Steroid Users Face Triple the Risk of Long-Term Erectile Dysfunction

Why would steroids cause this?

Anabolic-androgenic steroids are synthetic versions of testosterone. Doctors prescribe them for specific conditions such as delayed puberty or muscle-wasting disease, but athletes and bodybuilders take them to build muscle, cut fat and boost performance.

The problem lies in how the body regulates hormones. The hypothalamic-pituitary-gonadal axis — the feedback system linking brain and testicles — shuts down natural testosterone production when the brain detects a hormone overload. Constant suppression shrinks the testicles and crashes natural output, producing a condition called hypogonadism: the body can no longer make sufficient testosterone on its own.

For many men who abuse steroids, hypogonadism persists for years after they stop. Symptoms include fatigue, depression, loss of muscle mass and sexual health problems — with erectile dysfunction among the most common when androgen levels stay low. Medical professionals suspect this prolonged suppression drives much of the observed risk, though the study could not test that mechanism directly.

Takeaway: artificial testosterone switches off the body's own production, and the shutdown can outlast the drug use by years.

How did the study work?

The team ran a longitudinal cohort study — research that follows a defined group over time — using Denmark's national health and law enforcement databases. They identified steroid users through Anti-Doping Denmark, which tests for performance-enhancing drugs in public fitness centers. The group covered men sanctioned between 2001 and 2018, including both those who tested positive in urine tests and suspected users who refused testing.

For each user, the researchers randomly selected men of the exact same age from the general population, matched to the sanction date. Average age at the start of tracking was 27. The team followed prescription records from the sanction date until the end of 2022, death or emigration, and tracked new prescriptions for sildenafil or tadalafil through the Danish National Prescription Register.

What are the study's limits?

The design is observational, not experimental, so it shows association rather than proof of cause. Several caveats matter for practitioners:

• Prescription records are an indirect measure; sildenafil and tadalafil occasionally treat lower urinary tract symptoms or Raynaud's disease, a blood vessel disorder, which could slightly inflate the estimates.
• Black-market pills obtained outside registered pharmacies went uncounted.
• Erectile dysfunction is underdiagnosed because many men avoid discussing sexual health with doctors — likely depressing rates in both groups.
• Some men may have quit steroids after being sanctioned, diluting the measured association.
• The researchers lacked data on steroid doses, duration of use, smoking, alcohol and other lifestyle factors known to damage the blood vessels behind erections.

Cardiovascular disease, psychological stress and recreational drug use could all contribute to the differences in treatment rates.

The bottom line: a 3.2-fold elevated risk of impotence medication is a number worth putting in front of any patient weighing anabolic steroids.