One of the first long-term studies that followed weight-training middle-aged men for nearly a decade has found that consistent use of anabolic-androgenic steroids (AAS) leads to the thickening of the heart’s left ventricular wall, which increasingly reduces the organ's ability to function. However, this damage was reversed over time after people quit the drugs.
We know that what are referred to as "performance-enhancing drugs" have a broad health tradeoff, but long-term use is not well understood. And this is a serious issue, given that scientists estimate up to four million Americans aged 13-50 years are using AAS to boost their training game. This use is also heavily skewed towards men.
We also know that AAS impact our health in many ways, including compromising heart function. But most studies have been shorter term, and haven't covered what happens when people stop taking the drugs.
"It was still unclear whether the cardiac abnormalities demonstrated in previous studies, including increased heart muscle thickness and reduced cardiac function, progress with continued exposure or whether they improve with dose reduction or after cessation," says lead researcher Dr. Vibeke M. Almaas from Oslo University Hospital. "To address this knowledge gap, we conducted a follow-up of our previously published group of male AAS users engaged in recreational strength training."
The international team of researchers led by Norway's Oslo University uncovered that long-term use severely compromises heart function in men, thickening the left ventricle (LV) wall. This increasingly interferes with your LV's ability to pump blood to the aorta, thus reducing the oxygenated blood being circulated through the body. And it's serious.
"We found that continued use of anabolic steroids among adult and middle-aged male strength athletes, even at lower dosages, was associated with a persistent thickening of the heart muscle, impaired contractions and worsening of the heart’s ability to relax," says Dr. Almaas. "As many as 17% of those who continued using AAS had severely reduced heart function. However, this could be reversed if the men stopped using anabolic steroids and continued to abstain from them over the long term."
In the study, 101 AAS-using men and 71 non-users who had participated in earlier research between 2017 and 2019 were contacted to be part of this follow-up. From this pool, 70 were AAS users, while 35 non-users formed the control group.
Of the men who were part of the original study's AAS-using cohort, 35 were still taking the drugs, while the remaining participants were in varying stages of quitting, long-term abstinence and relapse.
Scientists then conducted intensive surveys detailing medical history, heart issues, training and weight-lifting regimens, AAS type and dose and drug use over time. Participants were also asked about their alcohol consumption, smoking and illicit drug use. Urine and blood samples were taken to measure hormones, and echocardiography provided heart imaging.
What the researchers found was that only the men who had stopped taking AAS and were on high blood pressure medication showed improvement in heart health. Those who said they'd reduced their AAS intake over the decade had compromised LV function regardless of their titrating.
"Discontinuation of AAS use was associated with a reduction in heart muscle thickening and improvements in cardiac function, suggesting that at least some of these adverse effects may be reversible after stopping, and may even become comparable with the non-users in the control group," says Dr. Almaas. "Antihypertensive therapy among ongoing AAS-users was associated with improved LV systolic function."
In the AAS-users group, the 15 men who had stopped taking the drugs cold-turkey showed a significant reduction in the heart muscle thickness compared with their original scans from nearly a decade earlier.
AAS users who were not on high blood pressure medication had an 8% deterioration of left ventricle systolic function, while those on hypertension drugs showed an 11% improvement here. However, the LV wall thickness had not changed.
"Our findings underline the importance of continuing both preventive work and harm reduction efforts," says co-author Dr. Astrid Bjørnebekk, head of the Anabolic Androgenic Steroid Research Group at Oslo University Hospital. "Anabolic steroids have been prohibited in competitive sports for decades, and since 2013, non-medical use and possession have also been illegal in Norway. Despite this, national reports indicate continued use of performance- and appearance-enhancing drugs, and increasing interest in them."
The team found no ties to other drug use or lifestyle choices and heart health, but couldn't rule out these factors from having some impact.
While a small study, featuring a fraction of those from the 2017-2019 groups, and one that also relied on self-reporting, it gives scientists more longitudinal evidence to work with when it comes to what AAS use does to the body over time.
Types of AAS include oral 17-alpha-alkylated androgens (stanozolol) and parenteral 19-nortestosterone derivatives (like nandrolone). All anabolic steroids are listed as Schedule III drugs under the Designer Anabolic Steroid Control Act of 2014 (DASCA). However, as that act details, there are loopholes that make AAS accessible. And the gray area is fueled by training communities online and overseas markets.
The study was published in European Heart Journal:Cardiovascular Imaging.
Source: European Society of Cardiology
