The Influence of Doping on the Skin: Dermatological Manifestations of Anabolic-Androgenic Steroid Use in Sport - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.79.76696Keywords
anabolic androgenic steroids, Doping in Sports, skin diseases, Drug-Related Side Effects and Adverse Reactions, Acne vulgaris, alopecia, InjectionsAbstract
Background: Anabolic-androgenic steroids (AAS) are used by competitive and recreational athletes. The latter are not subject to anti-doping testing. Cutaneous manifestations are common, may appear early and can be overlooked.
Aim: To synthesise evidence on dermatological manifestations of AAS use in sport and their implications for early recognition.
Material and methods: The narrative review included 28 publications from 2000-2026 identified through PubMed, ScienceDirect, SpringerLink, Quality in Sport archive and reference lists. Searches were restricted to full texts in English or Polish language and human subjects. Evidence was synthesised thematically.
Results: Supraphysiological AAS exposure may promote sebaceous gland hypertrophy and sebum secretion via the androgen receptor. Acne is the most commonly reported visible adverse effect, ranging from exacerbation of lesions to acne fulminans. Other effects include androgenetic alopecia in men, hirsutism as part of virilisation in women, striae and keloids. Injections may cause abscesses, granulomas, pyomyositis and non-tuberculous mycobacterial infections.
Conclusions: These manifestations may suggest AAS use but are not diagnostic. They should prompt enquiry, particularly in individuals who train intensively, covering supplements and injections. Some may persist after cessation, highlighting the importance of early detection, counselling and education. Risk information alone may not discourage use.
References
[1] Furth G, Marroquin NA, Kirk J, Ajmal H, Szeto MD, Zueger M, et al. Cutaneous Manifestations of Anabolic-Androgenic Steroid Use in Bodybuilders and the Dermatologist’s Role in Patient Care. JMIR Dermatol 2023;6:e43020. https://doi.org/10.2196/43020.
[2] Hartgens F, Kuipers H. Effects of Androgenic-Anabolic Steroids in Athletes. Sports Med 2004;34:513–54. https://doi.org/10.2165/00007256-200434080-00003.
[3] Bond P, Smit DL, De Ronde W. Anabolic–androgenic steroids: How do they work and what are the risks? Front Endocrinol 2022;13:1059473. https://doi.org/10.3389/fendo.2022.1059473.
[4] Mossakowski M, Kaźmierczak M, Jajczak M, Parys J, Mikosińska A, Kałuziak P, et al. An Overview of the Deadly Effects of Anabolic-Androgenic Steroids: Clinical Cases and Scientific Insights. Qual Sport 2025;37:57251. https://doi.org/10.12775/QS.2025.37.57251.
[5] Dutka M, Bernacki R, Bernacki P, Zardzewiały W, Skrzyńska K, Zaremskyi O, et al. Anabolic-androgenic steroids in sport. Qual Sport 2024;21:54158. https://doi.org/10.12775/QS.2024.21.54158.
[6] Melnik B, Jansen T, Grabbe S. Abuse of anabolic‐androgenic steroids and bodybuilding acne: an underestimated health problem. JDDG J Dtsch Dermatol Ges 2007;5:110–7. https://doi.org/10.1111/j.1610-0387.2007.06176.x.
[7] Walker J, Adams B. Cutaneous manifestations of anabolic-androgenic steroid use in athletes. Int J Dermatol 2009;48:1044–8; quiz 1048. https://doi.org/10.1111/j.1365-4632.2009.04139.x.
[8] Smit DL, Buijs MM, de Hon O, den Heijer M, de Ronde W. Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100 men. Scand J Med Sci Sports 2021;31:427–38. https://doi.org/10.1111/sms.13843.
[9] Heerfordt IM, Windfeld-Mathiasen J, Dalhoff KP, Mogensen M, Andersen JT, Horwitz H. Cutaneous manifestations of misuse of androgenic anabolic steroids: A retrospective cohort study. J Am Acad Dermatol 2024;90:1047–8. https://doi.org/10.1016/j.jaad.2024.01.007.
[10] Horwitz H, Andersen JT, Dalhoff KP. Health consequences of androgenic anabolic steroid use. J Intern Med 2019;285:333–40. https://doi.org/10.1111/joim.12850.
[11] Voelcker V, Sticherling M, Bauerschmitz J. Severe ulcerated ‘bodybuilding acne’ caused by anabolic steroid use and exacerbated by isotretinoin. Int Wound J 2010;7:199–201. https://doi.org/10.1111/j.1742-481X.2010.00676.x.
[12] Huang G, Basaria S. Do anabolic-androgenic steroids have performance-enhancing effects in female athletes? Mol Cell Endocrinol 2018;464:56–64. https://doi.org/10.1016/j.mce.2017.07.010.
