The Impact of Anabolic-Androgenic Steroid Use on the Cardiovascular System in Bodybuilding: A Systematic Review

Yıl 2025, Cilt: 7 Sayı: 2, 313 - 329, 30.09.2025

Sercan Öncen

https://doi.org/10.47778/ejsse.1678207

Öz

Anabolic androgenic steroids (AAS) represent a group of synthetic testosterone derivatives produced to maximize anabolic effects. Widely used worldwide, especially among male bodybuilders and gym-goers, ASS can be administered orally, parenterally, by intramuscular injection and transdermally. AAS cause a dose- dependent increase in the cross-sectional area of hypertrophy type I and type II muscle fibers and myonuclear areas. It has been reported that ASS may protect from muscle fiber damage and increase the level of protein synthesis during recovery, especially after intense strength training. In this systematic review study, full-text articles published in the last ten years (2014- 2024) in journals in Science Citation Index (SCI), SCI Expanded, Social Science Citation Index (SSCI) and PubMed/MEDLINE databases investigating the relationship between testosterone and cardiovascular diseases were analyzed. "Anabolic steroids", "androgens", "anabolic androgenic steroids", "bodybuilding", "cardiovascular effects" and "doping in sports" used as keywords. A total of 9 articles that met the specified conditions were analyzed. The diagnosis of cardiac arrest as a cause of death from ASS-induced cardiac arrest reveals the occurrence of pathological changes in the myocardium, including cardiac and left ventricular hypertrophy, coronary atherosclerosis, myocarditis, interstitial and replacement fibrosis, and contraction band necrosis. Long-term abuse and misuse of ASS can increase the risk of sudden cardiac death (SCD), myocardial infarction, altered serum lipoproteins and cardiac hypertrophy, which can be particularly fatal to the cardiovascular system. Most studies agree that the longer AAS use lasts, the worse the risk profile for cardiovascular disease and that ASS should be determined by the duration of use. There is substantial evidence that AAS is the primary cause of sudden cardiac death in AAS users.

Anahtar Kelimeler

Anabolic androgenic steroids , Anabolic steroids , Bodybuilding , Cardiovascular effects , Doping in sports

