Volume 275, 1 October 2025, 112829Author links open overlay panel, , , , , , , Highlights•

Anabolic-androgenic steroids (AAS) are commonly used by recreational weightlifters.

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AAS use are associated with adverse cardiovascular health and brain effects.

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PCASL-MRI generates derivatives to measure CBF and sCoV of CBF in gray matter.

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Increased sCoV among AAS consumers indicates that AAS use may impact cerebrovascular health.

AbstractBackground

Anabolic-androgenic steroids (AAS) are commonly used by recreational weightlifters for performance enhancement, despite associated health risks, including cardiovascular and brain effects. This study investigates the cerebrovascular effects of prolonged AAS use in male weightlifters, focusing on cerebral blood flow (CBF) and other indicators of cerebrovascular health.

Methods

Eighty-six males were included, with 41 current consumers of AAS and 45 non-using weightlifting controls. Cerebrovascular health was evaluated using magnetic resonance imaging (MRI) pseudo-continuous arterial spin labeling (PCASL) derivatives to measure CBF and spatial coefficient of variation (sCoV) of CBF in gray matter. Additionally, MRI T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences were used to analyze white matter hyperintensities as a marker of small-vessel disease.

Results

AAS consumers had significantly higher sCoV than weightlifting controls (p = 0.001). Further, sCoV in total gray matter correlated with testosterone/epitestosterone ratio and total years of AAS use. No significant differences were found in CBF or white matter hyperintensity volume.

Conclusion

These findings indicate that long-term AAS use may impact cerebrovascular health, evidenced by increased sCoV. Although cerebral perfusion was unaffected, elevated sCoV suggest that AAS use may pose a risk for cerebrovascular pathology later in life.

Keywords

Anabolic androgenic steroids

Arterial spin labeling (ASL) perfusion MRI

Cerebral blood flow

Spatial coefficient of variation

Substance misuse

Data AvailabilityThe raw data cannot be shared publicly due to General Data Protection Regulation (GDPR) and is available from the corresponding author ([email protected]) on reasonable request.

© 2025 The Authors. Published by Elsevier B.V.