Impact of Anabolic Steroids on Tendons: A Narrative Review

Anabolic-androgenic steroids (AAS), synthetic testosterone derivatives, are used to increase muscle mass and performance. However, high doses negatively affect tendons and ligaments, disrupting collagen balance and increasing injury risk due to a mismatch between muscle strength and tendon resilience. AAS use increases tendon rupture risk by weakening collagen structure and elasticity, despite muscle growth. Injuries often occur at major tendon sites and require imaging-based diagnosis, with surgery preferred in active individuals. Education and prevention are key due to AAS-related systemic risks. This review compiles data from clinical, experimental, and imaging studies on AAS effects on tendons. It focuses on structural changes, common rupture sites (e.g., triceps, pectoralis major, quadriceps), diagnostic tools, and treatment strategies. This review aims to analyze the effects of AAS on tendon structure and function, identify the most common tendon injuries associated with AAS use, and present current diagnostic and treatment strategies to aid in prevention and clinical management.