Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Use of androgens and other hormones by athletes

Peter J Snyder, MD
Section Editors
Alvin M Matsumoto, MD
Peter Fricker, MBBS, FACSP
Deputy Editor
Kathryn A Martin, MD


Some athletes use drugs to attempt to improve their performance. The focus of the general news media is on the professional athletes who are caught using hormonal drugs, most commonly, androgens, in sporting events such as the Olympic Games and major league baseball. However, the majority of individuals using these medications are recreational athletes (eg, weightlifters and bodybuilders) who use them to improve overall strength and personal appearance [1].

This topic will focus on the epidemiology, physical and adverse effects, and detection of hormones used to improve athletic performance and physical appearance. The use of nonhormonal agents and nonpharmacologic enhancement methods (such as blood transfusions) are reviewed separately. (See "Prohibited non-hormonal performance-enhancing drugs in sport".)


Performance-enhancing drugs (PEDs) – Agents used to attempt to enhance athletic performance, and in the case of weightlifters/bodybuilders, physical appearance, with a goal of appearing leaner and more muscular. Although users take these drugs to improve their performance, data supporting their efficacy are limited. (See 'Efficacy' below.)

Doping – "Doping" refers to the use of banned substances in competitive sports.

Androgenic steroids (AS) – These (naturally occurring or synthetic) hormones increase lean body mass and decrease fat mass and are the most frequently used class of PEDs. The synthetic hormones differ from testosterone, as described below. The author of this topic uses the term "androgens" or "androgenic steroids" rather than "anabolic-androgenic steroids" because the anabolic effects of a steroid cannot be separated from its androgenic effects.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Dec 2017. | This topic last updated: Dec 04, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2018 UpToDate, Inc.
  1. Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of 500 users. Med Sci Sports Exerc 2006; 38:644.
  2. Sjöqvist F, Garle M, Rane A. Use of doping agents, particularly anabolic steroids, in sports and society. Lancet 2008; 371:1872.
  3. Melnik BC. Androgen abuse in the community. Curr Opin Endocrinol Diabetes Obes 2009; 16:218.
  4. Sagoe D, Molde H, Andreassen CS, et al. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol 2014; 24:383.
  5. Casey A, Hughes J, Izard RM, Greeves JP. Supplement use by UK-based British Army soldiers in training. Br J Nutr 2014; 112:1175.
  6. final-2011-hrb-active-duty-survey-report reduced.pdf (Accessed on June 23, 2015).
  7. Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 2014; 35:341.
  8. Buckman JF, Farris SG, Yusko DA. A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug Alcohol Depend 2013; 131:50.
  9. Ip EJ, Lu DH, Barnett MJ, et al. Psychological and physical impact of anabolic-androgenic steroid dependence. Pharmacotherapy 2012; 32:910.
  10. United States Anti-Doping Agency - Results Management. http://www.usada.org/results/ (Accessed on January 11, 2011).
  11. Kann L, Kinchen S, Shanklin SL, et al. Youth risk behavior surveillance--United States, 2013. MMWR Suppl 2014; 63:1.
  12. Monitoring the Future - a continuing study of American youth. http://www.monitoringthefuture.org (Accessed on February 15, 2011).
  13. Holt RI, Sönksen PH. Growth hormone, IGF-I and insulin and their abuse in sport. Br J Pharmacol 2008; 154:542.
  14. Buckman JF, Yusko DA, White HR, Pandina RJ. Risk profile of male college athletes who use performance-enhancing substances. J Stud Alcohol Drugs 2009; 70:919.
  15. Hakansson A, Mickelsson K, Wallin C, Berglund M. Anabolic androgenic steroids in the general population: user characteristics and associations with substance use. Eur Addict Res 2012; 18:83.
  16. Pope HG Jr, Kanayama G, Athey A, et al. The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates. Am J Addict 2014; 23:371.
  17. Rahnema CD, Lipshultz LI, Crosnoe LE, et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril 2014; 101:1271.
  18. Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The Anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy 2011; 31:757.
  19. Abbate V, Kicman AT, Evans-Brown M, et al. Anabolic steroids detected in bodybuilding dietary supplements - a significant risk to public health. Drug Test Anal 2015; 7:609.
  20. http://list.wada-ama.org/prohibited-in-competition/prohibited-substances/ (Accessed on October 15, 2014).
  21. HERSHBERGER LG, SHIPLEY EG, MEYER RK. Myotrophic activity of 19-nortestosterone and other steroids determined by modified levator ani muscle method. Proc Soc Exp Biol Med 1953; 83:175.
