Liver tumors in anabolic steroid users: A practical approach for the gastroenterologist and hepatologist

Anabolic androgenic steroids (AAS), used at supraphysiological doses, are an underrecognized cause of primary hepatocellular tumors, particularly hepatocellular adenoma (HCA) and carcinoma (HCC), typically arising in young, non-cirrhotic patients outside the usual demographic for liver cancer. This review summarizes the clinical presentation, imaging features, and molecular basis of androgen-associated hepatocellular neoplasia and provides a practical framework for recognition and management. Androgen receptor (AR) signaling drives hepatocarcinogenesis through the cell cycle-related kinase/β-catenin pathway and mTOR complex 1-mediated AR stabilization; the β-catenin-activated HCA subtype, over-represented in this setting, carries the highest risk of malignant transformation. Because serum alpha-fetoprotein is often normal and cirrhosis is typically absent, diagnosis requires a high index of clinical suspicion and a structured exposure history. We outline an approach to imaging work-up, AAS cessation, and follow-up, and discuss when referral for biopsy, resection, or specialist hepatology review is warranted.