Regression of Anabolic-Androgenic Steroid-Associated Cardiomyopathy Eight Years After Cessation of Anabolic-Androgenic Steroid Abuse: A Case Report and Literature Review

The non-medical use of anabolic-androgenic steroids (AAS) is widespread among strength-training athletes and, increasingly, among men who have no medical indication for testosterone therapy. The cardiotoxic profile of these drugs includes concentric myocardial hypertrophy, systolic and diastolic dysfunction, myocardial fibrosis and an elevated risk of sudden cardiac death. Whether AAS-associated cardiomyopathy is reversible once AAS are withdrawn remains unsettled: published outcomes range from near-complete recovery to irreversible severe biventricular dysfunction. Here we report the case of a man first assessed at the age of 26, after 33 cumulative months of supraphysiological AAS abuse, and reassessed eight years later. Marked regression of concentric left ventricular hypertrophy, with an accompanying reduction in right ventricular free wall thickness, was documented: left ventricular (LV) mass index fell from 261 to 111 g/m2 (57%), interventricular septal and posterior wall thickness decreased by 47% and 49%, and relative wall thickness fell from 0.86 to 0.43. The transmitral E/A ratio rose from 1.18 to 1.45. No cardiovascular pharmacotherapy was given at any stage of follow-up, which distinguishes this observation from previously published cases in which heart-failure-directed treatment was given concurrently.