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Do Anabolic Steroids Cause Acne?

Yes. Using Anabolic Steroids Dramatically Increases the Risk of Developing Acne, Including Severe Acne.

By: Dan Kern, Acne.org Founder & CSO
Last updated: May 07, 2020

The Essential Information

Using anabolic steroids, especially testosterone, is highly correlated with acne development. In other words, if you take anabolic steroids, your chances of developing acne on the face and the body, including severe and scarring acne, increase dramatically.

Why is this the case? Anabolic steroids increase the amount of skin oil produced in skin pores, and people with more skin oil tend to have more acne and more severe cases of acne

Abuse of steroids can cause other serious conditions as well, including liver damage and heart problems. They can also cause less serious, but still troubling and irreversible problems, such as gynecomastia (breast growth in men), balding, thickened skin, excessive body hair growth, and premature aging.

Because anabolic steroids can be damaging to the body and skin, they should be taken only under strict guidance from a medical professional, only when absolutely necessary, and for the shortest time possible. 

The Bottom Line - Don't Use Them: Using anabolic steroids means you are not only most likely going to develop acne, and potentially severe acne, you are also risking living with irreversible negative consequences for the rest of your life. If you want to look more muscular, consider a less damaging over-the-counter supplement that has been proven to work, such as creatine monohydrate (google it--you'll find tons of info on it, it works, and it's inexpensive). 

The Science

Steroid hormones naturally exist in the human body. They are responsible for important body processes that include the development of sex organs, as well as the formation of the immune and stress response.

Anabolic steroids, also called anabolic-androgenic steroids (AAS), are a subtype of male steroid hormones called androgen steroids. One common and familiar anabolic steroid is testosterone. Even though anabolic steroids are male hormones, they are also found in females at a much lower concentration. 

Anabolic steroids have two functions:

  1. Anabolic function: Grow the skeletal muscles. This is why athletes and bodybuilders sometimes abuse them for this purpose.
  2. Androgenic function: Promote male sex characteristics, such as hair growth, balding, thickened skin, and deeper voice.

While anabolic steroids naturally exist in the body, they can also be man-made and supplemented through either injecting into muscle tissue or swallowed orally.

Androgen (Testosterone)

Although doctors use anabolic steroids to treat a variety of health conditions, including delayed puberty, reduced sex drive, and the wasting of the body due to severe diseases like HIV/AIDS and cancer, anabolic steroid treatment can cause severe side effects, including, but not limited to, hormonal imbalances, breast growth in men, atrophy of the testicles, hypertension, liver damage, heart problems, hair loss, excessive hair growth, and skin problems like acne.1

How Anabolic Steroids Cause Acne

It is well-known that anabolic steroids directly cause acne, and anyone who takes anabolic steroids should be prepared for breakouts. Anabolic steroid-induced acne may be severe and may occur on the face as well as the body.

The reason anabolic steroids lead to acne is relatively simple. They increase the production of skin oil (sebum) in the pores of the skin. Increased sebum production normally leads to more acne.2

Acne Formation

Adding evidence to the connection between anabolic steroids and acne, other studies that have focused on castrated men who do not have androgen steroid hormones have found that due to a lack of androgen steroid hormones, castrated men "do not develop acne." However, scientists can observe acne in castrated men who receive testosterone replacement.2,3

How Steroid Use Affects Acne

The Evidence: Anabolic Steroids Cause Acne

The evidence that anabolic steroids lead to acne is strong:

  • One study found that people with naturally high levels of testosterone tend to notice more acne.4
  • Six studies showed that externally administered anabolic steroids also cause increased acne.5-10
  • One case report described a 22-year-old patient who developed very severe acne after AAS injections.11

Studies show that anabolic steroids increase acne

Expand to read details of studies

Journal of Clinical and Experimental Dermatology Research

A 1986 study published in the Journal of Clinical and Experimental Dermatology examined the blood steroid levels of 17 male and 42 female patients with and without acne. The researchers found that testosterone levels were 22.4% higher in acne patients compared to those of healthy individuals.4

The Journal of Clinical Endocrinology and Metabolism

A 1994 study published in The Journal of Clinical Endocrinology and Metabolism examined how a high dose of testosterone impacts behavior and physiology of healthy men. To perform this study, healthy men were injected with an abundance of testosterone once a week for 20 weeks. The researchers found that half of the 19 participants who took a high dose of testosterone developed acne, and the majority of the men who developed acne were younger and had a previous medical history of it.5

The New England Journal of Medicine

A 1996 study published in The New England Journal of Medicine examined how testosterone injections affected muscle growth and strength in men. For 10 weeks, 43 men received weekly injections of testosterone or a placebo. After study completion, the researchers found that 3 of the 21 participants who received testosterone developed acne during the study. The occurrence of acne was only 14%, which is the lowest incidence found among these studies.6

British Journal of Sports Medicine

A 1997 study published in the British Journal of Sports Medicine examined the side effects reported by 100 male anabolic steroid abusers. They found that the most common side effect was acne - 54% of the study participants experienced the skin condition.7

