Sexual and reproductive effects of androgenic anabolic steroids abuse: a clinical challenge in male and female cisgender and transgender individuals

Currently, worldwide millions of individuals, athletes, and non-athletes, of different ages and probably of all social genders (cisgender males and females, male to female (MtF) and female to male (FtM) transgenders, etc.), are current or former androgenic anabolic steroids (AAS) abusers. AAS abuse is associated with seriously increased short- and long-term risks for general, reproductive and sexual health. Indeed, to improve the knowledge and health of the population at risk of AAS misuse and standardize the current clinical practice concerning the health risks of such abuse, it is essential to also prevent, detect, diagnose, and treat all reproductive and sexual sequelae of non-therapeutic AAS assumption. The main AAS-related pathways and factors influencing reproduction and sexuality in humans, the possible reproductive and sexual signs and symptoms associated with AAS abuse and to AAS withdrawal, and the major concerns in the diagnosis and management of such clinical conditions are reported. The scientific literature has mainly evaluated male AAS abusers, but, we tried to describe/hypothesize all the possible reproductive and sexual side effects and concerns of AAS abuse also in other genders.