Scientists are warning that the quest for the ideal male physique can have potentially devastating side effects—especially when it comes to fertility. Researchers James Mossman and Allan Pacey recently coined the phenomenon the “Mossman-Pacey paradox,” and it deals with men who resort to dangerous anabolic steroids to achieve their perception of peak attractiveness, while potentially damaging their fertility because of the very drugs that helped them get there.

“They are trying to look really big, to look like the pinnacles of evolution,” Mossman, who practices at Brown University, told BBC. “But they are making themselves very unfit in an evolutionary sense, because without exception they had no sperm in their ejaculation at all.”


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What would possess men to (rather ironically) carve themselves into these “pinnacles of evolution” knowing that they’re severely damaging their fertility? Eager to get more context about men who fall into this paradox, we spoke with Dr. Thomas O’Connor, MD, an internal medicine physician who specializes in the effects of anabolic steroid abuse in men. As usual, the “Metabolic Doc” didn’t hold back.

“This is Adonis syndrome,” O’Connor says. “This is bigorexia. It’s a form of obsessive-compulsive.” 

Colloquially known as “bigorexia,” muscle dysmorphia is a disorder where people, most notably males, perceive their bodies as too small, leading to an unhealthy obsession with developing more muscle. To combat their perceived lack of size, they’ll fanatically hit the gym, never being satisfied with the results. This type of behavior naturally lends itself to the abuse of anabolic steroids, and as they pursue physical excellence, the inevitable side effects crop up. To better understand the effects that steroid use has on male fertility, O’Connor compared it to female birth control.

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“When men use steroids over a prolonged period, they become infertile—many of them,” with O’Connor adding these drugs are, “basically a birth control pill for men,” because of the “profound effects on semen—sperm count.” When we asked O’Connor what constitutes “a prolonged period” of time, he says it’s usually “several years.” 

“These are men that in the beginning they don’t have problems,” he says. “These drugs are so seductive. If you use [steroids] a little bit, your fertility is probably not affected. That’s the whole paradox of this—that they’re using a little bit in the beginning, they feel great and they feel phenomenal and they could even go on and off these drugs. And there’s something called post-cycle therapy, where they use it to regain fertility and regain your old testosterone levels.”

Treating men who use steroids regularly, O’Connor warns that infertility is just the beginning of the slippery slope that these guys knowingly enter, disregarding far worse dangers.

“I have men with heart failure, heart attacks, kidney failure, liver failure, complete erectile dysfunction,” he says, “and they still take the drugs.”

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