  22. The Federal Register - US Department of Justice, Drug Enforcement Administration. Rules regarding the implementation of the Anabolic Steroid Control Act of 2004. http://www.thefederalregister.com/d.p/2005-12-16-05-23907 (Accessed on April 01, 2011).
  23. Leder BZ, Longcope C, Catlin DH, et al. Oral androstenedione administration and serum testosterone concentrations in young men. JAMA 2000; 283:779.
  24. King DS, Sharp RL, Vukovich MD, et al. Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men: a randomized controlled trial. JAMA 1999; 281:2020.
  25. Brown GA, Vukovich MD, Martini ER, et al. Endocrine responses to chronic androstenedione intake in 30- to 56-year-old men. J Clin Endocrinol Metab 2000; 85:4074.
  26. Acacio BD, Stanczyk FZ, Mullin P, et al. Pharmacokinetics of dehydroepiandrosterone and its metabolites after long-term daily oral administration to healthy young men. Fertil Steril 2004; 81:595.
  27. Wallace MB, Lim J, Cutler A, Bucci L. Effects of dehydroepiandrosterone vs androstenedione supplementation in men. Med Sci Sports Exerc 1999; 31:1788.
  28. Morales AJ, Haubrich RH, Hwang JY, et al. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxf) 1998; 49:421.
  29. Kohler M, Thomas A, Geyer H, et al. Confiscated black market products and nutritional supplements with non-approved ingredients analyzed in the Cologne Doping Control Laboratory 2009. Drug Test Anal 2010; 2:533.
  30. Gao W, Kim J, Dalton JT. Pharmacokinetics and pharmacodynamics of nonsteroidal androgen receptor ligands. Pharm Res 2006; 23:1641.
  31. Starcevic B, Ahrens BD, Butch AW. Detection of the selective androgen receptor modulator S-4 (Andarine) in a doping control sample. Drug Test Anal 2013; 5:377.
  32. Van Wagoner RM, Eichner A, Bhasin S, et al. Chemical Composition and Labeling of Substances Marketed as Selective Androgen Receptor Modulators and Sold via the Internet. JAMA 2017; 318:2004.
  33. Handelsman DJ. Clinical review: The rationale for banning human chorionic gonadotropin and estrogen blockers in sport. J Clin Endocrinol Metab 2006; 91:1646.
  34. Evans-Brown M, Kimergård A, McVeigh J, et al. Is the breast cancer drug tamoxifen being sold as a bodybuilding dietary supplement? BMJ 2014; 348:g1476.
  35. Pemmaraju N, Munsell MF, Hortobagyi GN, Giordano SH. Retrospective review of male breast cancer patients: analysis of tamoxifen-related side-effects. Ann Oncol 2012; 23:1471.
  36. Handelsman DJ. Indirect androgen doping by oestrogen blockade in sports. Br J Pharmacol 2008; 154:598.
  37. Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab 2010; 95:1533.
  38. Mareck U, Geyer H, Guddat S, et al. Identification of the aromatase inhibitors anastrozole and exemestane in human urine using liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom 2006; 20:1954.
  39. Bhasin S, Storer TW, Berman N, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med 1996; 335:1.
  40. Storer TW, Magliano L, Woodhouse L, et al. Testosterone dose-dependently increases maximal voluntary strength and leg power, but does not affect fatigability or specific tension. J Clin Endocrinol Metab 2003; 88:1478.
  41. Broeder CE, Quindry J, Brittingham K, et al. The Andro Project: physiological and hormonal influences of androstenedione supplementation in men 35 to 65 years old participating in a high-intensity resistance training program. Arch Intern Med 2000; 160:3093.
  42. Hausmann R, Hammer S, Betz P. Performance enhancing drugs (doping agents) and sudden death--a case report and review of the literature. Int J Legal Med 1998; 111:261.
  43. Kennedy MC, Lawrence C. Anabolic steroid abuse and cardiac death. Med J Aust 1993; 158:346.
  44. Payne JR, Kotwinski PJ, Montgomery HE. Cardiac effects of anabolic steroids. Heart 2004; 90:473.
  45. Hartgens F, Cheriex EC, Kuipers H. Prospective echocardiographic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes. Int J Sports Med 2003; 24:344.
  46. Thompson PD, Cullinane EM, Sady SP, et al. Contrasting effects of testosterone and stanozolol on serum lipoprotein levels. JAMA 1989; 261:1165.
  47. 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.
  48. Coviello AD, Kaplan B, Lakshman KM, et al. Effects of graded doses of testosterone on erythropoiesis in healthy young and older men. J Clin Endocrinol Metab 2008; 93:914.
