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
- gynaecomastia
- hirsutism
- voice pitch alterations
- clitoral hypertrophy
- testicular atrophy
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 masculinisation/feminisation (adolescents)
- cognitive impairment
- short stature (adolescents)
- needle marks
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
Diagnostic investigations
1st investigations to order
- urine toxicology testing
- testosterone to epitestosterone ratio
- serum testosterone, LH, and FSH
- FBC
- serum glucose
- serum electrolytes
- lipid panel
- LFTs
- creatine kinase
- hepatitis serology
- HIV serology
Emerging tests
- nuclear medicine cardiovascular imaging
Treatment algorithm
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).
References
Key articles
Anawalt BD. Diagnosis and management of anabolic androgenic steroid use. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2490-500.Full text Abstract
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 484 (reaffirmed 2021): performance enhancing anabolic steroid abuse in women. Obstet Gynecol. 2011 Apr;117(4):1016-8.Full text Abstract
National Institute on Drug Abuse. Anabolic steroids and other appearance and performance enhancing drugs (APEDs). May 2023 [internet publication].Full text
Pope HG Jr, Kanayama G. Body image disorders and anabolic steroid withdrawal hypogonadism in men. Endocrinol Metab Clin North Am. 2022 Mar;51(1):205-16. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Use of other ergogenic compounds
- Polycystic ovarian syndrome (PCOS)
- Drug-induced hirsutism
More DifferentialsGuidelines
- Anabolic steroids and other appearance and performance enhancing drugs (APEDs)
- Drug misuse and dependence: UK guidelines on clinical management
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