What medications can be prescribed for managing withdrawal from anabolic steroids?

Management of Anabolic Steroid Withdrawal

For patients experiencing withdrawal from anabolic-androgenic steroids (AAS), a combination of hormonal therapy and symptomatic management should be implemented, with human chorionic gonadotropin (hCG) and selective estrogen receptor modulators (SERMs) as the primary pharmacological interventions to restore hypothalamic-pituitary-gonadal function. 1

Clinical Presentation of AAS Withdrawal

• Common withdrawal symptoms include mood disorders (particularly depression which may be severe and include suicidal ideation), insomnia, anorexia, decreased libido, fatigue, headache, muscle and joint pain, and cravings to resume steroid use 2, 3
• Physical symptoms are accompanied by psychological dependence, making cessation difficult without appropriate support 4
• Withdrawal symptoms are reported by approximately 95% of men attempting to discontinue AAS use, with low mood (72.9%), tiredness (58.5%), and reduced libido (57.0%) being the most common 1

Assessment and Monitoring

• Document baseline symptoms and medication history, including duration of AAS use and typical dosing 5
• Use a standardized assessment tool to evaluate the patient's current dependence level 5
• Monitor for signs of hypogonadism, including very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis 6

Pharmacological Management

Primary Interventions (Post-Cycle Therapy)

• Human Chorionic Gonadotropin (hCG) - Stimulates testicular function and testosterone production 2, 1
• Selective Estrogen Receptor Modulators (SERMs) such as clomiphene - Helps restore hypothalamic-pituitary-gonadal axis function 6, 1
  • These interventions have been shown to reduce withdrawal symptoms by approximately 60% and suicidal thoughts by 50% 1

Symptomatic Relief Medications

• Antidepressants - Particularly selective serotonin reuptake inhibitors (SSRIs) for depression and mood disorders 2
• Nonsteroidal anti-inflammatory drugs (NSAIDs) - For headache, muscle and joint pain 2
• Clonidine - May help manage hyperadrenergic withdrawal symptoms 2, 4

Treatment Duration and Monitoring

• Men who used AAS for less than 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation 6
• Longer-term users (≥1 year of high-dose use) may require more extended treatment with clomiphene or hCG 6
• Regular monitoring of testosterone levels, mood symptoms, and other withdrawal manifestations is essential 5

Special Considerations

• Patients with persistent clinical symptoms or laboratory evidence of hypothalamic-pituitary-gonadal dysfunction may require more aggressive hormonal intervention 2
• For breakthrough anxiety or agitation, use the lowest effective dose of medication rather than adding multiple agents 5
• Be aware that many medications used for symptomatic relief have their own potential for abuse or side effects 2

Patient Education

• Educate patients about the risks of AAS use and the benefits of supervised withdrawal 5
• Inform patients about the expected timeline for recovery based on their usage history 6
• Discuss the importance of adherence to the treatment plan to minimize withdrawal symptoms and prevent relapse 1

Monitoring for Complications

• Monitor for cardiovascular complications, as high-dose AAS use is associated with increased cardiovascular risk 6
• Assess liver function in patients who have used oral alkylated AASs 6
• Screen for persistent mental health issues, particularly depression with suicidal ideation 3, 1

The evidence suggests that post-cycle therapy with hCG and SERMs is effective in reducing withdrawal symptoms and should be the cornerstone of pharmacological management for patients discontinuing AAS use 1.