Reviews in Endocrine and Metabolic Disorders

, Volume 16, Issue 3, pp 199–211 | Cite as

Doping with anabolic androgenic steroids (AAS): Adverse effects on non-reproductive organs and functions

  • Eberhard NieschlagEmail author
  • Elena Vorona


Since the 1970s anabolic androgenic steroids (AAS) have been abused at ever increasing rates in competitive athletics, in recreational sports and in bodybuilding. Exceedingly high doses are often consumed over long periods, in particular by bodybuilders, causing acute or chronic adverse side effects frequently complicated by additional polypharmacy. This review summarizes side effects on non-reproductive organs and functions; effects on male and female reproduction have been recently reviewed in a parallel paper. Among the most striking AAS side effects are increases in haematocrit and coagulation causing thromboembolism, intracardiac thrombosis and stroke as well as other cardiac disturbances including arrhythmias, cardiomyopathies and possibly sudden death. 17α-alkylated AAS are liver toxic leading to cholestasis, peliosis, adenomas and carcinomas. Hyperbilirubinaemia can cause cholemic nephrosis and kidney failure. AAS abuse may induce exaggerated self-confidence, reckless behavior, aggressiveness and psychotic symptoms. AAS withdrawal may be accompanied by depression and suicidal intentions. Since AAS abuse is not or only reluctantly admitted physicians should be aware of the multitude of serious side effects when confronted with unclear symptoms,


Anabolic androgenic steroids (AAS) Performance and appearance enhancing drugs (PAED) Adverse effects Stroke Cardiomyopathies Hepatotoxicity Aggression Depression 



The authors thank Susan Nieschlag M.A. for language editing and Maria Schalkowski for processing the manuscript.

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Pope Jr HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35:341–75.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Geyer H, Schänzer W, Thevis M. Anabolic agents: recent strategies for their detection and protection from inadvertent doping. Br J Sports Med. 2014;48:820–6.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Sagoe D, Molde H, Andreassen CS, Torsheim T, Pallesen S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol. 2014;24:383–98.PubMedCrossRefGoogle Scholar
  4. 4.
    Brennan BP, Kanayama G, Pope Jr HG. Performance-enhancing drugs on the web: a growing public-health issue. Am J Addict. 2013;22:158–61.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Striegel H, Simon P, Frisch S, Roecker K, Dietz K, Dickhuth HH, et al. Anabolic ergogenic substance users in fitness-sports: a distinct group supported by the health care system. Drug Alcohol Depend. 2006;81:11–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Hecker A. Der Schmerz blüht. Frankfurter Allgemeine Zeitung 18.10.2014 Nr. 242, p. 40.Google Scholar
  7. 7.
    Fischer-Solms H. Spitzensport: Doping in Ost und West. In: Wir gegen uns: Sport im geteilten Deutschland. Darmstadt: Primus-Verlag; 2009. pp. 111–21.Google Scholar
  8. 8.
    Nieschlag E, Vorona E. Medical consequences of doping with anabolic androgenic steroids (AAS): effects on reproductive functions. Eur J Endocrinol. 2015.03.24.Google Scholar
  9. 9.
    Shahidi NT. A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids. Clin Ther. 2001;23:1355–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Turillazzi E, Perilli G, Di Paolo M, Neri M, Riezzo I, Fineschi V. Side effects of AAS abuse: an overview. Mini Rev Med Chem. 2011;11:374–89.PubMedCrossRefGoogle Scholar
  11. 11.
    Hero M, Wickman S, Hanhijärvi R, Siimes MA, Dunkel L. Pubertal upregulation of erythropoiesis in boys is determined primarily by androgen. J Pediatr. 2005;146:245–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Coviello AD, Kaplan B, Lakshman KM, Chen T, Singh AB, Bhasin S. Effects of graded doses of testosterone on erythropoiesis in healthy young and older men. J Clin Endocrinol Metab. 2008;93:914–9.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Zitzmann M, Nieschlag E. Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men. J Clin Endocrinol Metab. 2007;92:3844–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;15:507–14.CrossRefGoogle Scholar
  15. 15.
