The use of steroids today has taken on an epidemic character: in professional sports, one cannot survive without them, as everyone uses them; in amateur sports, the opportunity to quickly gain mass while also burning fat looks very appealing.
However, hormonal changes in the body rarely go unnoticed.
Anabolic steroids have an extensive list of side effects. The consequences of their use in sports are the result of taking them in excessively large doses, over a long period, and combining them with other pharmacological agents.
The principles of scientific ethics prohibit conducting experiments to study the effects of steroids on female athletes’ bodies. Therefore, many conclusions about the consequences of their use are drawn by scientists based on the analysis of various medical cases in which the testosterone levels in women change.
In this material, we will discuss the impact of steroids on sexual function in women: the ability to conceive (pregnancy), the regularity of menstruation, and the risk of breast cancer.
This article is based on the results of a scientific study by Professor Eberhard Nieschlag from the Center for Reproductive Medicine and Andrology at the University of Münster in Germany 1.
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The Impact of Steroids on Sexual Function in Women
Menstrual Delay and Pregnancy
In women, it is commonly believed that the use of steroids leads to a later onset of the first menstruation, menstrual pain (dysmenorrhea), delayed menstruation of more than 35 days (oligomenorrhea), cessation of menstruation, absence of ovulation, and consequently, the inability to conceive or infertility.
However, the cause of the listed sexual function disorders in women may also be the high level of physical activity itself, which leads to a decrease in estrogen levels in the blood 2,3.
A study of over 3,800 women in Norway showed that those who led an active lifestyle had three times more problems with conceiving a child than physically inactive women.
The inability to become pregnant may be a consequence of intense training to the point of physical exhaustion. After reducing the load, the ability to conceive is restored 4.
Out of 717 professional female athletes who participated in the IAAF 2011 championship (International Association of Athletics Federations), none used anabolic steroids, but 168 of them either had absent or delayed menstruation.
The type of sport and body composition (the ratio of muscle mass to fat) can also affect reproductive function.
In ballet dancers, who start training very early and maintain their form with an extremely low body fat percentage, the first menstruation occurs 2 years later than in their inactive peers.
For women who run, menstrual disorders occur proportionally to the distance run each week.
All of this indicates that menstrual problems and the inability to conceive in female athletes are not always a result of steroid use. And due to the lack of scientific research, it is impossible to give an accurate assessment of the impact of steroids on the ability to become pregnant, give birth to a healthy child, or infertility in women.
Despite the fact that steroids are often blamed for menstrual disorders in female athletes and the inability to conceive, the causes of these deviations may also include high physical activity, low body fat percentage, type of sport, and duration of training.
But, as in the case of men, some information about the effects of steroids on women’s bodies can be learned from medical cases when women undergo hormone therapy using testosterone.
In one of the large-scale studies of the side effects of testosterone use in therapeutic doses in women, it was shown that there were no significant differences in the incidence of cardiovascular diseases, breast cancer, formation of blood clots in the veins or arteries of the lungs (pulmonary embolism), diabetes, or hepatitis compared to healthy individuals 5,6.
This conclusion should not be interpreted as confirmation of the safety of steroid use by female athletes: the doses of anabolic steroids in sports significantly exceed therapeutic ones.
Scientific research for unequivocal statements is lacking.
Elevated testosterone levels in women who take it for therapeutic purposes do not increase the risk of chronic diseases
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Breast Cancer
Some anabolic steroids are partially converted into estrogen, the female sex hormone, in the breasts of both women and men. This is known as the aromatization effect. This fact is often the reason for concern regarding their influence on the risk of breast cancer, and in men, it leads to the development of gynecomastia or the growth of female breasts.
Drugs such as clomid and tamoxifen are taken during PCT to reduce estrogen concentration in the breasts.
It is important to understand that not all steroids have an aromatization effect, so the estrogenic reason for increased breast cancer risk is unlikely 7.
Breast cancer is the most common form of cancer in women 8, not just athletes.
This fact should be kept in mind when trying to understand how the use of anabolic steroids by women in sports may be related to this.
Opinions among scientists on this issue are contradictory.
The majority of existing studies do not confirm the existence of a relationship between breast cancer risk and testosterone levels in the blood of women of menstruating age (when conception is possible) 9. However, a slight increase in breast cancer risk is noted in postmenopausal women (when menstruation ceases) with elevated testosterone levels 10.
Let’s consider a few medical cases.
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Breast Cancer Risk in Women Taking Testosterone for Libido Stimulation
Recently, it has become popular to use small doses of testosterone, mainly administered through the skin, to treat certain sexual problems in women, particularly low sexual desire. Due to this, scientists have raised concerns about whether this increases the likelihood of breast cancer.
Recent scientific reviews of available studies on this matter confirmed the absence of grounds for concern, however, the authors also emphasize that rigorous studies, as is customary in science, have not been conducted 9,11,12.
Risk of Breast Cancer in Transsexuals (Female-to-Male)
Studies on transsexual women who change their sex and take steroids for a long time also show no increased risk of breast cancer in them 13,14.
Since 1970, when hormone therapy began to be used for sex reassignment, only one case of breast cancer has been recorded in the scientific literature for a woman who changed her sex, which developed 10 years after breast removal and continuous testosterone hormone therapy during that time 15.
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Risk of Breast Cancer in Conditions Where Testosterone Levels in Women Are Comparable to Those Used in Sports
There are also certain conditions in women where testosterone levels rise to levels comparable to those used in sports. For example, polycystic ovary syndrome.
Such cases serve as a model for scientists to study the long-term effects of steroid use by women in sports. Scientific studies do not confirm here either that the risk of breast cancer increases in such conditions 16.
Based on studies of medical cases where women take testosterone to increase libido, change sex, or when it is elevated due to illness, scientists conclude that elevated testosterone levels do not increase the risk of breast cancer.
Testosterone May Reduce the Likelihood of Breast Cancer
Moreover, scientists have shown that testosterone hormone therapy in women suppresses the growth and division of breast cells and therefore reduces the likelihood of breast cancer 17. One study showed that women undergoing testosterone hormone therapy have a significantly lower incidence of breast cancer 18.
In conclusion: there are NO rigorous scientific studies on the impact of steroid use on the risk of breast cancer in female athletes. There are also virtually no documented cases of breast cancer in female athletes in the scientific literature. This could partly be interpreted as a relative safety of steroids for female athletes. However, such a conclusion is unwarranted; more thorough research is needed.
Elevated testosterone levels may even reduce the risk of breast cancer in women.
Conclusion
The principles of scientific ethics do not allow researchers to conduct experiments on the effects of steroid use on athletes. Therefore, no one can provide a definitive answer to the question of how steroids affect the ability to conceive, the regularity of menstruation, and the risk of breast cancer today, and it is unlikely that this will be possible in the future.
Most of the conclusions mentioned above regarding the harm of steroids to women’s sexual health are made based on medical case data, where the testosterone levels in the blood differ only slightly from natural levels and are incomparable to those used in sports.
The available data suggest that the likelihood of negative effects from steroid use by women in sports on the regularity of menstruation, inability to conceive, and breast cancer is low.
However, strict scientific research on this issue is necessary.