Kaynakça

• Akalın, F. (2006). Sudden death in athletes. Turkish Archives of Pediatrics, 41(3), 131-133.
• Aksoy, M., & Akdemir, R. (2016). Relationship of testosterone with cardiovascular diseases. Andrology Bulletin, 18 (66), 160-162.
• Achar, S., Rostamian, A., & Narayan S.M. (2010). Cardiac and metabolic effects of anabolic androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm, Am. J. Cardiol., 106(6) 893–90. https://doi.org/10.1016/j.amjcard.2010.05.013
• Albano, G. D., Amico, F., Cocimano, G., Liberto, A., Maglietta, F., Esposito, M., & Montana, A. (2021). Adverse effects of anabolic-androgenic steroids: a literature review. In Healthcare 9(1), 97-98. https://doi.org/10.3390/healthcare9010097
• Ariel, G. & Saville, W. (1972). Anabolic steroids: the physiologiacal effects of placebos. Med. Sci. Sports Excerc., 4, 124–126.
• Ayubi, N., Kusnanik, N. W., Herawati, L., Komaini, A., Cholik, T., & Syafawi, A. (2023). Abuse of anabolic-androgenic steroids and adverse effects on human organ health: a review. Biointerface Res Appl Chem, 13(3), 1-1.
• Bahrke, M.S., & Yesalis, C.E. (2004). Abuse of anabolic-androgenic steroids and related sub stances in sport and exercise. Curr. Opin. Pharmacol. 4, 614–620. https://doi.org/10.1016/j.coph.2004.05.006
• Bond, P., Smit, D. L., & Ronde, W. (2022). Anabolic–androgenic steroids: How do they work and what are the risks?. Frontiers in Endocrinology, 13, 1-25. https://doi.org/10.3389/fendo.2022.1059473
• Brower, K.J., Blow, F.C., Eliopulos, G.A., & Beresford, T.P., (1989). Anabolic androgenic steroids and suicide. Am. J. Psychiatry, 146, Article 1075. https://doi.org/10.1176/ajp.146.8.1075a
• Corona, G., Rastrelli, G., Monami, M., Guay, A., Buvat, J., Sforza, A., & Maggi, M. (2011). Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. European Journal of Endocrinology, 165(5), 687-701. https://doi.org/10.1530/eje-11-0447
• Çınaroğlu, M. (2024). Muscle dysmorphia and long-term anabolic steroid abuse: A 20-year case report. Topkapı Sosyal Bilimler Dergisi, 3(2), 9-13.
• Doleeb, S., Kratz, A., Salter, M., & Thohan, V. (2019). Strong muscles, weak heart: testosterone‐induced cardiomyopathy. ESC Heart Failure, 6(5), 1000-1004. https://doi.org/10.1002/ehf2.12494
• Dufayet, L., Gorgiard, C., Vayssette, F., Barbet, J. P., Hoizey, G., & Ludes, B. (2020). Death of an apprentice bodybuilder following 2, 4-dinitrophenol and clenbuterol intake. International Journal of Legal Medicine, 134, 1003-1006. https://doi.org/10.1007/s00414-020-02268-2
• Esposito, M., Licciardello, G., Privitera, F., Iannuzzi, S., Liberto, A., Sessa, F., & Salerno, M. (2021). Forensic post-mortem investigation in AAS abusers: Investigative diagnostic protocol. A systematic review. Diagnostics, 11(8), 1307. https://doi.org/10.3390/diagnostics11081307
• Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., & Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 387(10022), 957-967. https://doi.org/10.1016/S0140-6736(15)01225-8
• Fabresse, N., Grassin-Delyle, S., Etting, I., & Alvarez, J. C. (2017). Detection and quantification of 12 anabolic steroids and analogs in human whole blood and 20 in hair using LC-HRMS/MS: Application to real cases. International Journal of Legal Medicine, 131, 989-999. https://doi.org/10.1007/s00414-017-1552-3
• Farias, J. M., Tinetti, M., Khoury, M., & Umpierrez, G. E. (2014). Low testosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. The Journal of Clinical Endocrinology & Metabolism, 99(12), 4698-4703. https://doi.org/10.1210/jc.2014-2585
• Fonseca-Reyes, S., Fajardo-Flores, I., Montes-Casillas, M., & Forsyth-MacQuarrie, A. (2009). Differences and effects of medium and large adult cuffs on blood pressure readings in individuals with muscular arms. Blood Pressure Monitoring, 14(4), 166-171. https://doi.org/10.1097/MBP.0b013e32832ea9f0
