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. 2025 Jul;53(8):1978-1987.
doi: 10.1177/03635465251340701. Epub 2025 May 23.

Effect of Current and Former Anabolic-Androgenic Steroid Abuse on the Patellar Tendon

Ann Damgaard  1   2 , Grith Højfeldt  1   2 , Olivia Thorsgaard  1 , Yeliz Bulut  2   3 , Frederik Hvid Linden  4 , Peter Schjerling  1   2 , Abigail L Mackey  1   2 , Caroline Kistorp  2   3 , S Peter Magnusson  1   2   5 , Michael Kjær  1   2 , Rene B Svensson  1   2   6
Affiliations

Effect of Current and Former Anabolic-Androgenic Steroid Abuse on the Patellar Tendon

Ann Damgaard et al. Am J Sports Med. 2025 Jul.

Abstract

Background: Anabolic-androgenic steroids (AASs) are synthetic derivatives of testosterone that are abused by athletes to enhance their physical appearance and performance. AAS abusers have an increased risk of tendon ruptures compared with nonusers, and it has been proposed that AASs damage tendon tissue. Only a few human studies have investigated the effect of AASs on tendon tissue, and to our knowledge, there are no data on female sex.

Purpose/hypothesis: The purpose was to investigate the effect of current and former abuse of AASs on the patellar tendon (PT). It was hypothesized that AASs would not affect tendon tissue.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: This study included recreational athletes with current (female: n = 4; male: n = 18; total: n = 22) or former (female: n = 5; male: n = 7; total: n = 12) AAS abuse and nonusers (female: n = 5; male: n = 9; total: n = 14). The authors investigated the proportion of tendon injuries, PT cross-sectional area by magnetic resonance imaging, mechanical properties by ultrasound, gene expression levels of connective tissue proteins, and cell density by histological staining from tendon biopsy samples.

Results: The combined AAS group (both current and former abusers) reported a higher proportion of upper body tendon injuries compared with nonusers (79.4% vs 28.6%, respectively; P = .002). There was no difference in PT cross-sectional area (P = .918) or cell density (fascicular matrix: P = .413; interfascicular matrix: P = .982) between current AAS abusers, former AAS abusers, and nonusers. There was a greater expression of IGF-1 mRNA in current AAS abusers compared with nonusers (P = .043), but there were no group differences in other mRNA targets. Former AAS abusers had significantly higher tendon deformation (P = .030) and strain (P = .026) at common force compared with nonusers. There were no significant differences between male and female participants in the effect of AASs on tendon tissue.

Conclusion: These data show that the PT itself was not severely affected by AAS abuse.

Keywords: anabolic-androgenic steroids; doping; knee; patellar tendon; testosterone.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This project was financially supported by unrestricted grants from the Novo Nordisk Foundation (No. 0065138). The funding source had no role in the study design, study conduct, statistical analysis, or writing of the article or in any publication decisions. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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