Androgen Use Among Female Amateur Athletes: A Retrospective Analysis

Most research on non-prescribed androgen use has focused on men, while women remain underrepresented in the literature, despite unique risks such as virilization and reproductive consequences. This is one of the largest described cohorts of females who use androgen, all of whom underwent in-person consultation, allowing for a more reliable characterization compared to previous studies. We conducted a retrospective chart review of all female patients with a history of non-prescribed androgen use attending a harm reduction clinic in the Netherlands between April 2023 and August 2025. Demographics, training background, motivations, patterns of androgen, and other performance- and image-enhancing drug (PIED) use were extracted. Descriptive statistics were applied. Forty-one women were included (median age 33 years, range 22-59). All performed weekly resistance training, and most (75%) were competitive amateur bodybuilders. The primary motivation was improvement of body composition, muscle size, and strength. Most reported intermittent oral cycles with oxandrolone. Continuous use beyond 1 year was rare. The most frequently used androgen was oxandrolone (88%). Clenbuterol, thyroid hormone, and growth hormone were the most frequent non-androgen PIEDs. Androgen use in this outpatient female cohort was characterized by lower dosages than commonly reported in male cohorts, predominantly oral administration, and motivations tied almost exclusively to bodybuilding or strength sports. While these patterns may reduce some dose-dependent risks such as heart failure, reliance on oral androgens increases the risk of hepatotoxicity and adverse lipid effects. A prospective study with a systematic approach is required to provide more reliable data on the health risk of androgen use in women.