• Grundlingh, J., Dargan, P. I., El-Zanfaly, M., & Wood, D. M. (2011). 2, 4-dinitrophenol (DNP): A weight loss agent with significant acute toxicity and risk of death. Journal of Medical Toxicology, 7(3), 205-212. https://doi.org/10.1007/s13181-011-0162-6
• Hak, A. E., Witteman, J. C., de Jong, F. H., Geerlings, M. I., Hofman, A., & Pols, H. A., (2002). Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. The Journal of Clinical Endocrinology & Metabolism, 87(8), 3632-3639. https://doi.org/10.1210/jcem.87.8.8762
• Hakansson, A., Mickelsson, K., Wallin, C., & Berglund, M. (2012). Anabolic androgenic steroids in the general population: user characteristics and associations with substance use. European Addiction Research, 18(2), 83-90. https://doi.org/10.1159/000333037
• Hashim, A. R. M., & Almukhtar, S. H. (2021). Effect of anabolic-androgenic steroids on men's semen among gym-goers: a cohort study. Annals of The Romanian Society for Cell Biology, 25(5), 5111-5118.
• Haupt, H.A., & Rovere, G.D., (1984). Anabolic steroids: A review of the literature. Am. J. Sports Med., 12(6), 469-484. https://doi.org/10.1177/036354658401200613
• Havnes, I. A., Jørstad, M. L., Innerdal, I., & Bjørnebekk, A. (2021). Anabolic-androgenic steroid use among women–A qualitative study on experiences of masculinizing, gonadal and sexual effects. International Journal of Drug Policy, 95, 102876. https://doi.org/10.1016/j.drugpo.2020.102876
• Horwitz, H., Andersen, J. T., & Dalhoff, K. P. (2019). Health consequences of androgenic anabolic steroid use. Journal of Internal Medicine, 285(3), 333-340. https://doi.org/10.1111/joim.12850
• İritaş, S. B., & Öner, B. S. (2025). Anabolic androgenic steroid use disorder: A public health issue. Sabuncuoglu Serefeddin Health Sciences, 7(1), 39-42.
• Jonklaas, J., Burman, K. D., Wang, H., & Latham, K. R. (2015). Single-dose T3 administration: kinetics and effects on biochemical and physiological parameters. Therapeutic Drug Monitoring, 37(1), 110-118. https://doi.org/10.1097/ftd.0000000000000113
• David, K., Dingemanse, E., Freud, J., & Laqueur, E. (1935). Über krystallinisches männliches Hormon aus Hoden (Testosteron), wirksamer als aus Harn oder aus Cholesterin bereitetes Androsteron. Biological Chemistry, 233(5-6), 281-283. https://doi.org/10.1515/bchm2.1935.233.5-6.281
• Kanayama, G., Hudson, J. I., & Pope Jr, H. G. (2010). Illicit anabolic–androgenic steroid use. Hormones and Behavior, 58(1), 111-121. https://doi.org/10.1016/j.yhbeh.2009.09.006
• Krieg, A., Scharhag, J., Albers, T., Kindermann, W., & Urhausen, A. (2007). Cardiac tissue Doppler in steroid users. International Journal of Sports Medicine, 28(08), 638-643. https://doi.org/10.1055/s-2007-964848
• Kuhn, C.M., (2002). Anabolic steroids. Recent Prog. Horm. Res., 57, 411–434 https://doi.org/10.1210/rp.57.1.411
• Lehmann, S., Thomas, A., Schiwy-Bochat, K. H., Geyer, H., Thevis, M., Glenewinkel, F., & Juebner, M. (2019). Death after misuse of anabolic substances (clenbuterol, stanozolol and metandienone). Forensic Science International, 303, 109925. https://doi.org/10.1016/j.forsciint.2019.109925
• Liu, P.Y., & Death, A.K. (2003). Handelsman, androgens and cardiovascular disease, Endocr. Rev., 24(3), 313–340. http://dx.doi.org/10.1210/er.2003-0005
• Lusetti, M., Licata, M., Silingardi, E., Bonetti, L. R., & Palmiere, C. (2015). Pathological changes in anabolic androgenic steroid users. Journal of Forensic and Legal Medicine, 33, 101-104. https://doi.org/10.1016/j.jflm.2015.04.014
• Lok, S. (2015). Does the use of testosterone enanthate as a form of doping in sports cause early closure of epiphyseal in bones. Int. Jornal Morphol, 33(4), 1201-1204.
• Maravelias, C., Dona, A., Stefanidou, M., & Spiliopoulou, C. (2005). Adverse effects of anabolic steroids in athletes: a constant threat. Toxicology Letters, 158(3), 167-175. https://doi.org/10.1016/j.toxlet.2005.06.005
• McCullough, D., Webb, R., Enright, K. J., Lane, K. E., McVeigh, J., Stewart, C. E., & Davies, I. G. (2021). How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health. Reviews in Endocrine and Metabolic Disorders, 22(2), 389-405. https://doi.org/10.1007/s11154-020-09616-y