    Rochira V, Zirilli L, Madeo B, Maffei L, Carani C. Testosterone action on erythropoiesis does not require its aromatization to estrogen: insights from the testosterone and estrogen treatment of two aromatase-deficient men. J Steroid Biochem Mol Biol. 2009;113:189–94.PubMedCrossRefGoogle Scholar
  16. 16.
    Sakhri S, Gooren LJ. Safety aspects of androgen treatment with 5α-dihydrotestosterone. Andrologia. 2007;39:216–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Maggio M, Snyder PJ, Ceda GP, Milaneschi Y, Luci M, Cattabiani C, et al. Is the haematopoietic effect of testosterone mediated by erythropoietin? The results of a clinical trial in older men. Andrology. 2013;1:24–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Bachman E, Travison TG, Basaria S, Davda MN, Guo W, Li M, et al. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci. 2014;69:725–35.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Palacios A, Campfield LA, McClure RD, Steiner B, Swerdloff RS. Effect of testosterone enanthate on hematopoiesis in normal men. Fertil Steril. 1983;40:100–4.PubMedGoogle Scholar
  20. 20.
    De Caro L, Ghizzi A. Effect of testosterone on the in vitro proliferation of bone marrow granulocyte-macrophage cells (CFU-GM). II. Observations in hypogonadal subjects. Boll Soc Ital Biol Sper. 1989;65:203–10.PubMedGoogle Scholar
  21. 21.
    Ferenchick GS, Hirokawa S, Mammen EF, Schwartz KA. Anabolic-androgenic steroid abuse in weight lifters: evidence for activation of the hemostatic system. Am J Hematol. 1995;49:282–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Shapiro J, Christiana J, Frishman W. Testosterone and other anabolic steroids as cardiovascular drugs. Am J Ther. 1999;6:167–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Zitzmann M, Junker R, Kamischke A, Nieschlag E. Contraceptive steroids influence the hemostatic activation state in healthy men. J Androl. 2002;23:503–11.PubMedGoogle Scholar
  24. 24.
    Kahn NN, Sinha AK, Spungen AM, Bauman WA. Effects of oxandrolone, an anabolic steroid, on hemostasis. Am J Hemato. 2006;81:95–100.CrossRefGoogle Scholar
  25. 25.
    Alén M. Androgenic steroid effects on liver and red cells. Br J Sports Med. 1985;19:15–20.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Nieschlag E, Behre HM, Nieschlag S, editors. Andrology: male reproductive health and dysfunction. 3rd ed. Heidelberg: Springer; 2010. p. 437–55.Google Scholar
  27. 27.
    Clasing D, Müller RK. Dopingkontrolle. Sportverlag Strauß. 2008;5. Auflage.Google Scholar
  28. 28.
    Sjöqvist F, Garle M, Rane A. Use of doping agents, particularly anabolic steroids, in sports and society. Lancet. 2008;371:1872–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Lippi G, Banfi G. Doping and thrombosis in sports. Semin Thromb Hemost. 2011;37:918–28.PubMedCrossRefGoogle Scholar
  30. 30.
    Youssef MY, Alqallaf A, Abdella N. Anabolic androgenic steroid-induced cardiomyopathy, stroke and peripheral vascular disease. BMJ Case Rep. 2011;2011. doi: 10.1136/bcr.12.2010.3650.
  31. 31.
    Shamloul RM, Aborayah AF, Hashad A, Abd-Allah F. Anabolic steroids abuse-induced cardiomyopathy and ischaemic stroke in a young male patient. BMJ Case Rep. 2014;2014. doi: 10.1136/bcr-2013-203033.
  32. 32.
    Schollert PV, Bendixen PM. Dilated cardiomyopathy in a user of anabolic steroids. Ugeskr Laeger. 1993;155:1217–8.PubMedGoogle Scholar
  33. 33.
    Ferrera PC, Putnam DL, Verdile VP. Anabolic steroid use as the possible precipitant of dilated cardiomyopathy. Cardiology. 1997;88:218–20.PubMedCrossRefGoogle Scholar
  34. 34.
    Vogt AM, Geyer H, Jahn L, Schänzer W, Kübler W. Cardiomyopathy associated with uncontrolled self medication of anabolic steroids. Z Kardiol. 2002;91:357–62.PubMedCrossRefGoogle Scholar
  35. 35.