  49. Stergiopoulos K, Brennan JJ, Mathews R, et al. Anabolic steroids, acute myocardial infarction and polycythemia: a case report and review of the literature. Vasc Health Risk Manag 2008; 4:1475.
  50. Pope HG Jr, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. Arch Gen Psychiatry 1994; 51:375.
  51. O'Connor DB, Archer J, Hair WM, Wu FC. Exogenous testosterone, aggression, and mood in eugonadal and hypogonadal men. Physiol Behav 2002; 75:557.
  52. Bhasin S, Woodhouse L, Casaburi R, et al. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab 2001; 281:E1172.
  53. Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: a randomized controlled trial. Arch Gen Psychiatry 2000; 57:133.
  54. McCabe SE, Brower KJ, West BT, et al. Trends in non-medical use of anabolic steroids by U.S. college students: results from four national surveys. Drug Alcohol Depend 2007; 90:243.
  55. Beaver KM, Vaughn MG, Delisi M, Wright JP. Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the United States. Am J Public Health 2008; 98:2185.
  56. Gruber AJ, Pope HG Jr. Psychiatric and medical effects of anabolic-androgenic steroid use in women. Psychother Psychosom 2000; 69:19.
  57. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 484: Performance enhancing anabolic steroid abuse in women. Obstet Gynecol 2011; 117:1016. Reaffirmed 2018.
  58. Coward RM, Rajanahally S, Kovac JR, et al. Anabolic steroid induced hypogonadism in young men. J Urol 2013; 190:2200.
  59. Knuth UA, Maniera H, Nieschlag E. Anabolic steroids and semen parameters in bodybuilders. Fertil Steril 1989; 52:1041.
  60. Gazvani MR, Buckett W, Luckas MJ, et al. Conservative management of azoospermia following steroid abuse. Hum Reprod 1997; 12:1706.
  61. Aitken C, Delalande C, Stanton K. Pumping iron, risking infection? Exposure to hepatitis C, hepatitis B and HIV among anabolic-androgenic steroid injectors in Victoria, Australia. Drug Alcohol Depend 2002; 65:303.
  62. Fernández-Balsells MM, Murad MH, Lane M, et al. Clinical review 1: Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2010; 95:2560.
  63. Sollender JL, Rayan GM, Barden GA. Triceps tendon rupture in weight lifters. J Shoulder Elbow Surg 1998; 7:151.
  64. Cope MR, Ali A, Bayliss NC. Biceps rupture in body builders: three case reports of rupture of the long head of the biceps at the tendon-labrum junction. J Shoulder Elbow Surg 2004; 13:580.
  65. Kanayama G, DeLuca J, Meehan WP 3rd, et al. Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study. Am J Sports Med 2015; 43:2638.
  66. Catlin DH, Cowan DA. Detecting testosterone administration. Clin Chem 1992; 38:1685.
  67. Sottas PE, Saudan C, Schweizer C, et al. From population- to subject-based limits of T/E ratio to detect testosterone abuse in elite sports. Forensic Sci Int 2008; 174:166.
  68. Schulze JJ, Lundmark J, Garle M, et al. Doping test results dependent on genotype of uridine diphospho-glucuronosyl transferase 2B17, the major enzyme for testosterone glucuronidation. J Clin Endocrinol Metab 2008; 93:2500.
  69. Jakobsson J, Ekström L, Inotsume N, et al. Large differences in testosterone excretion in Korean and Swedish men are strongly associated with a UDP-glucuronosyl transferase 2B17 polymorphism. J Clin Endocrinol Metab 2006; 91:687.
  70. Schulze JJ, Lorentzon M, Ohlsson C, et al. Genetic aspects of epitestosterone formation and androgen disposition: influence of polymorphisms in CYP17 and UGT2B enzymes. Pharmacogenet Genomics 2008; 18:477.
  71. Stenman UH, Hotakainen K, Alfthan H. Gonadotropins in doping: pharmacological basis and detection of illicit use. Br J Pharmacol 2008; 154:569.
  72. Aguilera R, Chapman TE, Starcevic B, et al. Performance characteristics of a carbon isotope ratio method for detecting doping with testosterone based on urine diols: controls and athletes with elevated testosterone/epitestosterone ratios. Clin Chem 2001; 47:292.
  73. Thevis M, Kohler M, Schänzer W. New drugs and methods of doping and manipulation. Drug Discov Today 2008; 13:59.
  74. Thomas A, Kohler M, Schänzer W, et al. Determination of Synacthen in urine for sports drug testing by means of nano-ultra-performance liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom 2009; 23:2669.
