Anabolic steroid-induced tendon pathology: a review of the literature

Anabolic steroids have attained a prominent, albeit highly controversial, position among ergogenic aids for power athletes. Adverse effects of these compounds are well documented, but their popularity persists. One of their possible side effects which has received little attention is abnormal form and function of connective tissue in steroid-abusing athletes. Scientific and medical literature addressing this concern is scant and is generally limited to observed effects in animals. Anabolic steroid use paralleled with exercise may lead to dysplasia of collagen fibrils, which can decrease the tensile strength of tendon. Changes in tendon's crimp morphology have been shown to occur, as well, which may alter the rupturing strain of tendon and the normal biomechanics of the extremities. Given the megadoses of steroids taken by some athletes and the large forces incurred by power-trained musculature, the integrity of tendinous tissue in these athletes may be at significant risk of compromise if steroids do, in fact, exert a destructive effect. Additional investigation in the area reviewed here is warranted before anabolic steroids can be decisively implicated in human connective tissue disruption. It is recommended, however, that consideration be given to including potential tissue alterations among the side effects of steroid abuse.