The impact of anabolic-androgenic steroids used by athletes on cardiovascular system
DOI:
https://doi.org/10.20883/medical.e1568Keywords:
testosterone, anabolic-androgenic steroids, cardiovascular system, myocardial infarction, heart failure, sudden cardiac deathAbstract
Introduction. In many countries, the use of anabolic-androgenic steroids (AAS) has become increasingly common among individuals who engage in physical activity and wish to improve their body composition with particular influence on increasing muscle mass. This phenomenon affects not only professional sports competitors but also amateur athletes and recreational exercisers. Easy access to these preparations, both through online sales and illegal trade, encourages the widespread use of AAS, despite their well-documented adverse health effects. With regard to the cardiovascular system, these substances may cause many pathological changes leading to the development of hypertension, myocardial ischemia, heart failure or the occurrence of sudden cardiac death. The mechanisms underlying these processes are multidirectional, on the one hand resulting from direct structural damage to the heart and blood vessels, and on the other hand indirectly inducing lipid disorders or prothrombotic processes.
Material and methods. A comprehensive literature review was conductes usuing PubMed and Google Scholar databases to identify studies investigating the impact of AAS on the cardiovascular system Keywords covered “anabolic-androgenic steroids”, “cardiovascular risk”, “myocardial hypertrophy”, and “AAS abuse”.
Results. This review synthesizes current knowledge on the multidirectional pathophysiological mechanisms of AAS. Although the available scientific evidence alearly indicates a significant cardiovascular risk associated with these substances, the detailed molecular pathways have not yet been explained.
Conclusions. The aim of the study was to inform clinicians and healthcare providers about the significant cardiovascular risks associated with AAS use, which is becoming an increasing health problem in clinical practice.
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References
de Souza GL, Hallak J. Anabolic steroids and male infertility: a comprehensive review. BJU Int. 2011;108(11):1860-1865. https://doi.org/10.1111/j.1464-410X.2011.10131.x DOI: https://doi.org/10.1111/j.1464-410X.2011.10131.x
Nieschlag E, Vorona E. Mechanisms in endocrinology: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol. 2015;173(2):R47-R58. https://doi.org/10.1530/EJE-15-0080 DOI: https://doi.org/10.1530/EJE-15-0080
Goldman AL, Pope HG, Bhasin S. The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men. J Clin Endocrinol Metab. 2019;104(4):1069-1074. https://doi.org/10.1210/jc.2018-01706 DOI: https://doi.org/10.1210/jc.2018-01706
Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of 500 users. Med Sci Sports Exerc. 2006;38(4):644-651. https://doi.org/10.1249/01.mss.0000210194.56834.5d DOI: https://doi.org/10.1249/01.mss.0000210194.56834.5d
Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. Subst Abuse Treat Prev Policy. 2014;2;9:27. https://doi.org/ 10.1186/1747-597X-9-27 DOI: https://doi.org/10.1186/1747-597X-9-27
Dz.U.2022.2301 Art. 124. - [Wprowadzanie do obrotu lub przechowywanie bez zezwolenia] - Prawo farmaceutyczne.
https://antydoping.pl/kontrole/przypadki-naruszenia-przepisow/
World Anti-Doping Code. International Standard Prohibited List 2025. WADA, Montreal 2025: 1.