Journal der Deutschen Dermatologischen Gesellschaft

A 2007 study published in the JDDG examined the side effects reported by the 4339 anabolic steroid abusers who called an anti-doping hotline run by Huddinge University Hospital in Stockholm, Sweden. AAS abusers reported acne as the third most common side effect after aggression and depression, with an incidence rate of 18%.8

The Netherlands Journal of Medicine

A 2018 study published in The Netherlands Journal of Medicine investigated side effects in 180 strength athletes who visited an AAS clinic over a 6-year period. The average age of the athletes was 34 years. The researchers found that 96% of the athletes experienced side effects, with acne being the most common side effect. 38% of the athletes developed acne.9

Journal of Internal Medicine

A 2019 study published in the Journal of Internal Medicine looked at side effects among 545 males who tested positive for AAS in Danish fitness centers over a 13-year period. To determine how many of the males suffered from acne, the researchers checked a prescription database. They found that 27% of the AAS users had redeemed at least one prescription for treating acne. The researchers concluded that acne is about 2.3 times more common in males who use AAS than in males who do not.10

International Wound Journal

A case report published in 2010 in the International Wound Journal described a 22-year-old male bodybuilder who had been injecting AAS over the course of a year. The bodybuilder suffered from severe acne lesions on the chest, which had been getting progressively worse over the last 6 months.11

Side Effects of Anabolic Steroids

The following are the most common side effects from anabolic steroid use:8,12

Most Common Clinical Side Effects of Anabolic-androgenic Steroids

And here we can see what side effects anabolic steroid users report:

Ten Most Common Side Effects Reported by Anabolic Steroid Users in Sweden

The above side effects represent only some of the myriad of side effects that anabolic steroids may lead to.

Steroid Abuse Side Effects

The Bottom Line

Anabolic steroids, especially testosterone, are highly correlated with acne development. Additionally, abuse of steroids can cause other undesirable side effects like reduced testicular volume and breast growth in men. They can also cause serious conditions, including liver damage and heart problems. Anabolic steroids can be damaging to the body and skin and should be taken only under strict guidance from a medical professional.

References:

  1. Kuhn, C. Anabolic steroids. Recent Prog. Horm. Res. 57, 411 - 434 (2002). https://pdfs.semanticscholar.org/0bc1/fc3860260aed749952d7d0692f5d1dd79d42.pdf
  2. Degitz, K., Placzek, M., Borelli, C. & Plewig, G. Pathophysiology of acne. J. Dtsch. Dermatol. Ges. 5, 316 - 323 (2007). https://www.ncbi.nlm.nih.gov/pubmed/17376098
  3. Leyden, J. et al. A systemic type I 5 α-reductase inhibitor is ineffective in the treatment of acne vulgaris. J. Am. Acad. Dermatol. 50, 443 - 447 (2004). https://www.ncbi.nlm.nih.gov/pubmed/14988688
  4. Lawrence, D. Shaw, M. & Katz, M. Elevated free testosterone concentration in men and women with acne vulgaris. Clin. Exp. Dermatol. 11, 263 - 273 (1986). https://www.ncbi.nlm.nih.gov/pubmed/2943538
  5. Bagatell, C., Heiman, J. R., Matsumodo, A. M., Rivier, J. E. & Bremner, W. J. Metabolic and behavioral effects of high-dose, exogenous testosterone in healthy men. J. Clin. Endocrinol. Metabol. 79, 561 - 567 (1994). https://www.ncbi.nlm.nih.gov/pubmed/8045977
  6. Bhasin, S. et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. New Eng. J. Med. 335, 1 - 7 (1996). https://www.ncbi.nlm.nih.gov/pubmed/8637535
  7. Evans, N. Gym and tonic: a profile of 100 male steroid users. Br. J. Sports Med. 31, 53 - 58 (1997). https://www.ncbi.nlm.nih.gov/pubmed/9132214
  8. Melnik, B. Jansen, T. & Grabbe, S. Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J. Dtsch. Dermatol. Ges. 5, 110 - 117 (2007). https://www.ncbi.nlm.nih.gov/pubmed/17274777
  9. Smit, D. L. & de Ronde, W. Outpatient clinic for users of anabolic androgenic steroids: an overview. Neth. J. Med. 76, 167 (2018). https://www.ncbi.nlm.nih.gov/pubmed/29845939
  10. Horwitz, H., Andersen, J. T. & Dalhoff, K. P. Health consequences of androgenic anabolic steroid use. J. Intern. Med. 285, 333-340 (2019). https://www.ncbi.nlm.nih.gov/pubmed/30460728
  11. Voelcker, V., Sticherling, M. & Bauerschmitz, J. Severe ulcerated 'bodybuilding acne' caused by anabolic steroid use and exacerbated by isotretinoin. Int. Wound J. 7, 199-201 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20602651
  12. Hartgens, F. & Kuipers, H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 34, 513 - 554 (2014). https://www.ncbi.nlm.nih.gov/pubmed/15248788

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