Hepatotoxicity of anabolic androgenic steroids in sport

Michał Jakub Sekuła, Blanka Świerczyńska, Krzysztof Smoluchowski, Adrian Undziakiewicz, Halina Piecewicz-Szczęsna

DOI: http://dx.doi.org/10.12775/JEHS.2020.10.09.040


Introduction and purpose: Anabolic-androgenic steroids (AAS) abuse is a common practice among professional as well as recreational athletes. The prevalence of this phenomenon seems to be continuously escalating, too. Even though AAS abuse may provide a desirable haematopoietic and musculotrophic effect, it causes a wide variety of local and systemic side effects. This review aims to demonstrate the AAS induced hepatotoxicity, it is based on the medical literature from the last 10 years.

 Brief description of the state of knowledge: Orally administered 17-α-alkylated steroids are considered to be the most hepatotoxic. They increase the number of reactive oxygen species (ROS) which directly injure the liver tissue. It may be manifested as an elevation of liver enzymes, peliosis hepatis or distinctive acute cholestasis. Furthermore, ASS abuse for a prolonged period of time may induce the growth of hepatocellular adenoma and hepatocellular cancer. Moreover, AAS intake can lead to liver enlargement, development of toxicant-associated fatty liver disease (TAFLD) and increase the risk of HCV and HBV infection.

 Conclusions: The collaboration of scientists, doctors, sports associations and governments is substantial. Introduction of innovative AAS detection methods and enforcement of stricter anti doping law may contribute to prevention of health consequences resulting from AAS abuse among athletes.


hepatotoxicity, anabolic androgenic steroids, liver injury, sport

Full Text:



2017 Anti-Doping Rule Violations (ADRVs) Report https://www.wada-ama.org/sites/default/files/resources/files/2017_adrv_report.pdf

2016 Anti-Doping Rule Violations (ADRVs) Report https://www.wada-ama.org/sites/default/files/resources/files/2016_adrvs_report_web_release_april_2018_0.pdf

2015 Anti-Doping Rule Violations (ADRVs) Report https://www.wada-ama.org/sites/default/files/resources/files/2015_adrvs_report_web_release_0.pdf

2014 Anti-Doping Rule Violations (ADRVs) Report https://www.wada-ama.org/sites/default/files/resources/files/wada-2014-adrv-report-en_0.pdf

Eberhard Nieschlag, Elena Vorona, Doping with anabolic androgenic steroids (AAS): Adverse effects on non-reproductive organs and functions, Rev Endocr Metab Disord. 2015 Sep;16(3):199-211

Eberhard Nieschlag, Elena Vorona, MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions in European Journal of Endocrinology, R47–R58, Volume 173: Issue 2

Mark M Schultzel, Michael H Johnson, Howard G Rosenthal, Bilateral deltoid myositis ossificans in a weightlifter using anabolic steroids, Orthopedics. 2014 Sep;37(9):e844-7

Mark W Niedfeldt, Anabolic Steroid Effect on the Liver, Curr Sports Med Rep. 2018 Mar;17(3):97-102.

Ammar Hassan, Robert J Fontana, Liver Injury Associated with Sporting Activities, Semin Liver Di. 2018 Nov;38(4):357-365.

Inmaculada Medina-Caliz, Miren Garcia-Cortes, Andres Gonzalez-Jimenez I wsp., Herbal and Dietary Supplement-Induced Liver Injuries in the Spanish DILI Registry, Clin Gastroenterol Hepatol. 2018 Sep;16(9):1495-1502.

R Solimini, M C Rotolo, L Mastrobattista, C Mortali, A Minutillo, S Pichini, R Pacifici, I Palmi, Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping, Eur Rev Med Pharmacol Sci. 2017 Mar;21(1 Suppl):7-16.

Harrison G. Pope, Jr., Ruth I. Wood, Alan Rogol, Fred Nyberg, Larry Bowers, and Shalender Bhasin, Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement, Endocr Rev. 2014 Jun; 35(3): 341–375.

Androgenic Steroids, National Institute of Diabetes and Digestive and Kidney Diseases; 2012–.2020 May 30.

Peter Bond, William Llewellyn, Peter Van Mol, Anabolic androgenic steroid-induced hepatotoxicity, Med Hypotheses. 2016 Aug;93:150-3.

M Neri, S Bello, A Bonsignore, S Cantatore, I Riezzo, E Turillazzi, V Fineschi, Anabolic androgenic steroids abuse and liver toxicity, Mini Rev Med Chem. 2011 May;11(5):430-7.