Báthori M, Tóth N, Hunyadi A, et al. Phytoecdysteroids and anabolic-androgenic steroids--structure and effects on humans. Curr Med Chem. 2008;15(1):75-91. https://doi.org/10.2174/092986708783330674 DOI: https://doi.org/10.2174/092986708783330674
Ostrowski J, Kuhns JE, Lupisella JA, et al. Pharmacological and x-ray structural characterization of a novel selective androgen receptor modulator: potent hyperanabolic stimulation of skeletal muscle with hypostimulation of prostate in rats. Endocrinology. 2007;148(1):4-12. https://doi.org/10.1210/en.2006-0843 DOI: https://doi.org/10.1210/en.2006-0843
Michels G, Hoppe UC. Rapid actions of androgens. Front Neuroendocrinol. 2008;29(2):182-198. https://doi.org/10.1016/j.yfrne.2007.08.004 DOI: https://doi.org/10.1016/j.yfrne.2007.08.004
Benten WP, Lieberherr M, Stamm O, et al. Testosterone signaling through internalizable surface receptors in androgen receptor-free macrophages. Mol Biol Cell. 1999;10(10):3113-3123. https://doi.org/10.1091/mbc.10.10.3113 DOI: https://doi.org/10.1091/mbc.10.10.3113
Feldkoren BI, Andersson S. Anabolic-androgenic steroid interaction with rat androgen receptor in vivo and in vitro: a comparative study. J Steroid Biochem Mol Biol. 2005;94(5):481-487. https://doi.org/10.1016/j.jsbmb.2004.12.036 DOI: https://doi.org/10.1016/j.jsbmb.2004.12.036
Reichhardt CC, Ahmadpour A, Christensen RG, et al. Understanding the influence of trenbolone acetate and polyamines on proliferation of bovine satellite cells. Domest Anim Endocrinol. 2021; 74: 106479, https://doi.org/ 10.1016/j.domaniend.2020.106479 DOI: https://doi.org/10.1016/j.domaniend.2020.106479
Hamam A, Abou-Omar M, Rabah H, et al. Worsening effect of testosterone deficiency on males with heart failure with preserved ejection fraction. BMC Endocr Disord. 2022;22(1):321. https://doi.org/10.1186/s12902-022-01249-3 DOI: https://doi.org/10.1186/s12902-022-01249-3
Augusto S Jr, Kaelber DC, Tang WHW. Testosterone therapy in patients with heart failure and protein-calorie malnutrition: Insights from a propensity-matched cohort study. Curr Probl Cardiol. 2025;50(7):103070. https://doi.org/10.1016/j.cpcardiol.2025.103070 DOI: https://doi.org/10.1016/j.cpcardiol.2025.103070
Ghosh D, Griswold J, Erman M, et al. Structural basis for androgen specificity and oestrogen synthesis in human aromatase. Nature. 2009;457(7226):219-223. https://doi.org/10.1038/nature07614 DOI: https://doi.org/10.1038/nature07614
Albano GD, Amico F, Cocimano G, et al. Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review. Healthcare (Basel). 2021;9(1):97. https://doi.org/10.3390/healthcare9010097 DOI: https://doi.org/10.3390/healthcare9010097
Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. Am J Cardiol. 2010;106(6):893-901. https://doi.org/10.1016/j.amjcard.2010.05.013 DOI: https://doi.org/10.1016/j.amjcard.2010.05.013
Adami PE, Koutlianos N, Baggish A, et al. Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2022;29(3):559-575. https://doi.org/10.1093/eurjpc/zwab198 DOI: https://doi.org/10.1093/eurjpc/zwab198
Bulut Y, Rasmussen JJ, Brandt-Jacobsen N, et al. Coronary Microvascular Dysfunction Years After Cessation of Anabolic Androgenic Steroid Use. JAMA Netw Open. 2024;7(12):e2451013. https://doi.org/10.1001/jamanetworkopen.2024.51013 DOI: https://doi.org/10.1001/jamanetworkopen.2024.51013
Vecchiato M, Ermolao A, Da Col M, et al. Mortality in male bodybuilding athletes. Eur Heart J. 2025;46(30):3006-3016. https://doi.org/10.1093/eurheartj/ehaf285 DOI: https://doi.org/10.1093/eurheartj/ehaf285
