{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:06:41Z","timestamp":1771459601503,"version":"3.50.1"},"reference-count":109,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Performance\u2010enhancing substances (PES) are used by many athletes worldwide to improve performance and enhance appearance. Although PES are more commonly used by men, use is increasing among women, leading to growing physical and psychosocial concerns. Illegal PES include androgenic and anabolic steroids (AAS), which represent a diverse class of synthetic derivatives of testosterone. PES use has been linked to an increased risk of cardiovascular, metabolic, endocrine, neurologic, infectious, hepatic, renal, and musculoskeletal disorders. Additionally, hormonal alterations secondary to PES use can induce or accelerate female pattern hair loss (FPHL). Despite the widespread prevalence of FPHL, research has disproportionately focused on male pattern hair loss (MPHL) and male athletes utilizing PES. This review article explores the pathophysiology of testosterone, gender\u2010based AAS dosing implications, incidence of FPHL, physical and psychosocial impacts of alopecia, and management strategies. Though research regarding the impact of androgen\u2010based PES on hair health exists, few studies address these issues in the context of female athletes. Importantly, clinicians must be equipped to provide female athletes with education regarding potential risks of AAS and to appropriately manage FPHL in this patient population. Furthermore, timely diagnosis and treatment of FPHL, alongside AAS cessation, are crucial to preventing further hair loss and optimizing the safety and efficacy of alopecia treatments. Given the compounded psychosocial concerns among female athletes worldwide on PES\u2014including hair loss, body image insecurities, and even eating disorders\u2014ongoing research in this area is critical.<\/jats:p>","DOI":"10.1111\/ijd.17941","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T23:24:58Z","timestamp":1751066698000},"page":"2235-2246","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Alopecia in Female Athletes Using Androgenic and Anabolic Steroids: Pathophysiology and Management"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-6122","authenticated-orcid":false,"given":"Anna L.","family":"Brinks","sequence":"first","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9768-3831","authenticated-orcid":false,"given":"Carli D.","family":"Needle","sequence":"additional","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archie J.","family":"Spindler","sequence":"additional","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalie M.","family":"Brody","sequence":"additional","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1945-7997","authenticated-orcid":false,"given":"Ilaria","family":"Scandagli","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Oh","sequence":"additional","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry","family":"Shapiro","sequence":"additional","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen I.","family":"Lo Sicco","sequence":"additional","affiliation":[{"name":"The Ronald O. Perelman Department of Dermatology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weeratian","family":"Tawanwongsri","sequence":"additional","affiliation":[{"name":"Division of Dermatology School of Medicine at Walailak University  Nakhon Si Thammarat Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1677\/joe.0.1700055"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mce.2017.07.010"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016\u20101300"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4314\/mmj.v34i3.3"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fspor.2022.839976"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0190\u20109622(93)70223\u2010G"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2013\u20101058"},{"key":"e_1_2_11_9_1","volume-title":"WADA Ethics Panel: Guiding Values in Sport and Anti\u2010Doping","author":"WADA","year":"2025"},{"key":"e_1_2_11_10_1","unstructured":"\u201cWADA \u201dhttps:\/\/www.wada\u2010ama.org\/en."},{"key":"e_1_2_11_11_1","unstructured":"WADA \u201cInternational Standards \u201d2025 https:\/\/www.wada\u2010ama.org\/en\/what\u2010we\u2010do\/international\u2010standards."},{"key":"e_1_2_11_12_1","unstructured":"USADA \u201cWADA Prohibited List \u201dhttps:\/\/www.usada.org\/athletes\/substances\/prohibited\u2010list\/."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.7417\/ct.2019.2117"},{"key":"e_1_2_11_14_1","unstructured":"\u201cH.R.4658 \u2013 To Amend the Controlled Substances Act to Provide Criminal Penalties for Illicit Use of Anabolic Steroids and for Coaches and Others Who Endeavor to Persuade or Induce Athletes to Take Anabolic Steroids and for Other Purposes \u201dStates sCotU 1990."},{"key":"e_1_2_11_15_1","unstructured":"\u201cH.R.4771 \u2010 Designer Anabolic Steroid Control Act of 2014 \u201dStates tCotU 2014."},{"key":"e_1_2_11_16_1","unstructured":"Agency DE \u201cDrug Scheduling \u201d2025 https:\/\/www.dea.gov\/drug\u2010information\/drug\u2010scheduling."},{"key":"e_1_2_11_17_1","unstructured":"WADA \u201cWorld Anti\u2010Doping Code \u201d2025 https:\/\/www.wada\u2010ama.org\/sites\/default\/files\/resources\/files\/2021_wada_code.pdf."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40318\u2010014\u20100045\u20105"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0015\u20100282(02)04850\u20101"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2014.982083"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1530\/ec\u201019\u20100537"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.99.6.904"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920\u2010002\u20100086\u20106"},{"key":"e_1_2_11_24_1","volume-title":"Anabolic Steroid Use Disorder","author":"AlShareef S.","year":"2019"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256\u2010200434080\u201000003"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.109s00011"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279\u2010017\u20100709\u2010z"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1530\/ec\u201023\u20100358"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2004.11.020"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12850"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1994.tb02483.x"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.08.062"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2009.03.032"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59081439"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.17567"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0015\u20100282(02)02985\u20100"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102007\u2010961807"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00403\u2010012\u20101265\u2010x"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcdb.2007.02.004"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21155342"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018\u201002548"},{"issue":"1","key":"e_1_2_11_42_1","first-page":"13","article-title":"Female