Cerretani, D., Neri, M., Cantatore, S., Ciallella, C., Riezzo, I., Turillazzi, E., Fineschi, V., Looking for organ damages due to Anabolic-androgenic Steroids (AAS): Is oxidative stress the culprit?, Mini-Reviews in Organic Chemistry Volume 10, Issue 4, 2013, Pages 393-399

Mostafa El-Moghazy, Ehab Tousson, Changes in the hepatic and renal structure and function after a growth promoter boldenone injection in rabbits, Animal Biology, Volume 62: Issue 2, 171–180

Stephan P. Frankenfeld, Leonardo P. Oliveira, Victor H. Ortenzi, Igor CC. Rego-Monteiro, Elen A. Chaves, Andrea C. Ferreira, Alvaro C. Leitão, Denise P. Carvalho and Rodrigo S. Fortunato, The Anabolic Androgenic Steroid Nandrolone Decanoate Disrupts Redox Homeostasis in Liver, Heart and Kidney of Male Wistar Rats, PLoS One. 2014; 9(9): e102699.

Amer A Almaiman, Sulaiman H Almaiman, Elsayed I Elagamy, Osama Al Wutayd, Mohammed Almarzuqi, Rayyan Alzunaidi, Sami Alhatlani, Eltayeb E Eid, Side effects of anabolic steroids used by athletes at Unaizah Gyms, Saudi Arabia: a pilot study, J Sports Med Phys Fitness. 2019 Mar;59(3):489-495.

Polly Carson, Christine J Hong, Marta Otero-Vinas, Emily Frances Arsenault, Vincent Falanga, 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 Mar;14(1):11-8.

Shehzad Basaria, Androgen abuse in athletes: detection and consequences, J Clin Endocrinol Metab. 2010 Apr;95(4):1533-43.

Roseman DA, Hwang SJ, Oyama-Manabe N, Chuang ML, O’Donnell CJ, Manning WJ, Fox CS. Clinical associations of total kidney volume: the Framingham Heart Study. Nephrol Dial Transplant 2016.

T Gagliano-Jucá, E R Tang, S Bhasin, K M Pencina, S Anderson, H Jara, Z Li, K Melamud, S L Coleman, A Aakil, R R Almeida, G Huang, T G Travison, T W Storer, S Basaria, Effects of testosterone administration (and its 5-alpha-reduction) on parenchymal organ volumes in healthy young men: findings from a dose-response trial, Andrology. 2017 Sep;5(5):889-897.

Ahmed M Elsharkawy, Stuart McPherson, Steven Masson, Alastair D Burt, Robert T Dawson, Mark Hudson, Cholestasis secondary to anabolic steroid use in young men, BMJ. 2012 Feb 2;344:e468

Michel I Kafrouni, Robert A Anders, Sumita Verma, Hepatotoxicity associated with dietary supplements containing anabolic steroids, Clin Gastroenterol Hepatol. 2007 Jul;5(7):809-12.

Brett M Hymel, David W Victor, Luis Alvarez, Nathan J Shores, Luis A Balart, Mastabol induced acute cholestasis: A case report, World J Hepatol. 2013 Mar 27;5(3):133-6.

Victor J Navarro, Ikhlas Khan, Einar Björnsson, Leonard B Seeff, Jose Serrano, Jay H Hoofnagle, Liver injury from herbal and dietary supplements, Hepatology. 2017 Jan;65(1):363-373.

Ahmed M Alkhunaizi, Mohamed A ElTigani, Rola S Rabah, Samih H Nasr, Acute bile nephropathy secondary to anabolic steroids, Clin Nephrol. 2016 Feb;85(2):121-6.

Mónica Milla Castellanos, Eduardo Gutiérrez Martínez, Ángel Sevillano Prieto, Paola Rodríguez Ramos, Manuel Praga Terente, Bile cast nephropathy associated with severe liver dysfunction caused by anabolic steroids, Nefrologia. Mar-Apr 2018;38(2):221-223

Piotr M. Stępień, Katarzyna Reczko, Anna Wieczorek, Dorota Zarębska-Michaluk, Paweł Pabjan, Teodora Król and Wiesław Kryczka, Severe intrahepatic cholestasis and liver failure after stanozolol usage – case report and review of the literature, Clin Exp Hepatol. 2015 May; 1(1): 30–33.

Marije N Boks, Anton T Tiebosch, Laurens A van der Waaij, A jaundiced bodybuilder Cholestatic hepatitis as side effect of injectable anabolic-androgenic steroids, J Sports Sci. 2017 Nov;35(22):2262-2264.

Charles D Magee, Stephen Witte, Ryan M Kwok, Patricia A Deuster, Mission Compromised? Drug-Induced Liver Injury From Prohormone Supplements Containing Anabolic-Androgenic Steroids in Two Deployed U.S. Service Members, Mil Med. 2016 Sep;181(9):e1169-71.

Amer A Almaiman, Sulaiman H Almaiman, Elsayed I Elagamy, Osama Al Wutayd, Mohammed Almarzuqi, Rayyan Alzunaidi, Sami Alhatlani, Eltayeb E Eid, Side effects of anabolic steroids used by athletes at Unaizah Gyms, Saudi Arabia: a pilot study, J Sports Med Phys Fitness. 2019 Mar;59(3):489-495.

