How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health
Open accessAbstract
It is estimated 6.4% of males and 1.6% of females globally use anabolic-androgenic steroids (AAS), mostly for appearance and performance enhancing reasons. In combination with resistance exercise, AAS use increases muscle protein synthesis resulting in skeletal muscle hypertrophy and increased performance. Primarily through binding to the androgen receptor, AAS exert their hypertrophic effects via genomic, non-genomic and anti-catabolic mechanisms. However, chronic AAS use also has a detrimental effect on metabolism ultimately increasing the risk of cardiovascular disease (CVD). Much research has focused on AAS effects on blood lipids and lipoproteins, with abnormal concentrations of these associated with insulin resistance, hypertension and increased visceral adipose tissue (VAT). This clustering of interconnected abnormalities is often referred as metabolic syndrome (MetS). Therefore, the aim of this review is to explore the impact of AAS use on mechanisms of muscle hypertrophy and markers of MetS. AAS use markedly decreases high-density lipoprotein cholesterol (HDL-C) and increases low-density lipoprotein cholesterol (LDL-C). Chronic AAS use also appears to cause higher fasting insulin levels and impaired glucose tolerance and possibly higher levels of VAT; however, research is currently lacking on the effects of AAS use on glucose metabolism. While cessation of AAS use can restore normal lipid levels, it may lead to withdrawal symptoms such as depression and hypogonadism that can increase CVD risk. Research is currently lacking on effective treatments for withdrawal symptoms and further long-term research is warranted on the effects of AAS use on metabolic health in males and females.
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Testosterone and related anabolic androgenic steroids increase muscle mass in both animals and humans.
“Testosterone [44] and related anabolic androgenic steroids [45] increase muscle mass in both animals and humans.”
From Effects of Skeletal Muscle Hypertrophy on Fat Mass and Glucose Homeostasis in Humans and Animals: A Narrative Review with Systematic Literature Search (2025) · cites this paper as [45]
The Introduction’s “Effects on skeletal muscle” section says testosterone and its AAS derivatives increase muscle protein accretion and that AAS are used to increase muscle mass. The “Resulting effect on muscle mass and/or performance” section reports increased muscle thickness in human participants, but the passages do not establish an increase in muscle mass in animals. (LLM, conf=0.83)
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Parr, M. K., & Laughlin, A. M. M. (2018) · AIMS molecular science · doi:10.3934/molsci.2018.2.131 · Cited by 13 · see citing works
The beneficial effects of HDL-C on atherosclerosis: rationale and clinical results
Santos‐Gallego, C. G., Torres, F., & Badimón, J. J. (2011) · Clinical Lipidology · doi:10.2217/clp.10.90 · Cited by 10 · see citing works
Lipoprotein Metabolism and the Treatment of Lipid Disorders
Freeman, M. W., & Walford, G. A. (2015) · Elsevier eBooks · doi:10.1016/b978-0-323-18907-1.00041-x · Cited by 8 · see citing works
Li, M., & Rabkin Simon, W. (2018) · International Journal of Sports and Exercise Medicine · doi:10.23937/2469-5718/1510109 · Cited by 6 · see citing works
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Havers, T., Held, S., Schönfelder, M., Geisler, S., & Wackerhage, H. (2025) · Sports Medicine · doi:10.1007/s40279-025-02263-w · Cited by 19 · see citing works
“Testosterone [44] and related anabolic androgenic steroids [45] increase muscle mass in both animals and humans.”
- Authors
- McCullough, D., Webb, R., Enright, K. J., Lane, K. E., McVeigh, J., Stewart, C. E., & Davies, I. G.
- Affiliations
- Liverpool John Moores University (GB)
- Liverpool Hope University (GB)
- Manchester Metropolitan University (GB)
- Corresponding author
- McCullough, Deaglan
- ORCID
- Venue
- Reviews in Endocrine and Metabolic Disorders
- Published
- 2020-12-02
- Volume
- 22
- Issue
- 2
- Pages
- 389-405
- ISSN
- 1389-9155 (ISSN-L)
- 1573-2606
- PMC
- PMC8087567
- OpenAlex
- W3108351505
- Cited by
- 62
- References
- 191
- Citations by year
- 2026: 16 · 2025: 17 · 2024: 4 · 2023: 8 · 2022: 11 · 2021: 6
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Reviews in Endocrine and Metabolic Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- e-space (Manchester Metropolitan University) (acceptedVersion, cc-by)
- Leeds Beckett Repository (Leeds Beckett University) (acceptedVersion, cc-by)
- Liverpool John Moores University (acceptedVersion)
- Funders
- Liverpool John Moores University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Social Sciences › Sociology and Political Science › Doping in Sports
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Pharmacological Effects and Assays
- Keywords
- anabolic steroids, skeletal muscle hypertrophy, muscle protein synthesis, androgen receptor, metabolic syndrome, cardiovascular disease, lipoproteins, insulin resistance, visceral adipose tissue, glucose metabolism, withdrawal symptoms, hypogonadism, resistance training, sex differences
- MeSH terms
- Cardiovascular Diseases, Female, Humans, Hypertrophy, Male, Steroids, Muscle, Skeletal, Anabolic Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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