Published March 30, 2025 | Version v1
Journal article Open

ADVERSE EFFECTS OF TRENBOLONE: A STRUCTURED REVIEW OF CASE REPORTS IN HUMANS

Creators

  • 1. Department of Specialization in Clinical Anabolism College of Governance, Engineering, and Education of São Paulo - FGE-SP, Brazil.
  • 2. Chairman of the Brazilian Society of Endocrinology and Metabolism in Sports and Exercise.
  • 3. President of the Brazilian Society of Endocrinology and Metabolism in Sports and Exercise.

Abstract

Introduction: Trenbolone is a potent anabolic steroid widely used in bodybuilding, despite its lack of approval for human use. Reports of adverse effects have increased, but systematic data on its health risks remain limited. This study aims to systematically review documented adverse effects of trenbolone in humans through published case reports. Methods: A structured review of case reports was conducted using PubMed, EMBASE, and CENTRAL databases, including studies up to 2024. The search strategy utilized Medical Subject Headings (MeSH) terms related to trenbolone. Inclusion criteria encompassed reports of adverse effects in humans with documented trenbolone use, while experimental studies, animal models, and reviews without original case data were excluded. Extracted data included patient demographics, trenbolone dosage, administration patterns, clinical presentation, toxicological findings, and affected organ systems. Results: A total of 23 case reports met the inclusion criteria. The most frequently reported complications involved the cardiovascular system (heart failure, myocardial infarction, ischemic stroke), hepatic system (cholestatic liver injury, hepatitis), renal system (nephropathy, acute kidney injury), and neuropsychiatric effects (psychosis, aggression, delirium). Most cases involved young male users, with trenbolone frequently sourced from unregulated markets. Toxicological confirmation was reported in only a minority of cases, complicating causality assessment. Conclusion: Trenbolone use is associated with severe health risks, particularly affecting the cardiovascular, hepatic, renal, and neuropsychiatric systems. The absence of clinical studies on its safety, along with widespread unregulated use, hinders risk assessment and patient management. Healthcare professionals should recognize potential adverse effects, promoting early detection and harm reduction. Further research is needed to clarify trenbolone’s long-term impact on human health.

