{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:58:22Z","timestamp":1790935102075,"version":"4.1.0"},"reference-count":74,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Anabolic\u2013androgenic steroids (AAS) are synthetic derivatives of testosterone that are used therapeutically but are frequently abused by athletes and individuals seeking to increase muscle mass. Their anabolic (promoting muscle growth) and androgenic (inducing masculine characteristics) effects result from androgen receptor activation in target tissues. However, chronic supraphysiological AAS exposure is associated with serious cardiovascular consequences, ranging from hypertension and lipid disorders to cardiomyopathy, atherosclerosis, and sudden cardiac death. This review provides an updated and integrative perspective on both the molecular and clinical aspects of AAS-induced cardiovascular toxicity, highlighting recent advances in understanding endothelial injury, oxidative stress, fibrosis, and arrhythmogenesis. Importantly, it emphasizes the emerging recognition of AAS abuse as a modifiable cardiovascular risk factor and discusses potential preventive and therapeutic strategies, including early cardiovascular screening and risk stratification. Understanding these mechanisms is essential for recognizing the clinical manifestations of AAS misuse and for improving cardiovascular risk assessment in affected individuals. These insights underscore the clinical significance of AAS abuse as a cardiovascular risk factor and the need for vigilant cardiac monitoring and early intervention in this population.<\/jats:p>","DOI":"10.3390\/ijms262211037","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T14:37:52Z","timestamp":1763131072000},"page":"11037","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Impact of Anabolic\u2013Androgenic Steroid Abuse on the Cardiovascular System: Molecular Mechanisms and Clinical Implications"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4029-5982","authenticated-orcid":false,"given":"Antoni","family":"Borowiec","sequence":"first","affiliation":[{"name":"Students\u2019 Scientific Society, Department of Pharmacology, Faculty of Medicine, University of Opole, 45-052 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8654-1229","authenticated-orcid":false,"given":"Iga","family":"Waluszewska","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Society, Department of Pharmacology, Faculty of Medicine, University of Opole, 45-052 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Jurkiewicz","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Society, 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-422X","authenticated-orcid":false,"given":"Wioletta","family":"Szczurek-Wasilewicz","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine, University of Opole, 45-052 Opole, Poland"},{"name":"2nd Department of Cardiology and Angiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1161\/CIRCULATIONAHA.124.071117","article-title":"Cardiovascular Disease in Anabolic Androgenic Steroid Users","volume":"151","author":"Heerfordt","year":"2025","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5108","DOI":"10.1210\/jcem.86.11.7983","article-title":"Anabolic-Androgenic Steroid Therapy in the Treatment of Chronic Diseases","volume":"86","author":"Basaria","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bond, P., Smit, D.L., and de Ronde, W. (2022). Anabolic-androgenic steroids: How do they work and what are the risks?. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1059473"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/j.1521-0391.2013.12118.x","article-title":"The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: Current best estimates","volume":"23","author":"Pope","year":"2014","journal-title":"Am. J. Addict."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1111\/j.1360-0443.2009.02734.x","article-title":"Anabolic-androgenic steroid dependence: An emerging disorder","volume":"104","author":"Kanayama","year":"2009","journal-title":"Addiction"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/20961790.2019.1595350","article-title":"Sudden cardiac death in anabolic androgenic steroids abuse: Case report and literature review","volume":"4","author":"Tapia","year":"2019","journal-title":"Forensic Sci. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1016\/j.forsciint.2011.10.032","article-title":"Anabolic androgenic steroids abuse and cardiac death in athletes: Morphological and toxicological findings in four fatal cases","volume":"217","author":"Montisci","year":"2012","journal-title":"Forensic Sci. Int."