Sun-Keun Choi, Jun-Shuo Jin, Soon-Gu Cho, Suk-Jin Choi, Chul-Soo Kim, Yun-Mee Choe, and Keon-Young Lee, Spontaneous liver rupture in a patient with peliosis hepatis: A case report, World J Gastroenterol. 2009 Nov 21; 15(43): 5493–5497.

Paulo Adriano Schwingel , Helma P Cotrim, Bernardo Rios Salles, Carlos Eduardo Almeida, Crimério Ribeiro dos Santos Jr, Bruno Nachef, Antonio Ricardo Andrade, Cláudio C Zoppi, Anabolic-androgenic steroids: a possible new risk factor of toxicant-associated fatty liver disease, Liver Int. 2011 Mar;31(3):348-53

Paulo Adriano Schwingel, Helma Pinchemel Cotrim, Crimério Ribeiro dos Santos Jr, Adriano Oliveira dos Santos, Antônio Ricardo Cardia Ferraz de Andrade, Marcos Vinicius Vilas Boas Carruego, Cláudio Cesar Zoppi, Recreational Anabolic-Androgenic Steroid Use Associated With Liver Injuries Among Brazilian Young Men, Subst Use Misuse. 2015;50(11):1490-8.

Lixia Wang, Cong Wang, Wei Li, Fanyang Meng, Yuying Li, Hongqiong Fan, Yanhua Zhou, Gnana Bharathi, Sujun Gao, Yan Yang, Multiple hepatocellular adenomas associated with long-term administration of androgenic steroids for aplastic anemia: A case report and literature review, Medicine (Baltimore). 2020 Jul 10;99(28):e20829.

Keizo Kato, Hiroshi Abe, Noriko Hanawa, Junya Fukuzawa, Ryota Matsuo, Takeshi Yonezawa, Sadahiro Itoh, Yoshiyuki Sato, Makiko Ika, Shohei Shimizu, Shinji Endo, Hiroshi Hano, Asami Izu, Masahiko Sugitani, Akihito Tsubota, Hepatocellular adenoma in a woman who was undergoing testosterone treatment for gender identity disorder, Clin J Gastroenterol. 2018 Oct;11(5):401-410.

D L Smit, J H Nuijens, W de Ronde, Spontaneous haemorrhage of hepatic adenoma in a patient addicted to anabolic steroids, Neth J Med. 2019 Sep;77(7):261-263.

Philipp Solbach, Andrej Potthoff, Hans-Jürgen Raatschen, Bisharah Soudah, Ulrich Lehmann, Andrea Schneider, Michael J Gebel, Michael P Manns, Arndt Vogel, 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 May 20;15:60.

Aline Hardt, Dirk Stippel, Margarete Odenthal, Arnulf H Hölscher, Hans-Peter Dienes, Uta Drebber, Development of hepatocellular carcinoma associated with anabolic androgenic steroid abuse in a young bodybuilder: a case report, Case Rep Pathol. 2012;2012:195607

Sounak Gupta, Bita V Naini, Richard Munoz, Rondell P Graham, Benjamin R Kipp, Michael S Torbenson, Taofic Mounajjed, Hepatocellular Neoplasms Arising in Association With Androgen Use, Am J Surg Pathol. 2016 Apr;40(4):454-61

M Robles-Diaz, A Gonzalez-Jimenez, I Medina-Caliz, C Stephens, M García-Cortes, B García-Muñoz, A Ortega-Alonso, E Blanco-Reina, R Gonzalez-Grande, M Jimenez-Perez, P Rendón, J M Navarro, P Gines, M Prieto, M Garcia-Eliz, F Bessone, J R Brahm, R Paraná, M I Lucena, R J Andrade, Spanish DILI Registry; SLatinDILI Network, Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids, Aliment Pharmacol Ther. 2015 Jan;41(1):116-25.

Mario Thevis, Tiia Kuuranne Hans Geyer, Annual banned‐substance review – Analytical approaches in human sports drug testing, https://doi.org/10.1002/dta.2735

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014


POL-index 2011 - 2014


BASE 2011 - 2014




Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska, EuroPub database, NLM Catalog Result - NCBI, BASE, Russian Sciences Index, Arianta.



US NLM = 101679844

101679844 - NLM Catalog Result - NCBI


Find a library that holds this journal: http://worldcat.org/issn/23918306


PBN Poland






Redaction, Publisher and Editorial Office

Publisher and Editorial Office
Department of Physical Culture,
Faculty of Earth Sciences and Spatial Management,
Nicolaus Copernicus University in Toruń, Poland
Address: Str. Lwowska 1, 87-100 Toruń, Poland

  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

Indexed in Index Copernicus Journals Master List.


ICV 2019 = 100.00 ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

RG Journal Impact: 0.18 *

*This value is calculated using ResearchGate data and is based on average citation counts from work published in this journal. The data used in the calculation may not be exhaustive.

RG Journal impact history

2020Available summer 2021
2018 / 20190.18

RG Journal impact over time

RG Journal impact

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski


Partnerzy platformy czasopism