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Anabolic steroid use disorder

Last reviewed: 6 Oct 2024
Last updated: 20 Jun 2023

Summary

Definition

History and exam

Key diagnostic factors

  • increased weight gain and muscular build
  • increased appetite
  • consumption of nutritional supplements
  • use of other drugs to counteract adverse effects of AAS use
  • aggression and mood swings
  • gynecomastia
  • hirsutism
  • voice pitch alterations
  • clitoral hypertrophy
  • testicular atrophy
Full details

Other diagnostic factors

  • acne and/or oily skin
  • temporal hairline recession/male pattern baldness
  • striae or keloids
  • menstrual irregularities
  • changes in libido
  • erectile dysfunction
  • infertility
  • premature masculinization/feminization (adolescents)
  • cognitive impairment
  • short stature (adolescents)
  • needle marks
Full details

Risk factors

  • male sex
  • participation in competitive sports or bodybuilding
  • history of muscle dysmorphia or other body image disorder
  • employment as nightclub security officer, professional male dancer, professional wrestler, or law enforcement officer
  • history of childhood physical or sexual abuse
Full details

Diagnostic tests

1st tests to order

  • urine toxicology testing
  • testosterone to epitestosterone ratio
  • serum testosterone, LH, and FSH
  • CBC
  • serum glucose
  • serum electrolytes
  • lipid panel
  • LFTs
  • creatine kinase
  • hepatitis serology
  • HIV serology
Full details

Emerging tests

  • nuclear medicine cardiovascular imaging

Treatment algorithm

ONGOING

elite athlete: anabolic-androgenic steroid (AAS) use

general population: anabolic-androgenic steroid (AAS) use

Contributors

Authors

Thozhukat Sathyapalan, MBBS, MD, FRCP, FACP, SFHEA

Professor

Chair in Academic Endocrinology, Diabetes and Metabolism

Hull York Medical School

York

UK

Disclosures

TS declares that he has no competing interests.

​Najeeb Shah, MBBS MRCP

Clinical Research Fellow

Hull York Medical School

York

UK

Disclosures

NS declares that he has no competing interests

Acknowledgements

Professor Thozhukat Sathyapalan and Dr Najeeb Shah would like to gratefully acknowledge Dr Marcel J. Casavant and Dr Jill R. K. Griffith, previous contributors to the topic.

Disclosures

MJC and JRKG declared that they had no competing interests.

Peer reviewers

Fred Hartgens, MD, PhD

Department of Epidemiology

Maastricht University Medical Centre

Department of Surgery

Outpatient Clinic Sports Medicine

Maastricht

Netherlands

Disclosures

FH is an author of a reference cited in this topic.

Harrison G. Pope Jr, MD, MPH

Professor of Psychiatry

Psychiatrist

Director

Biological Psychiatry Laboratory

McLean Hospital

Belmont

MA

Disclosures

HGP is an author of a number of references cited in this topic. HGP has received research grant funding from the US National Institute on Drug Abuse to investigate neuropsychological effect of long-term anabolic steroid use (NIDA R01 DA-041866).

  • Differentials

    • Use of other ergogenic compounds
    • Polycystic ovarian syndrome (PCOS)
    • Drug-induced hirsutism
    More Differentials
  • Guidelines

    • Anabolic steroids and other appearance and performance enhancing drugs (APEDs)
    • Performance enhancing anabolic steroid abuse in women
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