A study published in the European Journal of Preventive Cardiology in 2024 examined biventricular cardiac function in long-term anabolic-androgenic steroid (AAS) users. It compared 101 male users (69 current, 30 former) with 71 non-using weightlifting controls, using transthoracic echocardiography with speckle-tracking strain analysis.
AAS users had markedly reduced left ventricular ejection fraction (mean 49 +/- 7% versus 59 +/- 5% in controls) and higher left ventricular mass index (106 +/- 26 versus 80 +/- 15 g/m2). About 11% of users had an ejection fraction at or below 40%, a threshold indicating significant systolic dysfunction, and right ventricular strain was also impaired.
Notably, former users who had ceased use on average about six years earlier still showed reduced systolic function, suggesting that cardiac changes may not fully reverse after discontinuation.
The findings extend earlier imaging work from Aaron Baggish and colleagues, whose 2017 Circulation study of 140 weightlifters using echocardiography and coronary CT angiography reported reduced systolic and diastolic function and greater coronary plaque volume in AAS users. Together these studies point to dose- and duration-dependent structural heart changes with illicit high-dose use, distinct from the indicated-TRT population studied in TRAVERSE.