Brinkmann AO. Molecular basis of androgen insensitivity. Mol Cell Endocrinol. 2001;179(1-2):105-109. https://doi.org/10.1016/s0303-7207(01)00466-x DOI: https://doi.org/10.1016/S0303-7207(01)00466-X
Payne AH, Hales DB. Overview of steroidogenic enzymes in the pathway from cholesterol to active steroid hormones. Endocr Rev. 2004;25(6):947-970. https://doi.org/10.1210/er.2003-0030 DOI: https://doi.org/10.1210/er.2003-0030
Zmuda JM, Thompson PD, Winters SJ. Exercise increases serum testosterone and sex hormone-binding globulin levels in older men. Metabolism. 1996;45(8):935-939. https://doi.org/10.1016/s0026-0495(96)90258-9 DOI: https://doi.org/10.1016/S0026-0495(96)90258-9
Kienitz T, Quinkler M. Testosterone and blood pressure regulation. Kidney Blood Press Res. 2008;31(2):71-79. https://doi.org/10.1159/000119417 DOI: https://doi.org/10.1159/000119417
Charkoudian N, Rabbitts JA. Sympathetic neural mechanisms in human cardiovascular health and disease. Mayo Clin Proc. 2009;84(9):822-830. https://doi.org/10.4065/84.9.822 DOI: https://doi.org/10.4065/84.9.822
Liu PY, Death AK, Handelsman DJ. Androgens and cardiovascular disease. Endocr Rev. 2003;24(3):313-340. https://doi.org/10.1210/er.2003-0005 DOI: https://doi.org/10.1210/er.2003-0005
Yesalis CE, Bahrke MS. Anabolic-androgenic steroids. Current issues. Sports Med. 1995;19(5):326-340. https://doi.org/10.2165/00007256-199519050-00003 DOI: https://doi.org/10.2165/00007256-199519050-00003
Grace F, Sculthorpe N, Baker J, et al. Blood pressure and rate pressure product response in males using high-dose anabolic androgenic steroids (AAS). J Sci Med Sport. 2003;6(3):307-312. https://doi.org/10.1016/s1440-2440(03)80024-5 DOI: https://doi.org/10.1016/S1440-2440(03)80024-5
Riebe D, Fernhall B, Thompson PD. The blood pressure response to exercise in anabolic steroid users. Med Sci Sports Exerc. 1992;24(6):633-637. DOI: https://doi.org/10.1249/00005768-199206000-00004
Lenders JW, Demacker PN, Vos JA, et al. Deleterious effects of anabolic steroids on serum lipoproteins, blood pressure, and liver function in amateur body builders. Int J Sports Med. 1988;9(1):19-23. https://doi.org/10.1055/s-2007-1024972 DOI: https://doi.org/10.1055/s-2007-1024972
Schafstedde M, Nordmeyer S. The role of androgens in pressure overload myocardial hypertrophy. Front Endocrinol (Lausanne). 2023;14:1112892. https://doi.org/10.3389/fendo.2023.1112892 DOI: https://doi.org/10.3389/fendo.2023.1112892
Basualto-Alarcón C, Jorquera G, Altamirano F, et al. Testosterone signals through mTOR and androgen receptor to induce muscle hypertrophy. Med Sci Sports Exerc. 2013;45(9):1712-1720. https://doi.org/10.1249/MSS.0b013e31828cf5f3 DOI: https://doi.org/10.1249/MSS.0b013e31828cf5f3
Chung CC, Kao YH, Chen YC, et al. PCSK9 Enhances Cardiac Fibrogenesis via the Activation of Toll-like Receptor and NLRP3 Inflammasome Signaling. Int J Mol Sci. 2025;26(5):1921. Published 2025 Feb 23. https://doi.org/10.3390/ijms26051921 DOI: https://doi.org/10.3390/ijms26051921
Chung CC, Hsu RC, Kao YH, et a;. Androgen attenuates cardiac fibroblasts activations through modulations of transforming growth factor-β and angiotensin II signaling. Int J Cardiol. 2014;176(2):386-393. https://doi.org/10.1016/j.ijcard.2014.07.077 DOI: https://doi.org/10.1016/j.ijcard.2014.07.077
Mishra JS, More AS, Gopalakrishnan K, Kumar S. Testosterone plays a permissive role in angiotensin II-induced hypertension and cardiac hypertrophy in male rats. Biol Reprod. 2019;100(1):139-148. https://doi.org/10.1093/biolre/ioy179 DOI: https://doi.org/10.1093/biolre/ioy179
