Steroid (anabolic-androgenic) doping in sport
Steroid doping refers to use of anabolic-androgenic steroids (AAS) or steroid-like performance-enhancing drugs outside approved medical indications. AAS misuse is associated with clinically significant cardiovascular, hepatic, endocrine, reproductive, psychiatric, and infectious risks. [1], NHS: Anabolic steroid misuse
Health risks associated with anabolic-androgenic steroid doping
Cardiovascular complications are common and include hypertension, dyslipidemia, myocardial dysfunction, coronary atherosclerosis, and arrhythmias. [2], [1], USADA: Effects of Performance-Enhancing Drugs
Hepatic toxicity is a recognized risk and includes cholestatic injury and serious liver injury. [1], [3]
Reproductive endocrine effects include testicular atrophy and infertility. NHS: Anabolic steroid misuse, Causes of infertility (NHS)
Psychiatric and behavioral consequences include depression and withdrawal symptoms. USADA: Effects of Performance-Enhancing Drugs, [2]
Infectious and procedural harms can occur with unsterile injection practices. [2], [1]
Medication and supplement-related risk amplification
AAS misuse often occurs with “stacking” and “pyramiding” practices, which increase exposure and adverse-effect risk. NHS: Anabolic steroid misuse
Nonprescribed and mislabeled products increase risk for serious adverse events. [3]
Unapproved steroid-like products (including SARMs) are explicitly not FDA approved. [4]
Diagnostic evaluation after suspected steroid doping
AAS use should be treated as a substance use–related medical risk with assessment for cardiovascular symptoms, mood changes, and liver toxicity symptoms. [1], NHS: Anabolic steroid misuse
Basic evaluation commonly targets hypertension and dyslipidemia given the documented cardiovascular toxicity spectrum. [2], [1]
Liver injury assessment is indicated given recognition of serious liver injury associated with steroid/steroid-like body-building products. [3]
Reproductive endocrine assessment should be considered due to infertility and testicular atrophy risks. NHS: Anabolic steroid misuse, Causes of infertility (NHS)
Psychiatric screening should be considered because anabolic-androgenic steroid use can be associated with depression and withdrawal phenomena. USADA: Effects of Performance-Enhancing Drugs, [2]
Clinical management principles
Cessation of AAS exposure is recommended given the recognized harms across multiple organ systems. [1], NHS: Anabolic steroid misuse
Ongoing medical management should address specific toxicity syndromes that may emerge during use or after discontinuation. [1], USADA: Effects of Performance-Enhancing Drugs
If testosterone or androgen therapy is being considered for an approved medical indication, risk assessment and careful monitoring are emphasized by professional guidance. [5], [6]
Athlete health and safety messaging relevant to doping
Sports medicine and anti-doping medical materials emphasize serious effects on health, including cardiovascular risk, liver disease risk, and psychological dependence. WADA–AMA Sports Physician Toolkit
Urgent escalation indicators
Immediate medical evaluation is indicated with symptoms compatible with acute cardiovascular events or severe liver injury because life-threatening complications have been documented with steroid/steroid-like exposure. [3], USADA: Effects of Performance-Enhancing Drugs