  75. Malvey TC, Armsey TD 2nd. Tetrahydrogestrinone: the discovery of a designer steroid. Curr Sports Med Rep 2005; 4:227.
  76. United States Anti-Doping Agency - Therapeutic Use Exemptions (TUE). http://www.usada.org/tue/ (Accessed on January 11, 2011).
  77. Kanayama G, Brower KJ, Wood RI, et al. Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications. Drug Alcohol Depend 2010; 109:6.
  78. Miller KE, Hoffman JH, Barnes GM, et al. Adolescent anabolic steroid use, gender, physical activity, and other problem behaviors*. Subst Use Misuse 2005; 40:1637.
  79. Orchard JW, Fricker PA, White SL, et al. 4. The use and misuse of performance-enhancing substances in sport. Med J Aust 2006; 184:132.
  80. Wanjek B, Rosendahl J, Strauss B, Gabriel HH. Doping, drugs and drug abuse among adolescents in the State of Thuringia (Germany): prevalence, knowledge and attitudes. Int J Sports Med 2007; 28:346.
  81. Liu H, Bravata DM, Olkin I, et al. Systematic review: the effects of growth hormone on athletic performance. Ann Intern Med 2008; 148:747.
  82. Deyssig R, Frisch H, Blum WF, Waldhör T. Effect of growth hormone treatment on hormonal parameters, body composition and strength in athletes. Acta Endocrinol (Copenh) 1993; 128:313.
  83. Yarasheski KE, Campbell JA, Smith K, et al. Effect of growth hormone and resistance exercise on muscle growth in young men. Am J Physiol 1992; 262:E261.
  84. Berggren A, Ehrnborg C, Rosén T, et al. Short-term administration of supraphysiological recombinant human growth hormone (GH) does not increase maximum endurance exercise capacity in healthy, active young men and women with normal GH-insulin-like growth factor I axes. J Clin Endocrinol Metab 2005; 90:3268.
  85. Meinhardt U, Nelson AE, Hansen JL, et al. The effects of growth hormone on body composition and physical performance in recreational athletes: a randomized trial. Ann Intern Med 2010; 152:568.
  86. Fernandez MM, Hosey RG. Performance-enhancing drugs snare nonathletes, too. J Fam Pract 2009; 58:16.
  87. Segura J, Gutiérrez-Gallego R, Ventura R, et al. Growth hormone in sport: beyond Beijing 2008. Ther Drug Monit 2009; 31:3.
  88. Brennan BP, Kanayama G, Hudson JI, Pope HG Jr. Human growth hormone abuse in male weightlifters. Am J Addict 2011; 20:9.
  89. Bidlingmaier M, Strasburger CJ. Technology insight: detecting growth hormone abuse in athletes. Nat Clin Pract Endocrinol Metab 2007; 3:769.
  90. Powrie JK, Bassett EE, Rosen T, et al. Detection of growth hormone abuse in sport. Growth Horm IGF Res 2007; 17:220.
  91. Nelson AE, Meinhardt U, Hansen JL, et al. Pharmacodynamics of growth hormone abuse biomarkers and the influence of gender and testosterone: a randomized double-blind placebo-controlled study in young recreational athletes. J Clin Endocrinol Metab 2008; 93:2213.
  92. Travis J. Pharmacology. Growth hormone test finally nabs first doper. Science 2010; 327:1185.
  93. Guha N, Cowan DA, Sönksen PH, Holt RI. Insulin-like growth factor-I (IGF-I) misuse in athletes and potential methods for detection. Anal Bioanal Chem 2013; 405:9669.
  94. Rich JD, Dickinson BP, Merriman NA, Thule PM. Insulin use by bodybuilders. JAMA 1998; 279:1613.
  95. Elliott S. Erythropoiesis-stimulating agents and other methods to enhance oxygen transport. Br J Pharmacol 2008; 154:529.
  96. Spedding M, Spedding C. Drugs in sport: a scientist-athlete's perspective: from ambition to neurochemistry. Br J Pharmacol 2008; 154:496.
  97. Prommer N, Sottas PE, Schoch C, et al. Total hemoglobin mass--a new parameter to detect blood doping? Med Sci Sports Exerc 2008; 40:2112.
  98. Lamon S, Robinson N, Sottas PE, et al. Possible origins of undetectable EPO in urine samples. Clin Chim Acta 2007; 385:61.
  99. Botrè F, Pavan A. Enhancement drugs and the athlete. Neurol Clin 2008; 26:149.
  100. Pottgiesser T, Echteler T, Sottas PE, et al. Hemoglobin mass and biological passport for the detection of autologous blood doping. Med Sci Sports Exerc 2012; 44:835.