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Anabolic steroid use disorder

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 9 Aug 2025
Last updated: 15 Aug 2025

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
  • decreased breast size
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
  • sex hormone binding globulin (SHBG)
  • 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 has received travel grants from Novo Nordisk and Rhythm Pharmaceuticals and consultancy fees from Rhythm Pharmaceuticals.

​Emmanuel Ssemmondo, MBChB, MSc, MRCP

Clinical Research Fellow

Academic Diabetes Endocrinology and Metabolism

University of Hull

Hull University Teaching Hospitals NHS Trust

Hull

UK

Disclosures

ES declares that he has no competing interests.

Acknowledgements

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

Disclosures

NS, 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).

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

Handelsman DJ. Androgen misuse and abuse. Endocr Rev. 2021 Jul 16;42(4):457-501.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

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    • 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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  • Patient information

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