    Clark BM, Schofield RS. Dilated cardiomyopathy and acute liver injury associated with combined use of ephedra, gamma-hydroxybutyrate and anabolic steroids. Pharmacotherapy. 2005;25:756–61.PubMedCrossRefGoogle Scholar
  36. 36.
    Kistler L. Todesfälle bei Anabolikamissbrauch. Todesursache, Befunde und rechtsmedizinische Aspekte. Dissertation zum Erwerb des Doktorgrades der Medizin an der medizinischen Fakultät der Ludwig-Maximilians-Universität zu München. 2006.Google Scholar
  37. 37.
    Stergiopoulos K, Brennan JJ, Mathews R, Setaro JF, Kort S. Anabolic steroids, acute myocardial infarction and polycythemia: a case report and review of the literature. Vasc Health Risk Manag. 2008;4:1475–80.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Ahlgrim C, Guglin M. Anabolics and cardiomyopathy in a bodybuilder: case report and literature review. J Card Fail. 2009;15:496–500.PubMedCrossRefGoogle Scholar
  39. 39.
    Bispo M, Valente A, Maldonado R, Palma R, Glória H, Nóbrega J, et al. Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder. World J Gastroenterol. 2009;15:2920–2.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Fanton L, Belhani D, Vaillant F, Tabib A, Gomez L, Descotes J, et al. Heart lesions associated with anabolic steroid abuse: comparison of post-mortem findings in athletes and norethandrolone-induced lesions in rabbits. Exp Toxicol Pathol. 2009;61:317–23.PubMedCrossRefGoogle Scholar
  41. 41.
    Montisci M, El Mazloum R, Cecchetto G, Terranova C, Ferrara SD, Thiene G, et al. Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases. Forensic Sci Int. 2012;217:e13–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Thiblin I, Mobini-Far H, Frisk M. Sudden unexpected death in a female fitness athlete, with a possible connection to the use of anabolic androgenic steroids (AAS) and ephedrine. Forensic Sci Int. 2009;184:e7–11.PubMedCrossRefGoogle Scholar
  43. 43.
    Elashoff JD, Jacknow AD, Shain SG, Braunstein GD. Effects of anabolic-androgenic steroids on muscular strength. Ann Intern Med. 1991;115:387–93.PubMedCrossRefGoogle Scholar
  44. 44.
    Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med. 1996;335:1–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Bhasin S, Ravi J, Serra C, Singh R, Storer TW, Guo W, Travison TG, Basaria S. Androgen effects on the skeletal muscle. In: Nieschlag E, Behre HM, editors. Testosterone: action, deficiency, substitution. Cambridge University Press; 2012. Pp. 191–206.Google Scholar
  46. 46.
    Yu JG, Bonnerud P, Eriksson A, Stål PS, Tegner Y, Malm C. Effects of long term supplementation of anabolic androgen steroids on human skeletal muscle. PLoS ONE. 2014;9:1–11.CrossRefGoogle Scholar
  47. 47.
    Nielsen TL, Hagen C, Wraae K, Bathum L, Larsen R, Brixen K, et al. The impact of the CAG repeat polymorphism of the androgen receptor gene on muscle and adipose tissues in 20-29-year-old Danish men: Odense Androgen Study. Eur J Endocrinol. 2010;162:795–804.PubMedCrossRefGoogle Scholar
  48. 48.
    Esteban E, Rodon N, Via M, Gonzalez-Perez E, Santamaria J, Dugoujon JM, et al. Androgen receptor CAG and GGC polymorphisms in Mediterraneans: repeat dynamics and population relationships. J Hum Genet. 2006;51:129–36.PubMedCrossRefGoogle Scholar
  49. 49.
    Ackerman CM, Lowe LP, Lee H, Hayes MG, Dyer AR, Metzger BE, et al. Ethnic variation in allele distribution of the androgen receptor (AR) (CAG)n repeat. J Androl. 2012;33:210–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Egner IM, Bruusgaard JC, Eftestøl E, Gundersen K. A cellular memory mechanism aids overload hypertrophy in muscle long after an episodic exposure to anabolic steroids. J Physiol. 2013;591:6221–30.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Vanderschueren D, Vandenput L, Boonen S, Lindenberg M, Bouillon R, Ohlsson C. Androgens and bone. Endocr Rev. 2004;25:389–425.PubMedCrossRefGoogle Scholar
  52. 52.
