Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism

This case report published in Fertility and Sterility described the treatment of a young man who developed prolonged hypogonadotropic hypogonadism after using anabolic steroids purchased online. The patient presented with debilitating symptoms including severe fatigue, loss of libido, and erectile dysfunction, with markedly low serum testosterone and suppressed gonadotropins.

The therapeutic approach consisted of a single dose of triptorelin 100 mcg administered subcutaneously, used as a stimulus to restart the suppressed hypothalamic-pituitary-gonadal (HPG) axis. Within 1 month, serum testosterone returned to normal levels, accompanied by clinical recovery with return of energy and libido.

• The proposed mechanism involved the "flare effect" of triptorelin: the single dose stimulated an acute release of LH and FSH
• Unlike continuous use (which suppresses the axis), the single dose acted as a "reset" of the HPG axis
• The patient maintained normal testosterone levels during subsequent follow-up
• The approach avoided the need for long-term testosterone replacement therapy

This case is frequently cited in the sports medicine and endocrinology community as evidence of the potential of single-dose triptorelin to restore gonadal function suppressed by anabolic steroids. However, it is important to note that this is an isolated case report, and controlled clinical trials for this indication are still needed.