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References

  • 1. Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol, 2008 Jun; 154(3): 502-21. doi: 10.1038/bjp.2008.165.
  • 2. Llewellyn W. Anabolics 11th Edition, Editor Molecular Nutrition, 2017. ISBN-13: 978-0-9990621-0-4.
  • 3. Neumann F. Pharmacological and endocrinological studies on anabolic agents. Environ Qual Saf Suppl., 1976; 5: 253-64. PMID: 782871.
  • 4. Borecki R, Byczkiewicz P, Słowikowska-Hilczer J. Impact of trenbolone on selected organs. Endokrynol Pol., 2024; 75(3): 267-278. doi: 10.5603/ep.99130.
  • 5. Piatkowski T, Gibbs N, Neumann D, Dunn M. Consuming 'God Juice': Using 'ethnopharmacological-connoisseurship' to situate trenbolone use and knowledge among image and performance enhancing drug communities. Drug Alcohol Rev., 2024 Oct 21. doi: 10.1111/dar.13965.
  • 6. Higgins JP, Thomas J, Chandler J, editors. Cochrane handbook for systematic reviews of interventions. Version 6.2. Cochrane; 2021. https://training.cochrane.org/handbook Available.
  • 7. Christopoulos P, Katsanoulas C, Timplalexi G, Lathyris D, Vasiliagkou S, Antoniadou E. Wernicke's encephalopathy and anabolic steroid drug abuse. Is there any possible relation? Hippokratia, 2012 Oct; 16(4): 371-2.
  • 8. Kang G, Lakshminarasimhan V, Christopher L, Michael Q, Staffetti, Joseph S, Dilip G., Trenbolone-Induced Liver Injury. The American Journal of Gastroenterology, October 2019; 114(x): S1327, | DOI: 10.14309/01.ajg.0000599092.90929.6e
  • 9. Kraus SL, Emmert S, Schön MP, Haenssle HA. The dark side of beauty: acne fulminans induced by anabolic steroids in a male bodybuilder. Arch Dermatol, 2012 Oct; 148(10): 1210-2. doi: 10.1001/archdermatol.2012.855.
  • 10. Colburn S, Childers WK, Chacon A, Swailes A, Ahmed FM, Sahi R. The cost of seeking an edge: Recurrent renal infarction in setting of recreational use of anabolic steroids. Ann Med Surg (Lond), 2017 Jan 12; 14: 25-28. doi: 10.1016/j.amsu.2017.01.015.
  • 11. Gheddar L, Pélissier AL, Desfeux J, Niort F, Raul JS, Kintz P. Testing for Trenbolone, an Anabolic Steroid, in Biological Fluids and Head Hair in a Post-Mortem Case. J Anal Toxicol, 2021 Aug 19: bkab091. doi: 10.1093/jat/bkab091.
  • 12. Flores E, Damon F, Bashar A, Pedro P, Ishaan V, Melchor D. p. 2259 Severely Jaundiced Body Builder: A Case of Acute Cholestatic Syndrome With Anabolic Androgenic Steroid Use. Am J Gastroenterolog, October 2019; 114(x): S1264. | DOI: 10.14309/01.ajg.0000598568.04804.a3
  • 13. El Khoury C, Sabbouh T, Farhat H, Ferzli A. Severe Cholestasis and Bile Cast Nephropathy Induced by Anabolic Steroids Successfully Treated with Plasma Exchange. Case Rep Med, 2017; 2017: 4296474. doi: 10.1155/2017/4296474.
  • 14. Gnanapandithan K, Karthik N, Singh A. Rhabdomyolysis and Acute Kidney Injury Associated with Anabolic Steroid Use. Am J Med., 2019 Aug; 132(8): e652-e653. doi: 10.1016/j.amjmed.2019.02.052.
  • 15. LoBue SA, Goldman A, Giovane RA, Carlson SM, Bivona M, Albear S, et al. Recurrent Herpes Zoster Ophthalmicus Preceded by Anabolic Steroids and High-Dose L-Arginine. Case Rep Ophthalmol Med, 2020 Dec 28; 2020: 8861892. doi: 10.1155/2020/8861892.
  • 16. Geraci MJ, Cole M, Davis P. New onset diabetes associated with bovine growth hormone and testosterone abuse in a young body builder. Hum Exp Toxicol, 2011 Dec; 30(12): 2007-12. doi: 10.1177/0960327111408152.
  • 17. Kintz P, Gheddar L, Blanchot A, Ameline A, Raul JS. In a Case of Death Involving Steroids, Hair Testing is More Informative than Blood or Urine Testing. J Anal Toxicol, 2021 Sep 17; 45(8): 829-834. doi: 10.1093/jat/bkab048.
  • 18. Lehmann S, Thomas A, Schiwy-Bochat KH, Geyer H, Thevis M, Glenewinkel F, et al. Death after misuse of anabolic substances (clenbuterol, stanozolol and metandienone). Forensic Sci Int., 2019 Oct; 303: 109925. doi: 10.1016/j.forsciint.2019.109925.
  • 19. Anand JS, Chodorowski Z, Hajduk A, Waldman W. Cholestasis induced by parabolan successfully treated with the molecular adsorbent recirculating system. ASAIO J., 2006 Jan-Feb; 52(1): 117-8. doi: 10.1097/01.mat.0000196712.32953.21.
  • 20. Friedman O, Arad E, Ben Amotz O. Body Builder's Nightmare: Black Market Steroid Injection Gone Wrong: a Case Report. Plast Reconstr Surg Glob Open, 2016 Sep 29; 4(9): e1040. doi: 10.1097/GOX.0000000000001040.
  • 21. Khoodoruth MAS, Khan AA. Anabolic steroids-induced delirium: A case report. Medicine (Baltimore), 2020 Aug 14; 99(33): e21639. doi: 10.1097/MD.0000000000021639.