    Vanderschueren D, Sinnesael M, Gielen E, Claessens F, Boonen S. Testosterone and bone. In: Nieschlag E, Behre HM, editors. Testosterone: action, deficiency, substitution. Cambridge University Press; 2012. Pp. 177–99Google Scholar
  53. 53.
    Rolf C, Nieschlag E. Potential adverse effects of long-term testosterone therapy. Bailliere Clin Endocrinol Metab. 1998;12:521–34.CrossRefGoogle Scholar
  54. 54.
    Przkora R, Jeschke MG, Barrow RE, Suman OE, Meyer WJ, Finnerty CC, et al. Metabolic and hormonal changes of severely burned children receiving long-term oxandrolone treatment. Ann Surg. 2005;242:384–9.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Farkash U, Shabshin N, Pritsch Perry M. Rhabdomyolysis of the deltoid muscle in a bodybuilder using anabolic-androgenic steroids: a case report. J Athl Train. 2009;44:98–100.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Hall RC, Hall RC. Abuse of supraphysiologic doses of anabolic steroids. South Med J. 2005;98:550–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Horn S, Gregory P, Guskiewicz KM. Self-reported anabolic-androgenic steroids use and musculoskeletal injuries: findings from the center for the study of retired athletes health survey of retired NFL players. Am J Phys Med Rehabil. 2009;88:192–200.PubMedCrossRefGoogle Scholar
  58. 58.
    Schutzel MM, Johnson MH, Rosenthal HG. Bilateral deltoid myositis ossificans in a weightlifter using anabolic steroids. Orthopedics. 2014;37:844–7.CrossRefGoogle Scholar
  59. 59.
    Channer KS, Jones TH. Testosterone and cardiovascular disease. In: Nieschlag E, Behre HM, editors. Testosterone: action, deficiency, substitution. Cambridge University Press; 2012. pp 207–34.Google Scholar
  60. 60.
    Corona G, Maseroli E, Rastrelli G, Isidori AM, Sforza A, Mannucci E, et al. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf. 2014;13:1327–51.PubMedCrossRefGoogle Scholar
  61. 61.
    Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90:224–51.PubMedCrossRefGoogle Scholar
  62. 62.
    Hartgens F, Rietjens G, Keizer HA, Kuipers H, Wolffenbuttel BH. Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein (a). Br J Sports Med. 2004;38:253–9.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Kindermann W. Kardiovaskuläre Nebenwirkungen von anabol-androgenen Steroiden. Herz. 2006;31:566–73.PubMedCrossRefGoogle Scholar
  64. 64.
    Bonetti A, Tirelli F, Catapano A, Dazzi D, Dei Cas A, Solito F, et al. Side effects of anabolic androgenic steroids abuse. Int J Sports Med. 2008;29:679–87.PubMedCrossRefGoogle Scholar
  65. 65.
    Carson P, Hong CJ, Otero-Vinas M, Arsenault EF, Falanga V. Liver enzymes and lipid levels in patients with lipodermatosclerosis and venous ulcers treated with a prototypic anabolic steroid (stanozolol): a prospective, randomized, double-blinded, placebo-controlled trial. Int J Low Extrem Wounds. 2015;14:11–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Singh AB, Hsia S, Alaupovic P, Sinha-Hikim I, Woodhouse L, Buchanan TA, Shen R, Bross R, Berman N, Bhasin S. The effects of varying doses of T on insulin sensitivity, plasma lipids, apolipoproteins, and C-reactive protein in healthy young men. J Clin Endocrinol Metab. 2002;136–43.Google Scholar
  67. 67.
    Gåverik N, Strahm E, Garlw M, Lundmark J, Ståhle L, Ekström L, et al. Long term perturbation of endocrine parameters and cholesterol metabolism after discontinued abuse of anabolic androgenic steroids. J Steroid Mol Biol. 2011;127:295–300.CrossRefGoogle Scholar
  68. 68.
    Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. Am J Cardiol. 2010;106:893–901.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversible? Heart. 2004;90:496–501.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Sculthorpe N, Grace F, Jones P, Davies B. Evidence of altered cardiac electrophysiology following prolonged androgenic anabolic steroid use. Cardiovasc Toxicol. 2010;10:239–43.PubMedCrossRefGoogle Scholar
  71. 71.
    Akçakoyun M, Alizade E, Gündoğdu R, Bulut M, Tabakci MM, Açar G, et al. Long-term anabolic androgenic use is associated with increased atrial electromechanical delay in male bodybuilders. Biomed Res Int. 2014;2014:1–8.CrossRefGoogle Scholar
  72. 72.
    Alizade E, Avcı A, Fidan S, Tabakçı M, Bulut M, Zehir R, Simsek Z, Evlice M, Arslantaş U, Çakır H, Emiroglu MY, Akçakoyun M. The effect of chronic a nabolic-androgenic steroid use on Tp-E interval, Tp-E/Qt ratio, and Tp-E/Qtc ratio in male bodybuilders. Ann Noninvasive Electrocardiol. 2015. doi: 10.1111/anec.12256.
  73. 73.
    Dickerman RD, Shaller F, McConathy WJ. Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid use. Cardiology. 1998;90:145–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Karila TA, Karjalainen JE, Mäntysaari MJ, Viitasalo MT, Seppälä TA. Anabolic androgenic steroids produce dose-dependant increase in left ventricular mass in power athletes, and this effect is potentiated by concomitant use of growth hormone. Int J Sports Med. 2003;24:337–43.PubMedCrossRefGoogle Scholar
  75. 75.
    Lind JM, Chiu C, Ingles J, Yeates L, Humphries SE, Heather AK, et al. Sex hormone receptor gene variation associated with phenotype in male hypertrophic cardiomyopathy patients. J Mol Cell Cardiol. 2008;45:217–22.PubMedCrossRefGoogle Scholar
  76. 76.
    De Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E. Anabolic steroid use in body builders: an echocardiographic study of the left ventricle morphology and function. Int J Sports Med. 1991;12:408–12.PubMedCrossRefGoogle Scholar
  77. 77.
    Di Bello V, Giorgi D, Bianchi M, Bertini A, Caputo MT, Valenti G, Furioso O, Alessandri L, Paterni M, Giusti C. Effects of anabolic-androgenic steroids on weight-lifters’ myocardium: an ultrasonic videodensitometric study. Med Sci Sports Exerc. 1999;514–21.Google Scholar
  78. 78.
    Caso P, D’Andrea A, Caso I, Severino S, Calabrò P, Allocca F, et al. The athlete’s heart and hypertrophic cardiomyopathy: two conditions which may be misdiagnosed and coexistent. Which parameters should be analysed to distinguish one disease from the other? J Cardiovasc Med (Hagerstown). 2006;7:257–66.CrossRefGoogle Scholar
  79. 79.
    Luijkx T, Velthuis BK, Backx FJG, Buckens CFM, Prakken NHJ, Rienks R, et al. Anabolic androgenic steroid use is associated with ventricular dysfunction on cardiac MRI in strength trained athletes. Int J Cardiol. 2013;167:664–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Baumann S, Jabbour C, Huseynov A, Borggrefe M, Haghi D, Papavassiliu T. Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids. Asian J Sports Med. 2014;5, e24058.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Nascimento AD, de Lima E, Boёchat G, Meyrelles S, Bissoli N, Lenz D, Endringer D, de Andrade T. Testosterone induces apoptosis in cardiomyocytes by increasing proapoptotic signaling involving tumor necrosis factor-α and renin angiotensin system. Hum Exp Toxicol. 2015. doi: 10.1177/0960327115571766.
  82. 82.
    Sondergaard EB, Thune JJ, Gustafsson F. Characteristics and outcome of patients referred for management of advanced heart failure due to anabolic-androgenic steroid abuse. Scand Cardiovasc J. 2014;21:1–11.Google Scholar
  83. 83.
    Franke WW. Dualism in cardiac pathogenesis: illicit use of anabolic-androgenic steroids in a shot-put athlete homozygous for a missense desmoglein-2 (Dsg2) mutation. Cell Tissue Res. 2012;348:335–70.PubMedCentralCrossRefGoogle Scholar
  84. 84.
