From therapeutic benefit to cardiovascular risk: a multidisciplinary review on anabolic steroids
Year: 2026
Type: article
Abstract: Anabolic-androgenic steroids (AAS) have established therapeutic applications, particularly testosterone replacement therapy in men with hypogonadism; however, non-therapeutic use at supraphysiological doses is associated with important cardiovascular consequences. This narrative review synthesizes recent evidence on the mechanisms, risks, and clinical implications of AAS use, emphasizing the distinction between supervised therapeutic treatment and abuse. Evidence from randomized clinical trials, including the TRAVERSE and T4DM studies, indicates that testosterone replacement therapy, when appropriately indicated and monitored, does not increase the risk of major cardiovascular events, although it may be associated with arrhythmias and thromboembolic events. In contrast, observational studies demonstrate that abusive AAS use is associated with higher incidences of acute myocardial infarction, cardiomyopathy, arrhythmias, venous thromboembolism, hypertension, and dyslipidemia. The underlying mechanisms include androgen receptor overactivation, oxidative stress, endothelial dysfunction, pathological cardiac remodeling, myocardial fibrosis, lipid abnormalities, and prothrombotic effects. The magnitude of cardiovascular damage appears to depend primarily on dose, duration, and cumulative exposure, as well as the simultaneous use of multiple compounds. Clinical management should therefore adopt a multidisciplinary approach involving cardiology, endocrinology, psychiatry, and sports medicine, with individualized strategies for cardiovascular screening, risk prevention, patient education, and harm reduction.
Authors: Ana Clara Pessoa Pontes, Janaína Soares Dutra, Fábio Andrade De Carvalho, Carla Lúcia De Camargo, Ana Luisa Gordiano De Carvalho, Andres Mesquita Alves, Tamara Cotrim Marques, Helvis Bonfim Felipe De Lima, Letícia Braga De Oliveira, Larissa de Leite Veiga, Steffany Bonatto, Rodrigo Gamalier De Paiva, Márcio Pimentel Rocha, Milene Jakobi De Camargo
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7202202291