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Tungesvik, H.M., Bj\u00f8rnebekk, A., and Hisdal, J. (2024). Impaired vascular function among young users of anabolic\u2013androgenic steroids. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-70110-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.annepidem.2014.01.009","article-title":"The global epidemiology of anabolic-androgenic steroid use: A meta-analysis and meta-regression analysis","volume":"24","author":"Sagoe","year":"2014","journal-title":"Ann. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/nyas.15187","article-title":"Androgen abuse: Risks and adverse effects in men","volume":"1538","author":"Grant","year":"2024","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.biopsych.2011.06.024","article-title":"Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: A cross-sectional cohort study","volume":"71","author":"Pope","year":"2012","journal-title":"Biol. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.2174\/1570159X13666141210222725","article-title":"Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review","volume":"13","author":"Piacentino","year":"2015","journal-title":"Curr. Neuropharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2008.05.004","article-title":"Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: A looming public health concern?","volume":"98","author":"Kanayama","year":"2008","journal-title":"Drug Alcohol Depend."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1161\/01.CIR.98.3.256","article-title":"Androgen receptors mediate hypertrophy in cardiac myocytes","volume":"98","author":"Marsh","year":"1998","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1249\/00005768-199202000-00008","article-title":"The effect of anabolic-androgenic steroids on primary myocardial cell cultures","volume":"24","author":"Melchert","year":"1992","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1249\/00005768-199311000-00006","article-title":"The effects of anabolic steroids on myocardial structure and cardiovascular fitness","volume":"25","author":"Sachtleben","year":"1993","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sivalokanathan, S., Ma\u0142ek, \u0141.A., and Malhotra, A. (2021). The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020324"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1093\/molehr\/gaq049","article-title":"Endothelial regulation of eNOS, PAI-1 and t-PA by testosterone and dihydrotestosterone in vitro and in vivo","volume":"16","author":"Goglia","year":"2010","journal-title":"Mol. Hum. Reprod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1210\/en.2009-1048","article-title":"Androgen receptor-dependent activation of endothelial nitric oxide synthase in vascular endothelial cells: Role of phosphatidylinositol 3-kinase\/akt pathway","volume":"151","author":"Yu","year":"2010","journal-title":"Endocrinology"},{"key":"ref_20","first-page":"183","article-title":"Androgen actions on endothelium functions and cardiovascular diseases","volume":"13","author":"Cai","year":"2016","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0024-3205(02)01567-9","article-title":"Effects of testosterone and 17-beta-estradiol on TNF-alpha-induced E-selectin and VCAM-1 expression in endothelial cells. Analysis of the underlying receptor pathways","volume":"71","author":"Zhang","year":"2002","journal-title":"Life Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1210\/jc.2005-1664","article-title":"Dihydrotestosterone decreases tumor necrosis factor-alpha and lipopolysaccharide-induced inflammatory response in human endothelial cells","volume":"91","author":"Norata","year":"2006","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Carteri, R.B., Kopczynski, A., Rodolphi, M.S., Strogulski, N.R., Wannmacher, C.M.D., Franceschi, I.D., Hammerschmitt, M.E., Driemeier, D., and Portela, L.V. (2021). Anabolic-androgenic steroids impair mitochondrial function and redox status in the heart and liver of mice. Steroids, 172.","DOI":"10.1016\/j.steroids.2021.108861"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Frankenfeld, S.P., Oliveira, L.P., Ortenzi, V.H., Rego-Monteiro, I.C., Chaves, E.A., Ferreira, A.C., Leit\u00e3o, A.C., Carvalho, D.P., and Fortunato, R.S. (2014). The anabolic androgenic steroid nandrolone decanoate disrupts redox homeostasis in liver, heart and kidney of male Wistar rats. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102699"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Amini, H., Shirpoor, A., and Naderi, R. (2025). Nandrolone decanoate induces heart injury via oxidative damage and mitochondrial apoptotic pathway by regulation of TLR4\/NF-\u03baB\/NLRP3 axis in male rats: The rescue effect of N-acetylcysteine. Steroids, 214.","DOI":"10.1016\/j.steroids.2025.109563"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.toxrep.2023.02.010","article-title":"A study to demonstrate the potential of Anabolic Androgen Steroid to activate oxidative tissue damage, nephrotoxicity and decline endogenous antioxidant system in renal tissue of Adult Wistar Rats","volume":"10","author":"Memudu","year":"2023","journal-title":"Toxicol. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Fadah, K., Gopi, G., Lingireddy, A., Blumer, V., Dewald, T., and Mentz, R.J. (2023). Anabolic androgenic steroids and cardiomyopathy: An update. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1214374"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Albano, G.D., Amico, F., Cocimano, G., Liberto, A., Maglietta, F., Esposito, M., Rosi, G.L., Di Nunno, N., Salerno, M., and Montana, A. (2021). Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review. Healthcare, 9.","DOI":"10.3390\/healthcare9010097"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/j.1600-0838.2011.01436.x","article-title":"Cardiac autonomic dysfunction in anabolic steroid users","volume":"23","author":"Maior","year":"2013","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.toxrep.2017.05.005","article-title":"Use of anabolic androgenic steroids produces greater oxidative stress responses to resistance exercise in strength-trained men","volume":"4","author":"Arazi","year":"2017","journal-title":"Toxicol. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/1097-4652(2001)9999:9999<00::AID-JCP1057>3.0.CO;2-Y","article-title":"Anabolic-androgenic steroids induce apoptotic cell death in adult rat ventricular myocytes","volume":"187","author":"Zaugg","year":"2001","journal-title":"J. Cell. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"BR266","DOI":"10.12659\/MSM.881930","article-title":"Testosterone-induced hypertrophy, fibrosis and apoptosis of cardiac cells--an ultrastructural and immunohistochemical study","volume":"17","author":"Papamitsou","year":"2011","journal-title":"Med. Sci. Monit."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1177\/0960327115571766","article-title":"Testosterone induces apoptosis in cardiomyocytes by increasing proapoptotic signaling involving tumor necrosis factor-\u03b1 and renin angiotensin system","volume":"34","author":"Meyrelles","year":"2015","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.steroids.2018.02.004","article-title":"Effects of stanozolol on apoptosis mechanisms and oxidative stress in rat cardiac tissue","volume":"134","author":"Kara","year":"2018","journal-title":"Steroids"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev-physiol-021317-121427","article-title":"The Role of Autophagy in the Heart","volume":"80","author":"Sciarretta","year":"2018","journal-title":"Annu. Rev. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"672","DOI":"10.7150\/ijbs.11883","article-title":"Functions of autophagy in pathological cardiac hypertrophy","volume":"11","author":"Li","year":"2015","journal-title":"Int. J. Biol. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ding, W., Feng, H., Li, W.J., Liao, H.H., and Tang, Q.Z. (2020). Research Progress on the Interaction Between Autophagy and Energy Homeostasis in Cardiac Remodeling. Front. Pharmacol., 11.","DOI":"10.3389\/fphar.2020.587438"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1161\/CIRCRESAHA.114.302022","article-title":"Mammalian target of rapamycin signaling in cardiac physiology and disease","volume":"114","author":"Sciarretta","year":"2014","journal-title":"Circ. Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Yang, J., Xu, J., Han, X., Wang, H., Zhang, Y., Dong, J., Deng, Y., and Wang, J. (2018). Lysophosphatidic Acid Is Associated with Cardiac Dysfunction and Hypertrophy by Suppressing Autophagy via the LPA3\/AKT\/mTOR Pathway. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.01315"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Torrisi, M., Pennisi, G., Russo, I., Amico, F., Esposito, M., Liberto, A., Cocimano, G., Salerno, M., Li Rosi, G., and Di Nunno, N. (2020). Sudden Cardiac Death in Anabolic-Androgenic Steroid Users: A Literature Review. Medicina, 56.","DOI":"10.3390\/medicina56110587"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/978-3-540-79088-4_18","article-title":"Androgenic anabolic steroid abuse and the cardiovascular system","volume":"195","author":"Vanberg","year":"2010","journal-title":"Handb. Exp. Pharmacol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Fyksen, T.S., Gravning, J., Rosseb\u00f8, A., Vanberg, P., Gr\u00f8tta, O.J., Atar, D., and Halvorsen, S. (2025). Cardiac structure and function in anabolic-androgenic steroid users: A 16-year follow-up study. Open Heart, 12.","DOI":"10.1136\/openhrt-2025-003376"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Alhusban, Z., Alaaraj, M.M., Saimeh, A.R., Nassar, W., Awad, A., Ghanima, K., Abouelkheir, M., Hamed, A.M., Afsa, A., and Morra, M.E. (2025). Steroid-Induced Cardiomyopathy: Insights from a Systematic Literature Review and a Case Report. Clin. Case Rep., 13.","DOI":"10.1002\/ccr3.70171"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Stojko, M., Noco\u0144, J., Pi\u0142at, P., Szpila, G., Smolarczyk, J., \u017bmudka, K., Moll, M., and Hawranek, M. (2023). Innovative Reports on the Effects of Anabolic Androgenic Steroid Abuse-How to Lose Your Mind for the Love of Sport. Medicina, 59.","DOI":"10.3390\/medicina59081439"},{"key":"ref_45","first-page":"647","article-title":"Procoagulant State in Current and Former Anabolic Androgenic Steroid Abusers","volume":"118","author":"Chang","year":"2018","journal-title":"Thromb. Haemost."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1056\/NEJM198306093082305","article-title":"Danazol increases factor VIII and factor IX in classic hemophilia and Christmas disease","volume":"308","author":"Gralnick","year":"1983","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/2047487316651341","article-title":"Acute myocardial infarction in a young bodybuilder taking anabolic androgenic steroids: A case report and critical review of the literature","volume":"23","author":"Christou","year":"2016","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Choulerton, J., Guha, N., and Squires, R. (2021). Anabolic steroid use and ischaemic stroke in a young fitness enthusiast. BMJ Case Rep., 14.","DOI":"10.1136\/bcr-2020-234241"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"290","DOI":"10.3390\/hematolrep15020029","article-title":"Testosterone Usage Leading to Pulmonary Embolisms and Deep Vein Thrombosis: A Case Report and Review of the Literature","volume":"15","author":"Menakuru","year":"2023","journal-title":"Hematol. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Camilleri, E., Smit, D.L., van Rein, N., Le Cessie, S., de Hon, O., den Heijer, M., Lisman, T., Cannegieter, S.C., and de Ronde, W. (2023). Coagulation profiles during and after anabolic androgenic steroid use: Data from the HAARLEM study. Res. Pr. Thromb. Haemost., 7.","DOI":"10.1016\/j.rpth.2023.102215"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1055\/s-0040-1714398","article-title":"Anabolic-Androgenic Steroid Abuse Impairs Fibrin Clot Lysis","volume":"47","author":"Sidelmann","year":"2021","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1093\/gerona\/glt154","article-title":"Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: Evidence for a new erythropoietin\/hemoglobin set point","volume":"69","author":"Bachman","year":"2014","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1161\/01.CIR.91.11.2742","article-title":"Testosterone increases human platelet thromboxane A2 receptor density and aggregation responses","volume":"91","author":"Ajayi","year":"1995","journal-title":"Circulation"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1055\/s-0038-1661320","article-title":"Effect of stanozolol on factors VIII and IX and serum aminotransferases in haemophilia","volume":"53","author":"Greer","year":"1985","journal-title":"Thromb. Haemost."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1055\/s-0038-1661049","article-title":"Stanozolol-induced changes in fibrinolysis and coagulation in healthy adults","volume":"51","author":"Kluft","year":"1984","journal-title":"Thromb. Haemost."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/ajh.20532","article-title":"Effects of oxandrolone, an anabolic steroid, on hemostasis","volume":"81","author":"Kahn","year":"2006","journal-title":"Am. J. Hematol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1055\/s-0038-1661110","article-title":"Modulation of rapid plasminogen activator inhibitor in plasma by stanozolol","volume":"51","author":"Verheijen","year":"1984","journal-title":"Thromb. Haemost."