  • 22. Aknouche F, Gheddar L, Kernalléguen A, Maruejouls C, Kintz P. Anabolic steroids and extreme violence: a case of murder after chronic intake and under acute influence of metandienone and trenbolone. Int J Legal Med, 2021 Jul; 135(4): 1449-1453. doi: 10.1007/s00414-021-02587-y.
  • 23. Bispo M, Valente A, Maldonado R, Palma R, Glória H, Nóbrega J, et al. Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder. World J Gastroenterol, 2009 Jun 21; 15(23): 2920-2. doi: 10.3748/wjg.15.2920.
  • 24. Kumar V, Issa D, Smallfield G, Bouhaidar D. Acute pancreatitis secondary to the use of the anabolic steroid trenbolone acetate. Clin Toxicol (Phila), 2019 Jan; 57(1): 60-62. doi: 10.1080/15563650.2018.1491983.
  • 25. Boks MN, Tiebosch AT, van der Waaij LA. A jaundiced bodybuilder Cholestatic hepatitis as side effect of injectable anabolic-androgenic steroids. J Sports Sci., 2017 Nov; 35(22): 2262-2264. doi: 10.1080/02640414.2016.1265659.
  • 26. Shahsavari Nia K, Rahmani F, Ebrahimi Bakhtavar H, Hashemi Aghdam Y, Balafar M. A Young Man with Myocardial Infarction due to Trenbolone Acetate; a Case Report. Emerg (Tehran), 2014 Winter; 2(1): 43-5. Doi:10.22037/emergency.v2i1.5586
  • 27. Bey C, Abdelghaffar W, Ach T, Haloui N, Bouzid MI, Rafrafi R. A case of acute psychosis triggered by anabolic steroid abuse (trenbolone). Therapie, 2023 Nov-Dec; 78(6): 775-778. doi: 10.1016/j.therap.2023.04.001.
  • 28. Gheddar L, Blanchot A, Ameline A, Arbouche N, Raul JS, Kintz P. The Power of Keratinous Matrices (Head Hair, Body Hair and Nail Clippings) Analysis in a Case of Death Involving Anabolic Agents. J Anal Toxicol, 2023 Jan 24; 46(9): e307-e313. doi: 10.1093/jat/bkac101. PMID: 36516229.
  • 29. Choulerton J, Guha N, Squires R. Anabolic steroid use and ischaemic stroke in a young fitness enthusiast. BMJ Case Rep., 2021 Feb 4; 14(2): e234241. doi: 10.1136/bcr-2020-234241.
  • 30. Câmara LC, Viana DP. Cardiovascular Risks of Trenbolone Abuse: Emerging Evidence. Cardiol. Angiol. Int. J., 2025; 14: 16-19. Doi: 10.9734/ca/2025/v14i1467
  • 31. Windfeld-Mathiasen J, Heerfordt IM, Dalhoff KP, Trærup Andersen J, Andersen MA, Johansson KS, Biering-Sørensen T, Olsen FJ, Horwitz H. Cardiovascular Disease in Anabolic Androgenic Steroid Users. Circulation, 2025 Feb 13. doi: 10.1161/CIRCULATIONAHA.124.071117.
  • 32. Zelleroth S, Nylander E, Örtenblad A, Stam F, Nyberg F, Grönbladh A, Hallberg M. Structurally different anabolic androgenic steroids reduce neurite outgrowth and neuronal viability in primary rat cortical cell cultures. J Steroid Biochem Mol Biol, 2021 Jun; 210: 105863. doi: 10.1016/j.jsbmb.2021.105863.
  • 33. Shahidi NT. A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids. Clin Ther, 2001 Sep; 23(9): 1355-90. doi: 10.1016/s0149-2918(01)80114-4.
  • 34. Piatkowski T, De Andrade D, Neumann D, Tisdale C, Dunn M. Examining the association between trenbolone, psychological distress, and aggression among males who use anabolic-androgenic steroids. Int J Drug Policy, 2024 Dec; 134: 104636. doi: 10.1016/j.drugpo.2024.104636.
  • 35. Robles-Diaz M, Gonzalez-Jimenez A, Medina-Caliz I, Stephens C, García-Cortes M, García-Muñoz B, et al; Spanish DILI Registry; SLatinDILI Network. Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids. Aliment Pharmacol Ther, 2015 Jan; 41(1): 116-25. doi: 10.1111/apt.13023.
  • 36. Al Awadhi H, Al Qassimi S, Akhras A, Herlitz L, Ghosn M. Bile acid nephropathy induced by anabolic steroids: A case report and review of the literature. Clin Nephrol Case Stud, 2021 Nov 9; 9: 123-129. doi: 10.5414/CNCS110711.
  • 37. Câmara LC. Anabolic Androgenic Steroids from Underground Market: Drug Quality and Implications for Research. Asian J. Res. Med. Pharm. Sci., 2023; 12: 59-64. Doi:10.9734/AJRIMPS/2023/v12i3221
  • 38. Bonnecaze AK, O'Connor T, Burns CA. Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review. J Gen Intern Med., 2021 Jul; 36(7): 2055-2064. doi: 10.1007/s11606-021-06751-3.
  • 39. Piatkowski T, Ayurzana L, King M, Hattingh L, McMillan S. Community pharmacy's role in dispensing androgens and supporting harm reduction amid current policy dilemmas. Subst Abuse Treat Prev Policy, 2025 Jan 18; 20(1): 2. doi: 10.1186/s13011-025-00636-y.
  • 40. Camara LC, Freire MF. (185) Medical Knowledge and prejudice from the perspective of androgenic anabolic steroids users. J Sex Med, 2024; 21(6): qdae161.147. doi: 10.1093/jsxmed/qdae161.147.