[13] Evans NA. Current Concepts in Anabolic-Androgenic Steroids. Am J Sports Med 2004;32:534–42. https://doi.org/10.1177/0363546503262202.
[14] Van De Ven K, Maher L, Wand H, Memedovic S, Jackson E, Iversen J. Health risk and health seeking behaviours among people who inject performance and image enhancing drugs who access needle syringe programs in Australia. Drug Alcohol Rev 2018;37:837–46. https://doi.org/10.1111/dar.12831.
[15] Hope VD, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergård A, et al. Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking. Epidemiol Infect 2015;143:132–40. https://doi.org/10.1017/S0950268814000727.
[16] Filho NSC, Gaspar EF, Siqueira KL, Monteiro GC, Andreoli CV, Ejnisman B, et al. PYOMYOSITIS IN ATHLETES AFTER THE USE OF ANABOLIC STEROIDS - CASE REPORTS. Rev Bras Ortop Engl Ed 2011;46:97–100. https://doi.org/10.1016/S2255-4971(15)30185-3.
[17] Pai R, Parampalli U, Hettiarachchi G, Ahmed I. Mycobacterium fortuitum skin infection as a complication of anabolic steroids: a rare case report. Ann R Coll Surg Engl 2013;95:e12–3. https://doi.org/10.1308/003588413X13511609955175.
[18] Ip EJ, Yadao MA, Shah BM, Lau B. Infectious disease, injection practices, and risky sexual behavior among anabolic steroid users. AIDS Care 2016;28:294–9. https://doi.org/10.1080/09540121.2015.1090539.
[19] O’Sullivan AJ, Kennedy MC, Casey JH, Day RO, Corrigan B, Wodak AD. Anabolic-androgenic steroids: medical assessment of present, past and potential users. Med J Aust 2000;173:323–7. https://doi.org/10.5694/j.1326-5377.2000.tb125667.x.
[20] Young J. Doping with testosterone and androgenic/anabolic steroids: Impact on health, screening tools and medical care. Ann Endocrinol 2023;84:401–5. https://doi.org/10.1016/j.ando.2023.03.025.
[21] Vauhkonen PK, Laajala TD, Lindroos KM, Mäyränpää MI. Female doping: observations from a data lake study in the Hospital District of Helsinki and Uusimaa, Finland. BMC Womens Health 2023;23:242. https://doi.org/10.1186/s12905-023-02399-9.
[22] Kazandjieva J, Tsankov N. Drug-induced acne. Clin Dermatol 2017;35:156–62. https://doi.org/10.1016/j.clindermatol.2016.10.007.
[23] Quaglio G, Fornasiero A, Mezzelani P, Moreschini S, Lugoboni F, Lechi A. Anabolic steroids: dependence and complications of chronic use. Intern Emerg Med 2009;4:289–96. https://doi.org/10.1007/s11739-009-0260-5.
[24] Tawanwongsri W, Desai DD, Nohria A, Shapiro J, Lo Sicco KI. Hair loss in athletic testosterone use in males: a narrative review. Int J Dermatol 2025;64:654–8. https://doi.org/10.1111/ijd.17567.
[25] Richardson A, Antonopoulos GA. Anabolic-androgenic steroids (AAS) users on AAS use: Negative effects, “code of silence”, and implications for forensic and medical professionals. J Forensic Leg Med 2019;68:101871. https://doi.org/10.1016/j.jflm.2019.101871.
[26] Rochoy M, Danel A, Chazard E, Gautier S, Berkhout C. Doping with aromatase inhibitors and oestrogen receptor modulators in steroid users: Analysis of a forum to identify dosages, durations and adverse drug reactions. Therapies 2022;77:683–91. https://doi.org/10.1016/j.therap.2022.03.004.
[27] Brinks AL, Needle CD, Spindler AJ, Brody AM, Scandagli I, Oh C, et al. Alopecia in Female Athletes Using Androgenic and Anabolic Steroids: Pathophysiology and Management. Int J Dermatol 2025;64:2235–46. https://doi.org/10.1111/ijd.17941.
[28] Weinreb I, Goldblum JR, Rubin BP. Factitial soft tissue pseudotumor due to injection of anabolic steroids: a report of 3 cases in 2 patients. Hum Pathol 2010;41:452–5. https://doi.org/10.1016/j.humpath.2009.10.001.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Maja Warchoł, Robert Durski, Aleksandra Bernaś, Jakub Maciaszczyk , Maria Dzieniakowska , Adrian Kobus, Maja Podziewska , Adam Surma, Julia Piecyk , Norbert Kobus
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 17
Number of citations: 0