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"513","DOI":"10.2165\/00007256-200434080-00003","article-title":"Effects of androgenic-anabolic steroids in athletes","volume":"34","author":"Hartgens","year":"2004","journal-title":"Sports Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/0026-0495(90)90076-O","article-title":"Lipid and apoprotein modifications in body builders during and after self-administration of anabolic steroids","volume":"39","author":"Giada","year":"1990","journal-title":"Metabolism"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s11154-020-09616-y","article-title":"How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health","volume":"22","author":"McCullough","year":"2021","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1136\/bjsm.2003.000199","article-title":"Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein (a)","volume":"38","author":"Hartgens","year":"2004","journal-title":"Br. J. Sports Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1161\/CIRCULATIONAHA.116.026945","article-title":"Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use","volume":"135","author":"Baggish","year":"2017","journal-title":"Circulation"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"de Melo, A.F., Escouto, L., Pimp\u00e3o, A.B., Peixoto, P., Brasil, G., Ronchi, S.N., Pereira, S.A., and Bissoli, N.S. (2025). Anabolic-androgen steroids: A possible independent risk factor to Cardiovascular, Kidney and Metabolic Syndrome. Toxicol. Appl. Pharmacol., 495.","DOI":"10.1016\/j.taap.2025.117238"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ijcard.2007.12.027","article-title":"Androgenic anabolic steroids also impair right ventricular function","volume":"134","author":"Kasikcioglu","year":"2009","journal-title":"Int. J. Cardiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jsbmb.2017.01.012","article-title":"Administration of anabolic steroid during adolescence induces long-term cardiac hypertrophy and increases susceptibility to ischemia\/reperfusion injury in adult Wistar rats","volume":"171","author":"Seara","year":"2017","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1097\/CM9.0000000000000407","article-title":"Anabolic-androgenic steroids and cardiovascular risk","volume":"132","author":"Liu","year":"2019","journal-title":"Chin. Med. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S0306-4530(02)00025-2","article-title":"Neuroendocrine and behavioral effects of high-dose anabolic steroid administration in male normal volunteers","volume":"28","author":"Daly","year":"2003","journal-title":"Psychoneuroendocrinology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.fertnstert.2014.02.002","article-title":"Anabolic steroid-induced hypogonadism: Diagnosis and treatment","volume":"101","author":"Rahnema","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/toxsci\/kfr063","article-title":"Pharmacological doses of testosterone upregulated androgen receptor and 3-Beta-hydroxysteroid dehydrogenase\/delta-5-delta-4 isomerase and impaired leydig cells steroidogenesis in adult rats","volume":"121","author":"Kostic","year":"2011","journal-title":"Toxicol. Sci."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Desai, A., Yassin, M., Cayetano, A., Tharakan, T., Jayasena, C.N., and Minhas, S. (2022). Understanding and managing the suppression of spermatogenesis caused by testosterone replacement therapy (TRT) and anabolic-androgenic steroids (AAS). Ther. Adv. Urol., 14.","DOI":"10.1177\/17562872221105017"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Wang, J.M., Li, Z.F., Yang, W.X., and Tan, F.Q. (2022). Follicle-stimulating hormone signaling in Sertoli cells: A licence to the early stages of spermatogenesis. Reprod. Biol. Endocrinol., 20.","DOI":"10.1186\/s12958-022-00971-w"},{"key":"ref_72","first-page":"1069","article-title":"Ingestion of androgenic-anabolic steroids induces mild thyroidal impairment in male body builders","volume":"76","author":"Deyssig","year":"1993","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"247","DOI":"10.7326\/0003-4819-121-4-199408150-00002","article-title":"Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer","volume":"121","author":"Arafah","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Zarei, M., Zaeemi, M., and Rashidlamir, A. (2018). Effects of testosterone enanthate treatment in conjunction with resistance training on thyroid hormones and lipid profile in male Wistar rats. Andrologia, 50.","DOI":"10.1111\/and.12862"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/22\/11037\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T14:39:05Z","timestamp":1763131145000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/22\/11037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":74,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijms262211037"],"URL":"https:\/\/doi.org\/10.3390\/ijms262211037","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]}}}