Anabolic-androgenic steroid use is associated with reduced LVEF and increased LVMI in strength-trained athletesSteroid use is linked to heart structure and function changes

Echocardiography (Mount Kisco, N.Y.) Published September 6, 2026 Study authors: Fernandes Matheus de Medeiros, Batista Pedro Gomes, Chagas Camila Viviane Ribera, Silva Railla Raque… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that anabolic-androgenic steroid use is associated with impaired cardiac structure and function in athletes.

This meta-analysis evaluated the impact of anabolic-androgenic steroid (AAS) use on cardiac structure and function in strength-trained athletes. The analysis included 1906 athletes and compared those using AAS to non-using athletes. The study identified several significant associations between AAS use and cardiac metrics, including a reduced left ventricular ejection fraction (LVEF) with a mean difference of -2.84% (95% CI -4.24 to -1.44; p < 0.01). Additionally, global longitudinal strain (GLS) was impaired (MD +3.27%, p < 0.01), and the left ventricular mass index (LVMI) was increased (MD +18.21 g/m, p < 0.01).

Stratified analysis by duration of use indicated that the largest reduction in LVEF occurred after more than six years of exposure (MD -7.39%; 95% CI -10.71 to -4.07). While septal thickening was noted as detectable before six months, other metrics such as right ventricular strain did not have reported effect sizes.

The authors note that because the included studies were cross-sectional, the results cannot establish a progression of cardiac issues within individuals over time. Clinically, these findings suggest that AAS use is associated with measurable cardiac structural and functional abnormalities, with specific outcomes linked to the duration of exposure. The evidence is limited by the cross-sectional nature of the primary data source.

For many strength-trained athletes, the goal is to build muscle and power. However, using anabolic-androgenic steroids (AAS) can come with hidden costs to the heart. A large review of data from nearly 2,000 athletes shows that those using these steroids often have different heart structures compared to those who do not.

The findings show that steroid use is linked to an increase in left ventricular mass index, which means the heart muscle is thickening. It also showed a decrease in ejection fraction, which is the measure of how much blood the heart pumps out with each beat. These changes suggest that the heart muscle may be struggling to function normally.

One important finding is that the drop in pumping power was most significant in those who used steroids for more than six years. While these results show a clear link between steroid use and heart changes, it is important to note that the study compared different groups of people at one point in time. This means it cannot track how an individual's heart changes over many years of use.

What this means for you:

Steroid use is linked to heart muscle thickening and reduced pumping power, especially after six years of use.

Common questions

How does steroid use affect the heart's pumping ability?

The study found that athletes using anabolic-androgenic steroids had a reduced left ventricular ejection fraction. This is a measure of how much blood the heart pumps out with each beat. The reduction was most significant in those who used the substances for more than six years.

What physical changes happen to the heart muscle?

The data showed that steroid use is linked to an increased left ventricular mass index, which means the heart muscle thickens. The study also noted that septal thickening could be detected in less than six months of use.

Is the link between steroids and heart issues proven for every individual?

The study shows a clear link between steroid use and heart changes, but it is a cross-sectional comparison. This means it compares different groups of people at one time rather than following one person over many years, so it cannot track the exact progression for an individual.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up6.0 mo

PublishedSep 2026

PMID42672095

View Original Abstract ↓

PURPOSE: Nonmedical anabolic-androgenic steroid (AAS) use is increasing, and its duration-dependent cardiac effects remain unclear. We evaluated cardiac structure and function in AAS-using strength-trained athletes, overall and by exposure duration. METHODS: We searched PubMed, Embase, Cochrane Central, and SCOPUS through November 2025 for observational studies comparing AAS-using and nonusing strength-trained athletes of either sex. Random-effects models pooled mean differences (MD) overall and across four exposure strata (<6 months, 6 months-3 years, 3-6 years, >6 years); meta-regression assessed duration as a continuous moderator. RESULTS: Forty studies (1906 athletes; 95% male) were included. Overall, AAS users showed reduced left ventricular ejection fraction (LVEF; 29 studies; MD -2.84%; 95% CI -4.24 to -1.44; p < 0.01), impaired global longitudinal strain (GLS; MD +3.27%; p < 0.01), and increased left ventricular mass index (LVMI; MD +18.21 g/m; p < 0.01). Septal thickening was detectable before six months, preceding functional impairment. LVEF, LVMI, and posterior wall thickness (PWT) differed significantly across strata (all p ≤ 0.03), with the largest LVEF reduction beyond six years (MD -7.39%; 95% CI -10.71 to -4.07). Meta-regression suggested that exposure duration was associated with variation in selected structural and functional outcomes, corroborating LVEF, LVMI, and PWT, while GLS, E/e', and E/A ratio showed no significant association. Right ventricular strain was impaired in an exploratory, non-stratified analysis. CONCLUSION: AAS use is associated with cardiac structural and functional abnormalities, with exposure duration associated with selected, but not all, outcomes. These cross-sectional comparisons do not establish within-person progression; longitudinal surveillance with deformation imaging is warranted.

Anabolic-androgenic steroid use is associated with reduced LVEF and increased LVMI in strength-trained athletesSteroid use is linked to heart structure and function changes

Common questions

Study Details

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Anabolic-androgenic steroid use is associated with reduced LVEF and increased LVMI in strength-trained athletesSteroid use is linked to heart structure and function changes

Common questions

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