Anabolic steroids and erectile dysfunction: what a 2026 Danish study found

Men sanctioned for using anabolic-androgenic steroids (AAS) in Danish public gyms were about three times more likely to start prescription erectile-dysfunction (ED) medication in the years that followed, according to a 2026 cohort study in the Journal of Sexual Medicine. Researchers led by Magnus Middelboe at Copenhagen University Hospital matched each user to 50 men of the same age from the general population and followed national prescription records until the end of 2022. The adjusted hazard ratio for a first ED prescription was 3.2, and the estimated 15-year risk of redeeming ED medication was 24% among users versus 8% among controls (figures reported by PsyPost from the peer-reviewed paper). For someone who trains, the takeaway is blunt: illicit steroids are not a shortcut to a better body. They are linked to long-run sexual health problems that may need medical care.

TL;DR

Point	Detail
Study type	Longitudinal cohort, Denmark, national registries
Who was included	Males sanctioned by Anti-Doping Denmark in public gyms, 2006–2018
Comparison	50 age-matched men from the general population per user
Follow-up	To 31 December 2022 (about 10 years on average, per PsyPost)
Main finding	3.2× higher adjusted risk of starting ED medication; 24% vs 8% 15-year prescription risk
Among those treated	Median 6 ED prescriptions for users vs 3 for controls (PsyPost)
Mean age at sanction	About 27 (PsyPost)
Causation?	No. Observational data; confounding possible
Practical takeaway	Build muscle with training, food, sleep and progressive overload, not illicit AAS

What did the researchers study?

Anabolic-androgenic steroids are synthetic versions of testosterone. Doctors sometimes prescribe them for specific conditions. Outside medicine, some men use them to add muscle mass or improve gym performance. The authors cite an estimated lifetime prevalence of about 6% among men worldwide, so the problem is not limited to elite sport.

The Middelboe team asked a narrow question: among men already caught using AAS in Danish fitness centres, how often did they later collect prescription drugs used for erectile dysfunction, such as sildenafil or tadalafil, compared with men who were not sanctioned?

They used Anti-Doping Denmark, which tests in public gyms. Anyone sanctioned between 2006 and 2018 entered the user group, including men with positive urine tests and men who refused testing and were treated as suspected users. For each sanctioned man, statisticians drew 50 male controls from the Danish population, matched on age and the date of sanction.

Follow-up ran from the sanction date until death, emigration or 31 December 2022. Outcomes came from the Danish National Prescription Register: new prescriptions for ED medicines and, among users who filled them, total prescriptions and cumulative dose.

The work was approved by Danish data-protection and health authorities. Individual doses and years of illicit use before sanction were not available, which matters when you interpret the numbers.

What did they find?

PsyPost’s November 15, 2026 report on the paper gives these results (the full article is in the Journal of Sexual Medicine, DOI 10.1093/jsxmed/qdag223):

• 15-year risk of redeeming an ED prescription: about 24% in the AAS group versus about 8% in controls.
• Unadjusted: users were 3.6 times more likely to start ED medication.
• Adjusted for age, education and employment: 3.2 times more likely.
• Among men who sought treatment, median prescription count was 6 for users versus 3 for controls.
• Median cumulative dose was higher in users (interquartile range 16–300 versus 12–136 in controls), PsyPost reports.

Those figures describe pharmacy records in Denmark, not a survey of every gym member. They still paint a consistent picture: sanctioned AAS users disproportionately needed medical help for erections years later, and when they did, treatment tended to be more intensive.

The study cannot prove that steroids caused every prescription. Men who break anti-doping rules may differ in other ways: other recreational drugs, alcohol, smoking, psychological stress or reluctance to see doctors until problems are severe. The authors adjusted for socioeconomic status but did not have lifestyle data on smoking or drinking, PsyPost notes.

Why might steroids link to erectile dysfunction?

The paper’s introduction, visible on the Danish research portal, describes a mechanism many endocrinologists already worry about: HPGA suppression.

The hypothalamic-pituitary-gonadal axis (HPGA) controls natural testosterone. When blood levels rise because of synthetic androgens, the brain reduces signals to the testicles. Natural production falls. Testicular volume can shrink. When the drugs stop, some men cannot restart production quickly. That state is called hypogonadism when testosterone stays low with symptoms such as low libido, fatigue, lost muscle or erection difficulty.

Hypogonadism after AAS is not always short-lived. Clinic reports and smaller studies have described men who need specialist hormone care years after their last cycle. This Danish registry study adds population-scale, long-term evidence that sexual health often shows up in medical records.

Other pathways may matter too. AAS can affect lipids and blood pressure in some users. Psychological factors, including shame about sexual problems, can make men delay care until pharmacy data show a clear gap versus peers.

