sports and bodybuilding to police, construction, the defence force and fashion or entertainment industries .
How to treat erectile dysfunction
Now it’s time for the golden ticket: how to treat erectile dysfunction. There are lots of options out there and you should work with your doctor on the best treatment plan.
Medications, like Pilot’s ED treatment, are effective for 94% of ED patients . They are known as PDE5 inhibitors and they target the enzyme which causes issues with your blood flow.
Pilot offers 2 forms of ED treatment — the first lasts for 4-6 hours and can be taken when you know you'll need it. The second treatment is a daily medication that allows you to perform with less notice so you can enjoy spontaneous sex .
There are a few side effects to be aware of but they’re often short-term and minor. These include headaches, a stuffy nose, facial flushing, muscle aches or indigestion.
Studies tell us that it’s safe to take ED medications for up to 24 months, though we’re still exploring whether they work as permanent treatments . For this reason, many treatment plans include changing lifestyle factors.
Managing ED often comes down to managing the underlying conditions it may be caused by. Checking for conditions that limit blood flow to the penis or investigating traditional low T symptoms can help .
Erectile dysfunction can be caused by psychological issues and it can also contribute to poor mental health. Counselling is an effective treatment option if the ED cause is determined to be mental.
It’s also a useful strategy alongside other treatments as it can help with sexual confidence. You may also choose to involve your partner in your counselling sessions .
Pumps and rings
Pumps and rings work a little bit like medications because they have a direct effect on blood flow to your penis. Vacuum penile pumps and rubber rings can be placed over the penis to create blood flow. They are most useful for people who are able to get an erection but have trouble maintaining it .
If you're unsure of the best approach for you, take our online consult with an Aussie practitioner and they'll be able to help you tackle the issues you're experiencing.
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