    Friedrich FW, Carrier L. Genetics of hypertrophic and dilated cardiomyopathy. Curr Pharm Biotechnol. 2012;13:2467–76.PubMedCrossRefGoogle Scholar
  85. 85.
    Maisch B, Richter A, Sandmöller A, Porting I, Pankuweit S. Inflammatory dilated cardiomyopathy (DCMI). Herz. 2005;30:535–44.PubMedCrossRefGoogle Scholar
  86. 86.
    Nieschlag E. Is the use of methyltestosterone obsolete? Dtsch Med Wochenschr. 1981;106:1123–5.PubMedCrossRefGoogle Scholar
  87. 87.
    El Sherrif Y, Potts JR, Howard MR, Barnardo A, Cairns S, Knisely AS, et al. Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations? Liver Int. 2013;33:1266–70.PubMedCrossRefGoogle Scholar
  88. 88.
    Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab. 2010;95:1533–43.PubMedCrossRefGoogle Scholar
  89. 89.
    Robles-Diaz M, Gonzalez-Jimenez A, Medina-Caliz I, Stephens C, García-Cortes M, García-Muñoz B, et al. Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids. Aliment Pharmacol Ther. 2015;41:116–25.PubMedCrossRefGoogle Scholar
  90. 90.
    Nakao A, Sakagami K, Nakata Y, Komazawa K, Amimoto T, Nakashima K, et al. Multiple hepatic adenomas caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis. J Gastoenterol. 2000;35:557–62.CrossRefGoogle Scholar
  91. 91.
    Shah NL, Zacharias I, Khettry U, Afdhal N, Gordon FD. Methasteron-associated cholestatic liver injury: clinicopathologic findings in 5 cases. Clin Gastroenterol Hepatol. 2008;6:255–8.PubMedCrossRefGoogle Scholar
  92. 92.
    Socas L, Zumbado M, Pérez-Luzardo O, Ramos A, Pérez C, Hernández JR, et al. Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature. Br J Sports Med. 2005;39, e27.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Giannitrapani L, Soresi M, La Spada E, Cervello M, D’Alessandro N, Montalto G. Sex hormones and risk of liver tumor. Ann N Y Acad Sci. 2006;1089:228–36.PubMedCrossRefGoogle Scholar
  94. 94.
    Hardt A, Stippel D, Odenthal M, Hölscher AH, Dienes HP, Drebber U. Development of hepatocellular carcinoma associated with anabolic androgenic steroid abuse in a young bodybuilder: a case report. Case Rep Pathol. 2012;195607. doi: 10.1155/2012/195607.
  95. 95.
    Solbach P, Potthoff A, Raatschen HJ, Soudah B, Lehmann U, Schneider A, et al. Testosterone-receptor positive hepatocellular carcinoma in a 29-year old bodybuilder with a history of anabolic androgenic steroid abuse: a case report. BMC Gastroenterol. 2015;15:60. doi: 10.1186/s12876-015-0288-0.PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Johnson CA. Use of androgens in patients with renal failure. Semin Dial. 2000;13:36–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Luciano RL, Castano E, Moeckel G, Perazella MA. Bile acid nephropathy in a bodybuilder abusing an anabolic androgenic steroid. Am J Kidney Dis. 2014;64:473–6.PubMedCrossRefGoogle Scholar
  98. 98.
    Rosenfeld GA, Chang A, Poulin M, Kwan P, Yoshida E. Cholestatic jaundice, acute kidney injury and acute pancreatitis secondary to the recreational use of methandrostenolone: a case report. J Med Case Rep. 2011;5:138.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Unai S, Miessau J, Karbowski P, Baram M, Cavarocchi NC, Hirose H. Caution for anabolic androgenic steroid use: a case report of multiple organ dysfunction syndrome. Respir Care. 2013;58:e159–63.PubMedCrossRefGoogle Scholar
  100. 100.
    Deshmukh N, Petroczi A, Barker J, Szekely AD, Hussain I, Naughton DP. Potentially harmful advantage to athletes: a putative connection between UGT2B17 gene deletion polymorphism and renal disorders with prolonged use of anabolic androgenic steroids. Subst Abuse Treat Prev Policy. 2010;5:1–7.CrossRefGoogle Scholar
  101. 101.
