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

Krzysztof Kowalik¹Patryk Harasny²Laura Kaliczyńska³Konrad Reweda-Kwiatkowski¹Dariusz Starzyński⁴Michał Pawlak¹Arkadiusz Waloryszak¹Magdalena Ptak¹Andrzej Modrzejewski⁵Dagmara Lisman^1*

• ¹Pomeranian Medical University, Szczecin, Poland
• ²Provincial Hospital, Poznań, Poland
• ³Uniwersytet Szczecinski, Szczecin, Poland
• ⁴Endocrinology Clinic, Sedimed Medical Centre, Szczecin, Poland
• ⁵Pomorski Uniwersytet Medyczny w Szczecinie, Szczecin, Poland

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 behavioral 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.