What should gym trainees do instead of steroids?

If your goal is muscle, performance or confidence, the evidence-backed levers are boring and slow. They work.

1. Train with resistance at least twice a week. WHO recommends muscle-strengthening activities on two or more days for adults 18 to 64, on top of aerobic work. A simple split that tracks muscle groups beats copying a pro’s drug cycle.
2. Use progressive overload. Add a rep, a small load or a harder variation when the current set feels solid. Our beginner strength guide and plain-language overload explainer walk through the first weeks.
3. Eat enough protein from food. Most trainees benefit from spreading protein across meals. Vegetarian, vegan and non-vegetarian examples live in the protein per day guide and the protein calculator.
4. Protect sleep. Short sleep is linked to lower testosterone in small lab studies in young men; lifestyle is not a cure for true deficiency, but sleep supports recovery. See testosterone and lifestyle.
5. Log training and recovery. Trends in sessions, resting heart rate or subjective energy help you deload before you break down. revns tracks workouts, sleep and optional mood scores; it does not diagnose hormones or prescribe drugs.

Creatine is often confused with steroids online. It is not an anabolic steroid and is not what this study measured. Decide on creatine using the evidence guide, not gym lore.

Competitive athletes should follow their federation’s anti-doping rules. This post is not legal advice about sanctions.

Do steroids cause erectile dysfunction in everyone who uses them?

No study says every user will have ED. This cohort looked only at men already sanctioned, mostly in their twenties, in one country’s health system. Some users never appear in registries because they buy drugs without testing, or they treat ED outside pharmacies.

Even so, the gap between 24% and 8% over 15 years is large enough that a regular trainer should treat illicit AAS as a high-risk gamble, not a nutrition tweak.

If you already used steroids and your erections or libido are poor months after stopping, treat that as a medical question. Online “post-cycle therapy” kits are not a substitute for repeated morning blood tests and a clinician who understands andrology.

What does this study not show?

Be clear on limits so you do not over-interpret headlines:

• Prescriptions are a proxy, not a diagnosis. ED drugs are sometimes prescribed for other conditions, though that is uncommon in young men.
• Under-reporting: many men never discuss sexual problems with a doctor; both groups may be underestimated.
• Sanctions may have changed behaviour. Some sanctioned men may have quit AAS; they stayed in the user group, which can dilute the association.
• No dose or duration data before the positive or refused test.
• Denmark is not everywhere. Access to gyms, prescribing rules and cultural attitudes differ.

Association is not destiny. It is a reason to choose legal, proven training habits.

What should I do this week?

1. If you are tempted by gym steroids, write down the goal (muscle, weight, sport) and one legal plan for the next eight weeks: sessions per week, protein at meals, bedtime.
2. If you lifted without drugs, keep a simple log of sets and loads. Use the one-rep-max calculator only as a planning aid, not as a score to chase with drugs.
3. If you used AAS in the past and sexual function feels off, book a clinician. Ask about morning total testosterone on two separate days, symptoms, blood pressure and mental health.
4. If a training partner uses AAS, you do not need to preach. Know the risk data and protect your own choices.
5. Track sleep and training load for four weeks. A flat libido plus poor sleep and rising fatigue is worth mentioning to a doctor, whether or not steroids are involved.

When should I see a doctor?

Book an appointment if:

• erections are weak or absent most of the time for more than a few weeks;
• libido drops sharply and stays low;
• you have testicular pain, breast swelling or unexplained fatigue after steroid use;
• you have infertility concerns;
• you are on any hormone or steroid product and did not get it from a clinician who is monitoring you.

Seek urgent or emergency care for chest pain, fainting, a painful erection lasting more than four hours, or sudden neurological symptoms.

If you feel very low, hopeless or suicidal, contact your local crisis line or emergency number. In the United States you can call or text 988 for the Suicide and Crisis Lifeline. Outside the US, use your national health service’s crisis page. An app does not replace that care.

Related

• Testosterone and lifestyle: what sleep, weight and training can change
• Strength training after 40: what changes and what to do
• Creatine: what the evidence says, dose and myths
• Heart health for men: the numbers to track
• Progressive overload in plain words

This is general training guidance, not medical advice. Sexual health, hormone treatment and erectile dysfunction need a qualified clinician.

Sources

• Middelboe M et al. Anabolic-androgenic steroid use and erectile dysfunction. Journal of Sexual Medicine 2026;23(8):qdag223
• Capital Region of Denmark research portal entry for the same paper
• Karina Petrova. Steroid users face triple the risk of long-term erectile dysfunction. PsyPost, November 15, 2026
• WHO. Physical activity and adults 18–64