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Diagnosis and Management of Anabolic Androgenic Steroid Use
Open accessAbstract
CONTEXT: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. DESIGN: Key studies were extracted from PubMed (1990-2018) and Google Scholar with reference searches from relevant retrieved articles. RESULTS: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete's baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. CONCLUSIONS: Men who use AASs <1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use ≥1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.
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“However, the most recent estimate reports a lifetime prevalence of ever using anabolic androgenic steroids among males in the general population of 1–5%, which is much more common in males than in females (> 50:1) [207].”
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 [207]
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Metadata
- Authors
- Anawalt, B. D.
- Affiliations
- University of Washington (US)
- Corresponding author
- Anawalt, Bradley D
- ORCID
- Anawalt, Bradley D
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2019-02-11
- Volume
- 104
- Issue
- 7
- Pages
- 2490-2500
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC6517163
- OpenAlex
- W2914076077
- Cited by
- 118
- References
- 49
- Citations by year
- 2026: 15 · 2025: 16 · 2024: 20 · 2023: 18 · 2022: 24 · 2021: 16 · 2020: 8 · 2019: 1
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (NIH HSN27500006, HHSN27500003, U54HD042454-06)
- Topics
- Social Sciences › Sociology and Political Science › Doping in Sports
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Pharmacological Effects and Assays
- Keywords
- anabolic steroids, withdrawal syndrome, hypothalamic-pituitary-testicular axis, infertility, erythrocytosis, sex hormone-binding globulin, cardiovascular risk, liver disease, biological passport, clomiphene citrate, human chorionic gonadotropin, adverse effects
- MeSH terms
- Androgens, Doping in Sports, Dose-Response Relationship, Drug, Female, Humans, Male, Sex Factors, Substance Abuse Detection, Prevalence, Substance-Related Disorders, Anabolic Agents, Athletes, Performance-Enhancing Substances
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