Pendekatan rehabilitasi untuk disfungsi ereksi setelah penggunaan steroid anabolik androgenik jangka panjang: Sebuah tinjauan sistematis
DOI: https://doi.org/10.33024/hjk.v20i1.2893
Disfungsi Ereksi Agen Anabolik Steroid Rehabilitasi Modalitas Terapi Fisik Terapi Olahraga Gaya Hidup Psikoterapi
Abstract
Background: Erectile dysfunction (ED) is a recognized complication of long-term anabolic-androgenic steroid (AAS) abuse, yet treatment largely focuses on pharmacological strategies.
Purpose: To evaluate rehabilitation approaches for erectile dysfunction after long-term anabolic-androgenic steroid use.
Method: A systematic review was conducted using databases including Scopus, MEDLINE, PsycINFO, CINAHL, Web of Science, and the Cochrane Library. Eligible studies included men with erectile dysfunction (ED) after AAS exposure for ≥12 months and examined rehabilitation interventions within the field of Physical Medicine and Rehabilitation (PM&R). Data analysis used the International Index of Erectile Function (IIEF), Sexual Health Inventory for Men (SHIM), and Quality of Life (QoL). Data were synthesized narratively due to heterogeneity in study design.
Results: Of 713 records, 14 studies met inclusion criteria. PFMT consistently improved erectile rigidity and orgasm control. Aerobic and resistance training programs improve endothelial function and support partial testosterone recovery. Lifestyle modifications, including weight loss, smoking cessation, and sleep hygiene, further improve erectile outcomes. Psychosocial interventions such as cognitive behavioral therapy and sex therapy reduce anxiety, improve adherence, and enhance relationship satisfaction. A multimodal rehabilitation program integrating PFMT, exercise, and counseling demonstrated the greatest improvement in IIEF scores and quality of life compared with single-modality approaches. This suggests that multidisciplinary, non-pharmacological interventions are not only feasible but also effective in restoring erectile function and quality of life.
Conclusion: Interventions grounded in physical medicine and rehabilitation, particularly pelvic floor muscle training, structured exercise programs, lifestyle modification, and psychosocial support, are practical, low-risk, and potentially effective options for this population.
Suggestion: Based on current knowledge, a multidisciplinary rehabilitation model appears to offer the greatest therapeutic prospects, as it addresses the multifactorial nature of AAS-related erectile dysfunction, incorporating neuromuscular, vascular, behavioral, and psychological components. To advance this field, further research, including well-designed randomized controlled trials specifically focused on former AAS users, is essential.
Keywords: Anabolic Agents; Erectile Dysfunction; Exercise Therapy; Lifestyle; Physical Therapy Modalities; Psychotherapy; Rehabilitation; Steroids.
Pendahuluan: Erectile dysfunction (DE) merupakan komplikasi yang dikenal dari penyalahgunaan anabolic-androgenic steroids (AAS) jangka panjang, namun penanganannya sebagian besar berfokus pada strategi farmakologis.
Tujuan: Untuk mengevaluasi pendekatan rehabilitasi dalam disfungsi ereksi setelah penggunaan steroid anabolik-androgenik jangka panjang.
Metode: Penelitian sistematis dilakukan pada basis data berupa Scopus, MEDLINE, PsycINFO, CINAHL, Web of Science, dan Cochrane Library. Studi yang memenuhi syarat melibatkan pria dengan disfungsi ereksi/erectile dysfunction (ED) setelah paparan AAS selama ≥12 bulan dan meneliti intervensi rehabilitasi dalam bidang Physical Medicine and Rehabilitation (PM&R). Analisis data diukur menggunakan International Index of Erectile Function (IIEF), Sexual Health Inventory for Men (SHIM), dan Quality of Life (QoL). Data disintesis secara naratif karena adanya heterogenitas dalam desain studi.
Hasil: Dari 713 catatan, 14 studi memenuhi kriteria inklusi. PFMT secara konsisten meningkatkan kekakuan ereksi dan kontrol orgasme. Program latihan aerobik dan resistensi meningkatkan fungsi endotel dan mendukung pemulihan sebagian testosteron. Modifikasi gaya hidup termasuk penurunan berat badan, penghentian merokok, dan kebersihan tidur lebih lanjut meningkatkan hasil ereksi. Intervensi psikososial seperti terapi perilaku kognitif dan terapi seks mengurangi kecemasan, meningkatkan kepatuhan, dan meningkatkan kepuasan hubungan. Program rehabilitasi multimodal yang mengintegrasikan PFMT, olahraga, dan konseling menunjukkan peningkatan terbesar dalam skor IIEF dan kualitas hidup dibandingkan dengan pendekatan modalitas tunggal. Hal ini menunjukkan, bahwa intervensi multidisiplin non-farmakologis tidak hanya layak tetapi juga efektif dalam memulihkan fungsi ereksi dan kualitas hidup.
Simpulan: Intervensi yang berlandaskan kedokteran fisik dan rehabilitasi, terutama pelatihan otot dasar panggul, program latihan terstruktur, modifikasi gaya hidup, dan dukungan psikososial merupakan pilihan praktis, berisiko rendah, dan berpotensi efektif untuk populasi ini.
Saran: Berdasarkan pengetahuan terkini, model rehabilitasi multidisiplin tampaknya menawarkan prospek terapeutik terbesar, karena menangani sifat multifaktorial dari disfungsi ereksi terkait AAS, menggabungkan komponen neuromuskular, vaskular, perilaku, dan psikologis. Untuk memajukan bidang ini, penelian selanjutnya dapat melakukan uji coba terkontrol acak yang dirancang dengan baik dan berfokus secara khusus pada mantan pengguna AAS sangat penting.
Kata Kunci: Disfungsi Ereksi; Agen Anabolik; Steroid; Rehabilitasi; Modalitas Terapi Fisik; Terapi Olahraga; Gaya Hidup; Psikoterapi.
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