Pirompol P, Teekabut V, Weerachatyanukul W, et al. Supra-physiological dose of testosterone induces pathological cardiac hypertrophy. J Endocrinol. 2016;229(1):13-23. https://doi.org/10.1530/JOE-15-0506 DOI: https://doi.org/10.1530/JOE-15-0506
Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversible?. Heart. 2004;90(5):496-501. https://doi.org/10.1136/hrt.2003.015719 DOI: https://doi.org/10.1136/hrt.2003.015719
Angell PJ, Ismail TF, Jabbour A, et al. Ventricular structure, function, and focal fibrosis in anabolic steroid users: a CMR study. Eur J Appl Physiol. 2014;114(5):921-928. https://doi.org/10.1007/s00421-014-2820-2 DOI: https://doi.org/10.1007/s00421-014-2820-2
Abdullah R, Bjørnebekk A, Hauger LE, et al. Severe biventricular cardiomyopathy in both current and former long-term users of anabolic-androgenic steroids. Eur J Prev Cardiol. 2024;31(5):599-608. https://doi.org/10.1093/eurjpc/zwad362 DOI: https://doi.org/10.1093/eurjpc/zwad362
Baumann S, Jabbour C, Huseynov A, et al. Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids. Asian J Sports Med. 2014;5(4):e24058. https://doi.org/10.5812/asjsm.24058 DOI: https://doi.org/10.5812/asjsm.24058
Gregersen I, Scarth ME, Abdullah R, et al. Elevated interleukin 8 and matrix metalloproteinase 9 levels are associated with myocardial pathology in users of anabolic-androgenic steroids. Eur J Prev Cardiol. 2024;31(12):1469-1476. https://doi.org/10.1093/eurjpc/zwae126 DOI: https://doi.org/10.1093/eurjpc/zwae126
Kuipers H, Wijnen JA, Hartgens F, et al. Influence of anabolic steroids on body composition, blood pressure, lipid profile and liver functions in body builders. Int J Sports Med. 1991;12(4):413-418. https://doi.org/10.1055/s-2007-1024704 DOI: https://doi.org/10.1055/s-2007-1024704
Zgliczynski S, Ossowski M, Slowinska-Srzednicka J, et al. Effect of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men. Atherosclerosis. 1996;121(1):35-43. https://doi.org/10.1016/0021-9150(95)05673-4 DOI: https://doi.org/10.1016/0021-9150(95)05673-4
Alves JV, da Costa RM, Pereira CA, et al. Supraphysiological Levels of Testosterone Induce Vascular Dysfunction via Activation of the NLRP3 Inflammasome. Front Immunol. 2020;11:1647. https://doi.org/10.3389/fimmu.2020.01647 DOI: https://doi.org/10.3389/fimmu.2020.01647
Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004;34(8):513-554. https://doi.org/10.2165/00007256-200434080-00003 DOI: https://doi.org/10.2165/00007256-200434080-00003
Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use. Circulation. 2017;135(21):1991-2002. https://doi.org/10.1161/CIRCULATIONAHA.116.026945 DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.026945
Sader MA, Griffiths KA, McCredie RJ, et al. Androgenic anabolic steroids and arterial structure and function in male bodybuilders. J Am Coll Cardiol. 2001;37(1):224-230. https://doi.org/10.1016/s0735-1097(00)01083-4 DOI: https://doi.org/10.1016/S0735-1097(00)01083-4
Ferenchick GS, Adelman S. Myocardial infarction associated with anabolic steroid use in a previously healthy 37-year-old weight lifter. Am Heart J. 1992;124(2):507-508. https://doi.org/10.1016/0002-8703(92)90620-b DOI: https://doi.org/10.1016/0002-8703(92)90620-B
Halvorsen S, Thorsby PM, Haug E. Akutt hjerteinfarkt hos ung mann som brukte androgene anabole steroider [Acute myocardial infarction in a young man who had been using androgenic anabolic steroids]. Tidsskr Nor Laegeforen. 2004;124(2):170-172.