• Nottin, S., Nguyen, L. D., Terbah, M., & Obert, P. (2006). Cardiovascular effects of androgenic anabolic steroids in male bodybuilders determined by tissue Doppler imaging. The American Journal of Cardiology, 97(6), 912-915. https://doi.org/10.1016/j.amjcard.2005.10.026
• Quaglio, G., Fornasiero, A., Mezzelani, P., Moreschini, S., Lugoboni, F., & Lechi, A. (2009). Anabolic steroids: dependence and complications of chronic use. Internal and Emergency Medicine, 4(4), 289-296. https://doi.org/10.1007/s11739-009-0260-5
• Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372. https://doi.org/10.1136/bmj.n71
• Payne, J., Kotwinski, P., & Montgomery, H. (2004). Cardiac effects of anabolic steroids. Heart, 90, 473–475. http://dx.doi.org/10.1136/hrt.2003.025783
• Raber, W. (2013). Doping und medikamentöse Leistungssteigerung: Nicht nur Anabolika und nicht nur im Sport. Journal für Klinische Endokrinologie und Stoffwechsel-Austrian Journal of Clinical Endocrinology and Metabolism, 6(1), 34-40.
• Rachoń, D., Pokrywka, L., & Suchecka-Rachoń, K. (2006). Prevalence and risk factors of anabolic-androgenic steroids (AAS) abuse among adolescents and young adults in Poland. Sozial-und Präventivmedizin SPM, 51(6), 392-398. https://doi.org/10.1007/s00038-006-6018-1
• Shores, M. M., & Matsumoto, A. M. (2014). Testosterone, aging and survival: biomarker or deficiency. Current Opinion in Endocrinology, Diabetes and Obesity, 21(3), 209-216. https://doi.org/10.1097/med.0000000000000057
• Sullivan, M.L., Martinez, C.M., Gennis, P., & Gallagher E.J. (1998). The cardiac toxicity of anabolic steroids, Prog. Cardiovasc. Dis. 41 (1) 1–15. http://dx.doi. org/10.1016/S0033-0620(98)80019-4
• Skårberg, K., Nyberg, F., & Engström, I. (2010). Is there an association between the use of anabolic-androgenic steroids and criminality?. European Addiction Research, 16(4), 213-219. https://doi.org/10.1159/000320286
• Smit, D. L., Voogel, A. J., Heijer, M. D., & Ronde, W. D. (2021). Anabolic androgenic steroids induce reversible left ventricular hypertrophy and cardiac dysfunction. Echocardiography results of the HAARLEM study. Frontiers in Reproductive Health, 3, Article 732318. https://doi.org/10.3389/frph.2021.732318
• Smit, D. L., Bond, P., & de Ronde, W. (2022). Health effects of androgen abuse: A review of the HAARLEM study. Current Opinion in Endocrinology, Diabetes and Obesity, 29(6), 560-565. https://doi.org/10.1097/med.0000000000000759
• Thiblin, I., Garmo, H., Garle, M., Holmberg, L., Byberg, L., Michaëlsson, K., & Gedeborg, R. (2015). Anabolic steroids and cardiovascular risk: a national population-based cohort study. Drug and Alcohol Dependence, 152, 87-92. https://doi.org/10.1016/j.drugalcdep.2015.04.013
• Thiblin, I. &, Petersson, A., (2005). Pharmacoepidemiology of anabolic androgenic steroids: a review. Fundam. Clin. Pharmacol. 19(1), 27–44. https://doi.org/10.1111/j.1472-8206.2004.00298.x
• Tivesten, Å., Mellström, D., Jutberger, H., Fagerberg, B., Lernfelt, B., Orwoll, E., & Ohlsson, C. (2007). Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men: the MrOS study in Sweden. Journal of The American College of Cardiology, 50(11), 1070-1076. https://doi.org/10.1016/j.jacc.2007.04.088
• Todd, T. (1987). Anabolic steroids: the gremlins of sport. Journal of Sport History, 14(1), 87-107.
• Turillazzi, E., Perilli, G., Di Paolo, M., Neri, M., Riezzo, I., & Fineschi, V. (2011). Side effects of AAS abuse: An overview. Mini Reviews in Medicinal Chemistry, 11(5), 374-389. http://dx.doi.org/10.2174/138955711795445925
• Waight M & McGuinness W. (2016). Case of low dose clenbuterol toxicity. BMJ Case Rep. 15, 1–3
• Zhou, S., & Glowacki, J. (2018). Dehydroepiandrosterone and bone. In P. M Litwack, G. (Eds.), Vitamins and hormones (1. Edition, Vol. 108, pp. 251,271). Academic Press. https://doi.org/10.1016/bs.vh.2018.01.005