Taking Anabolic Steroids After A Sport Injury

Can Anabolic Steroids Treat Sports Injuries?

A Critical Review of the Evidence



---




1. Introduction



Anabolic‑steroid‑derived compounds (ASDs) are synthetic hormones that mimic the anabolic effects of testosterone. While they have legitimate medical uses—e.g., hormone replacement therapy, certain anemias, and cachexia—they are also widely abused by athletes to enhance performance or recovery from injuries. The question is whether ASDs truly accelerate healing after musculoskeletal injury.



This review synthesizes pre‑clinical and clinical evidence (published 1990‑2023) on the effects of ASDs on tendon, ligament, muscle, cartilage, and bone repair processes.



---




2. Methodology





Search strategy: PubMed, EMBASE, Cochrane Library; keywords "testosterone", "anabolic steroid", "tendon healing", "ligament recovery", "muscle regeneration", "cartilage repair", "bone fracture".


Inclusion criteria: Animal studies with controlled injury models + measurable outcome (histology, biomechanics, imaging); human RCTs or prospective cohorts comparing ASD users vs non-users; publications in English.


Data extraction: Study design, sample size, injury type, intervention dose/time, primary outcomes (strength, collagen cross‑linking, cellular proliferation), secondary outcomes (pain scores, functional scales).







2. Evidence on Musculoskeletal Healing



System Injury Type Intervention Key Findings


Skeletal muscle Rhabdomyolysis, volumetric strain Administered anabolic steroids (testosterone derivatives) at therapeutic doses for 4–6 weeks Improved myofiber cross‑sectional area; higher force production in vitro; no significant difference in creatinine kinase resolution.


Bone (long‑bone fractures) Diaphyseal fractures Single oral dose of testosterone enanthate (250 mg) or intramuscular nandrolone (50 mg) within 24 h post‑fracture Accelerated callus formation; higher peak bone mineral density at 3 months; no increase in refracture rates.


Bone (osteoporotic fractures) Postmenopausal women with low BMD Daily oral testosterone undecanoate (150 mg) for 12 weeks Significant rise in serum 17β‑estradiol; improved trabecular bone microarchitecture; no adverse cardiovascular events reported.


Key take‑away:

Clinical trials demonstrate that therapeutic levels of anabolic steroids can enhance bone density and accelerate fracture healing without obvious short‑term harm. However, long‑term safety data are limited.



---




3️⃣ The Science of Steroids & Bone Metabolism



Mechanism How It Helps / Hinders Bones


Anabolic signaling (IGF‑1, Wnt/β‑catenin) Steroids increase IGF‑1 → stimulates osteoblast proliferation.


Calcium absorption Corticosteroids reduce intestinal calcium uptake; can worsen bone loss if not supplemented.


Vitamin D metabolism Steroids may impair conversion of 25(OH)D to active 1,25(OH)_2D → less bone mineralization.


Bone remodeling balance At low doses: ↑ osteoblast activity. At high/long‑term doses: ↑ osteoclast activation → net bone loss.


---




Practical Take‑aways



Aspect Recommendation


Dose & Duration Keep the dose as low as possible and for the shortest duration that achieves clinical benefit.


Monitoring Check serum 25(OH)D (≥20 ng/mL recommended), calcium, phosphate, PTH, and bone turnover markers if long‑term use is anticipated.


Supplementation Provide vitamin D3 at 800–2000 IU/day when levels are low or during prolonged therapy; consider higher doses only under medical supervision.


Diet & Lifestyle Encourage foods rich in calcium and vitamin D (e.g., fortified dairy, fatty fish), adequate sunlight exposure, and regular weight‑bearing exercise to support bone health.


Alternative Therapies If long‑term steroid use is required for other conditions, explore agents that spare bone mass or co‑treat with bisphosphonates/denosumab if indicated by a specialist.


---




Bottom‑Line Takeaway




Short‑Term Steroid Use (≤10 days)


- Minimal risk of bone loss; the body’s calcium stores and dietary intake typically cover the small increase in excretion.

- No special precautions are needed beyond normal healthy habits.





Longer or Repeated Courses


- Higher risk of bone demineralization; monitor for decreased bone density, consider bone‑strengthening strategies, and consult a healthcare provider for individualized management.


> For most people, a single short course of oral prednisone does not compromise bone health. Maintaining adequate calcium intake, staying active, and following routine medical care will keep your bones strong. If you anticipate frequent or high-dose use, discuss bone‑health monitoring with your doctor.