Pattern Hair Loss May Be Triggered by Low Oestrogen to Androgen Ratio","volume":"42","author":"Riedel\u2010Baima B.","year":"2008","journal-title":"Endocrine Regulations"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2019.09.010"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1095\/biolreprod.111.092593"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21218191"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S423177"},{"issue":"287","key":"e_1_2_11_47_1","first-page":"323","article-title":"Is Hormone Testing Worthwhile in Patients With Female Pattern Hair Loss?","volume":"48","author":"Kozicka K.","year":"2020","journal-title":"Polski Merkuriusz Lekarski"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1258\/000456303766476977"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.3390\/molecules26206210"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1373\/49.1.167"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03401334"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-197511000-00009"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.5070\/D33B81S01S"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905\u2010023\u201002399\u20109"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13843"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13102-021-00345-6"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2024.01.007"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011\u2010016\u20100056\u20103"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(88)70241-8"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2004.04.008"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.1999.03049.x"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20100960.2011.00745.x"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102876"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2023.08.179"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016\u20100922"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2010.183"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usab274"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100041\u20101741037"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0022\u2010202X.2004.23237.x"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.5826\/dpc.1303a139"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2017.1359708"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.02.054"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsps.2024.102205"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijwd.2018.05.001"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2003.06.014"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdin.2023.08.002"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2024.0284"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.08.060"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.16086"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.1159\/000531890"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2021.02.054"},{"key":"e_1_2_11_82_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.57.3.285"},{"issue":"6","key":"e_1_2_11_83_1","first-page":"447","article-title":"Cardiovascular Adverse Effects of Doping in Sports","volume":"53","author":"Deligiannis A. P.","year":"2012","journal-title":"Hellenic Journal of Cardiology"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.5070\/d329461861"},{"key":"e_1_2_11_85_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010540\u201079088\u20104_18"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.17645"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.43559"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.2147\/ccid.S398950"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882\u2010019\u20101384\u20100"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010024\u201003263\u20105"},{"key":"e_1_2_11_91_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.84a.17056"},{"key":"e_1_2_11_92_1","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2021.1959506"},{"key":"e_1_2_11_93_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2025.01.067"},{"key":"e_1_2_11_94_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2337717"},{"issue":"7","key":"e_1_2_11_95_1","first-page":"56","article-title":"Adverse Effects and Safety of 5\u2010Alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review","volume":"9","author":"Hirshburg J. M.","year":"2016","journal-title":"Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_11_96_1","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2022.2109567"},{"key":"e_1_2_11_97_1","doi-asserted-by":"publisher","DOI":"10.5021\/ad.22.027"},{"key":"e_1_2_11_98_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102133.2002.04798.x"},{"issue":"1","key":"e_1_2_11_99_1","first-page":"65","article-title":"Antiandrogens in Hormonal Contraception Limit Muscle Strength Gain in Strength Training: Comparison Study","volume":"44","author":"Ruzi\u0107 L.","year":"2003","journal-title":"Croatian Medical Journal"},{"key":"e_1_2_11_100_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12899"},{"key":"e_1_2_11_101_1","doi-asserted-by":"publisher","DOI":"10.1080\/17425255.2025.2461483"},{"key":"e_1_2_11_102_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1P600"},{"key":"e_1_2_11_103_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.13202"},{"key":"e_1_2_11_104_1","doi-asserted-by":"publisher","DOI":"10.36849\/jdd.2020.5192"},{"key":"e_1_2_11_105_1","doi-asserted-by":"publisher","DOI":"10.4103\/jcas.Jcas_218_20"},{"key":"e_1_2_11_106_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57040311"},{"key":"e_1_2_11_107_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974\u20107753.114700"},{"key":"e_1_2_11_108_1","doi-asserted-by":"publisher","DOI":"10.2147\/ccid.S137296"},{"issue":"10","key":"e_1_2_11_109_1","first-page":"1235","article-title":"Vitamin and Mineral Deficiencies in Patients With Telogen Effluvium: A Retrospective Cross\u2010Sectional Study","volume":"15","author":"Cheung E. J.","year":"2016","journal-title":"Journal of Drugs in Dermatology"},{"key":"e_1_2_11_110_1","doi-asserted-by":"publisher","DOI":"10.5021\/ad.24.043"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.17941","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T08:16:54Z","timestamp":1762935414000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.17941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":109,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/ijd.17941"],"URL":"https:\/\/doi.org\/10.1111\/ijd.17941","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]},"assertion":[{"value":"2025-02-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}