Major RW, Pierides M, Squire IB, et al. Bodybuilding, exogenous testosterone use and myocardial infarction. QJM. 2015;108(8):651-652. https://doi.org/10.1093/qjmed/hcu173 DOI: https://doi.org/10.1093/qjmed/hcu173
Christou GA, Christou KA, Nikas DN, et al. Acute myocardial infarction in a young bodybuilder taking anabolic androgenic steroids: A case report and critical review of the literature. Eur J Prev Cardiol. 2016;23(16):1785-1796. https://doi.org/10.1177/2047487316651341 DOI: https://doi.org/10.1177/2047487316651341
Calof OM, Singh AB, Lee ML, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60(11):1451-1457. https://doi.org/10.1093/gerona/60.11.1451 DOI: https://doi.org/10.1093/gerona/60.11.1451
Glueck CJ, Wang P. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events. Metabolism. 2014;63(8):989-994. https://doi.org/10.1016/j.metabol.2014.05.005 DOI: https://doi.org/10.1016/j.metabol.2014.05.005
Bachman E, Travison TG, Basaria S, et al. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci. 2014;69(6):725-735. https://doi.org/10.1093/gerona/glt154 DOI: https://doi.org/10.1093/gerona/glt154
Shahani S, Braga-Basaria M, Maggio M, et al. Androgens and erythropoiesis: past and present. J Endocrinol Invest. 2009;32(8):704-716. https://doi.org/10.1007/BF03345745 DOI: https://doi.org/10.1007/BF03345745
Buhl LF, Christensen LL, Hjortebjerg R, et al. Illicit Anabolic Steroid Use and Cardiovascular Status in Men and Women. JAMA Netw Open. 2025;8(8):e2526636. https://doi.org/10.1001/jamanetworkopen.2025.26636 DOI: https://doi.org/10.1001/jamanetworkopen.2025.26636
D'Andrea A, Caso P, Salerno G, et al. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis. Br J Sports Med. 2007;41(3):149-155. https://doi.org/10.1136/bjsm.2006.030171 DOI: https://doi.org/10.1136/bjsm.2006.030171
Montisci R, Cecchetto G, Ruscazio M, et al. Early myocardial dysfunction after chronic use of anabolic androgenic steroids: combined pulsed-wave tissue Doppler imaging and ultrasonic integrated backscatter cyclic variations analysis. J Am Soc Echocardiogr. 2010;23(5):516-522. https://doi.org/10.1016/j.echo.2010.03.005 DOI: https://doi.org/10.1016/j.echo.2010.03.005
D'Andrea A, Radmilovic J, Caselli S, et al. Left atrial myocardial dysfunction after chronic abuse of anabolic androgenic steroids: a speckle tracking echocardiography analysis. Int J Cardiovasc Imaging. 2018;34(10):1549-1559. https://doi.org/10.1007/s10554-018-1370-9 DOI: https://doi.org/10.1007/s10554-018-1370-9
D'Andrea A, Radmilovic J, Russo V, et al. Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis. Eur J Prev Cardiol. 2022;28(17):1928-1938. https://doi.org/10.1093/eurjpc/zwab086 DOI: https://doi.org/10.1093/eurjpc/zwab086
Rasmussen JJ, Schou M, Madsen PL, et al. Cardiac systolic dysfunction in past illicit users of anabolic androgenic steroids. Am Heart J. 2018;203:49-56. https://doi.org/10.1016/j.ahj.2018.06.010 DOI: https://doi.org/10.1016/j.ahj.2018.06.010
Skorupska K., Skorupski W., Gąsiorowski M., et al. Praktyka kliniczna – ciekawe przypadki z Polish Archives of Internal Medicine. Zgubne skutki nadużywania steroidów anabolicznych – osobliwy przypadek niewydolności serca i toksycznego zapalenia wątroby u młodego kulturysty. Med. Prakt., 2023; 4: 111–116
Hammoud S, van den Bemt BJF, Jaber A, et al. Chronic anabolic androgenic steroid administration reduces global longitudinal strain among off-cycle bodybuilders. Int J Cardiol. 2023;381:153-160. https://doi.org/10.1016/j.ijcard.2023.03.057 DOI: https://doi.org/10.1016/j.ijcard.2023.03.057
Di Paolo M, Agozzino M, Toni C, et al. Sudden anabolic steroid abuse-related death in athletes. Int J Cardiol. 2007;114(1):114-117. https://doi.org/10.1016/j.ijcard.2005.11.033 DOI: https://doi.org/10.1016/j.ijcard.2005.11.033
Thiblin I, Mobini-Far H, Frisk M. Sudden unexpected death in a female fitness athlete, with a possible connection to the use of anabolic androgenic steroids (AAS) and ephedrine. Forensic Sci Int. 2009;184(1-3):7-11. https://doi.org/10.1016/j.forsciint.2008.11.004. DOI: https://doi.org/10.1016/j.forsciint.2008.11.004
Dallas McCarver autopsy report. https://www.documentcloud.org/documents/4311416-Dallas-McCarver-autopsy-report/
Montisci M, El Mazloum R, Cecchetto G, et al. Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases. Forensic Sci Int. 2012;217(1-3):13-18. https://doi.org/10.1016/j.forsciint.2011.10.032 DOI: https://doi.org/10.1016/j.forsciint.2011.10.032
Vecchiato M, Ermolao A, Zane L, et al. Mortality in female bodybuilding athletes. Eur Heart J. 2026;47(3):373-375. https://doi.org/10.1093/eurheartj/ehaf789 DOI: https://doi.org/10.1093/eurheartj/ehaf789
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