Special characteristics of doping in women

Updated: 15 June 2023

The use of anabolic-androgenic steroids (hereafter referred to as anabolic steroids), in other words, testosterone and its derivatives, is much less common in women than in men. It is estimated that the prevalence of anabolic steroid use in women is 0.2% in the Nordic countries and 1.6% worldwide. The corresponding figures for men are 2.9% and 6.4%. [1, 2] More detailed information on the prevalence of the use of other doping substances among women internationally is not available. According to the Finnish Institute for Health and Welfare’s 2014 substance abuse survey, 0.3% of women in Finland have used doping substances at some point in their lives. [3] In more specifically defined groups, such as women who do strength training and go to the gym, their use may be much more common. For example, in a Brazilian study, more than 13% of women who go to the gym recreationally have used anabolic steroids at some point. [25]

There are much fewer studies on women’s use of doping substances than men’s. A common assumption is that women prefer to use other doping substances rather than anabolic steroids because of their androgenic or masculinising effects. However, anabolic steroids are one of the most common groups of doping substances used by female elite athletes. [4]

Substances that have been assumed to be favoured by women include fat-burners such as ephedrine, thyroid hormones and clenbuterol. Women also use growth hormones and substances that increase their production in the body. Women’s goals in using growth hormones include burning fat, muscle growth, recovery from exercise, skin care and anti-ageing effects. [5, 6, 7, 8]

There is very little research on the use of slimming substances for doping purposes alone. Almost the only research evidence concerns women who use anabolic steroids. 

Women users often face the challenge of stigma and isolation. Research data and exchange of experiences are not widely or easily available. These factors may prevent women from seeking help. [24]

Ways women use anabolic steroids

There are both similarities and differences between men’s and women’s patterns of use. Like men, women too often use several substances at the same time. However, there are some differences in the way women use anabolic steroids compared to men. Women often prefer oral anabolic steroids, which are less androgenic in their effects. In particular, orally administered oxandrolone seems to be favoured by female users because of its weaker androgenic but strong anabolic effect. Oral anabolic steroids are often more harmful to the liver than intramuscular agents. [5, 6, 7, 8, 9, 24, 25]

Women often take anabolic steroids over shorter courses and use smaller doses than men. Women also do not use as many different anabolic steroids at the same time as men do. By choosing these methods of use, women often aim to curb androgenic changes and adverse effects. [5, 10, 24, 25]

How women start using anabolic steroids

Women look to anabolic steroids for the same effects as men: muscle growth and body shaping. [5, 9, 11, 25] Women’s motives for using these substances are very often related to goal-oriented and competitive training, such as power sports and bodybuilding. [5, 10, 12, 13] Since anabolic steroids have a more pronounced androgenic effect on females, few women are willing to undergo the masculine characteristics induced by anabolic steroids for the sake of a mere hobby. 

Female users appear to have more problems with addiction, body image, eating disorders and mental health compared to male users, and women who do not use anabolic steroids. [5, 12, 13, 14, 23]

The initiation of anabolic steroid use by a woman is often facilitated by a man close to her, such as a partner or coach. Women also tend to get their advice on the use of anabolic steroids and how long a course they should take from men, and this poses its own challenges. [10, 13, 15]

Gender-specific effects of anabolic steroid use for women

Most of the testosterone in men is produced in the testicles. A small proportion is secreted from the adrenal cortex. In women, testosterone is produced in the ovaries and the adrenal cortex. Women have much lower natural testosterone levels than men. The reference values for testosterone levels in men range from 10–38 nmol/l, with reference values for women ranging from 0.4–2 nmol/l. [16, 17]

Because women’s and men’s natural testosterone production and concentrations differ so much, it has been suggested that women may be more likely to achieve more pronounced changes in muscle mass and strength at lower doses than men. [17]

Testosterone plays a major role in the differences between men’s and women’s sexual characteristics. Therefore, typical symptoms of anabolic steroid use in women include androgenic changes such as their voice becoming lower, their breasts becoming smaller, acne, clitoral growth, irregular menstruation, aggression, uterine atrophy, increased sexual drive and increased hair growth and hair loss. Such changes can occur after just a few weeks of use. [9, 12, 14, 18]

Not all androgenic changes are necessarily considered negative; for example, an increase in sexual drive and clitoral growth may be considered a positive change. [19, 20]

Some changes, such as the voice becoming lower, may be permanent. The woman herself may not notice that her voice has changed. Female users have also reported hypomania-like effects from testosterone use, such as increased euphoria and self-confidence during use. [12, 20, 21, 22]

As with men, women’s use of anabolic steroids suppresses the function of the hypothalamic-pituitary-gonadal axis. The use of anabolic steroids reduces the function of the luteinising hormone, follicle-stimulating hormone, progesterone and sex hormone binding globulin (SHGB) in women. This may result in menstrual irregularities, reduced ovarian function and infertility. [18] 

Female users may use this information to determine whether the anabolic steroids they are taking are effective. During the use of anabolic steroids, not menstruating may be considered a positive thing, as it is a sign that the substances are working. However, after the course has ended it is desirable that menstruation resumes, as this shows that the body’s endocrine system has recovered. [20]

There is less research evidence of cardiovascular damage from the use of anabolic steroids for women than for men. Women may not exhibit all the blood count changes typical of male users (such as an increase in haemoglobin or haematocrit), which may be due to lower dosages of anabolic steroids. [23]

Joni Askola, Master of Health Science, Dopinglinkki