    Zhu AZ, Cox LS, Ahluwalia JS, Renner CC, Hatsukami DK, Benowitz NL, et al. Genetic and phenotypic variation in UGT2B17, a testosterone-metabolizing enzyme, is associated with BMI in males. Pharmacogenet Genomics. 2015;25:263–9.PubMedCrossRefGoogle Scholar
  102. 102.
    Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of 500 users. Med Sci Sports Exerc. 2006;38:644–51.PubMedCrossRefGoogle Scholar
  103. 103.
    Piacentino D, Kotzalidis GD, Del Casale A, Aromatario MR, Pomara C, Girardi P, et al. Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Curr Neuropharmacol. 2015;13:101–21.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Pope CG, Pope HG, Menard W, Fay C, Olivardia R, Phillips KA. Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image. 2005;2:395–400.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Björk T, Skåberg K, Engström I. Eating disorders and anabolic androgenic steroids in males – similarities and differences in self-image and psychiatric symptoms. Subst Abuse Treat Prev Policy. 2013;8:1–7.CrossRefGoogle Scholar
  106. 106.
    Blashill AJ, Safren SA. Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys. Pediatrics. 2014;133:469–75.PubMedPubMedCentralCrossRefGoogle Scholar
  107. 107.
    Virmani A, Ali SF, Binienda ZK. Neuroprotective strategies in drug abuse-evoked encephalopathy. Ann N Y Acad Sci. 2010;1199:52–68.PubMedCrossRefGoogle Scholar
  108. 108.
    Pomara C, Neri M, Bello S, Fiore C, Riezzo I, Turillazzi E. Neurotoxicity by synthetic androgen steroids: oxidative stress, apoptosis, and neuropathology: a review. Curr Neuropharmacol. 2015;13:132–45.PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Lindqvist AS, Moberg T, Eriksson BO, Ehrnborg C, Rosén T, Fahlke C. A retrospective 30-year follow-up study of former Swedish-elite male athletes in power sports with a past anabolic androgenic steroids use: a focus on mental health. Br J Sports Med. 2013;47:965–9.PubMedCrossRefGoogle Scholar
  110. 110.
    Kanayama G, Brower KJ, Wood RI, Hudson JI, Pope Jr HG. Treatment of anabolic-androgenic steroid dependence: emerging evidence and its implications. Drug Alcohol Depend. 2010;109:6–13.PubMedPubMedCentralCrossRefGoogle Scholar
  111. 111.
    Skarberg K, Nyberg F, Engstrom I. Multisubstance use as a feature of addiction to anabolic-androgenic steroids. Eur Addict Res. 2009;15:99–106.PubMedCrossRefGoogle Scholar
  112. 112.
    Lundholm L, Frisell T, Lichtenstein P, Långström N. Anabolic androgenic steroids and violent offending: confounding by polysubstance abuse among 10,365 general population men. Addiction. 2015;110:100–8.PubMedCrossRefGoogle Scholar
  113. 113.
    Thiblin I, Lindquist O, Rajs J. Cause and manner of death among users of anabolic androgenic steroids. J Forensic Sci. 2000;45:16–23.PubMedCrossRefGoogle Scholar
  114. 114.
    Kersey RD, Elliot DL, Goldberg L, Kanayama G, Leone JE, Pavlovich M, et al. National Athletic Trainers’ Association position statement: anabolic-androgenic steroids. J Athl Train. 2012;47:567–88.PubMedPubMedCentralGoogle Scholar
  115. 115.
    Thevis M, Kuuranne T, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal. 2015;7:1–20.PubMedCrossRefGoogle Scholar
  116. 116.
    Sottas PE, Vernec A. Current implementation and future of the athlete biological passport. Bioanalysis. 2012;4:1645–52.PubMedCrossRefGoogle Scholar
  117. 117.
    Pokrywka A, Kaliszewski P, Majorczyk E, Zembroń-Łacny A. Genes in sport and doping. Biol Sport. 2013;30:155–61.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Centre of Reproductive Medicine and AndrologyUniversity of MünsterMünsterGermany
  2. 2.Center of Excellence in Genomic Medicine ResearchKing Abdulaziz UniversityJeddahSaudi Arabia
  3. 3.Centre of Endocrinology, Diabetology and RheumatologyDortmundGermany

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