Effects of anabolic-androgenic steroids on blood parameters in Turkish male gym participants: a comparison of users and non-users

Abuse of anabolic-androgenic steroids (AAS) to enhance muscularity has become a global health problem. Gym participants may abuse AAS under the influence of performance goals, body image concerns, and ethnocultural masculinity norms. This study aimed to determine the prevalence of AAS-users among Turkish male gym participants and to compare their blood parameters with those of non-users. A retrospective cross-sectional analysis identified recreational male gym athletes aged 18-50 years who underwent measurement of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and total testosterone (TT) between 2015 and 2025. Athletes with gonadotropin (LH and FSH) suppression were defined as "AAS-users". A total of 161 athletes were included in the study, and 57 (35.4%) were AAS-users with severe gonadal suppression (median LH= 0.12 IU/L and FSH= 0.17 IU/L). AAS-users were predominantly young adults aged 18-25 years (54.5%). Compared with non-users, AAS-users had significantly higher levels of TT, vitamin-B12, creatinine, liver transaminases, red blood cells, hematocrit, hemoglobin, and platelets, and significantly lower levels of high-density lipoprotein (HDL). Vitamin-B12 showed the strongest inverse correlation with gonadotropin levels, whereas HDL showed the strongest positive correlation. The findings indicate that approximately one-third of Turkish gym participants were AAS-users. They exhibited AAS-related renal, hepatic, polycythemic, thrombocytic, and dyslipidemic alterations, along with a higher tendency to use vitamin supplements. The pursuit of a muscular physique is associated with substantial cardiometabolic risk among male AAS-users, particularly young adults. This underscores the need for targeted educational interventions to improve benefit-risk awareness.