Imaging cerebral circulation in long-term anabolic-androgenic steroid users and non-using weightlifters

Background: Anabolic-androgenic steroids (AAS) are commonly used by recreational weightlifters for performance enhancement, despite associated health risks, including cardiovascular and brain effects. This study investigates the cerebrovascular effects of prolonged AAS use in male weightlifters, focusing on cerebral blood flow (CBF) and other indicators of cerebrovascular health. Methods: Eighty-six males were included, with 41 current consumers of AAS and 45 non-using weightlifting controls. Cerebrovascular health was evaluated using magnetic resonance imaging (MRI) pseudo-continuous arterial spin labeling (PCASL) derivatives to measure CBF and spatial coefficient of variation (sCoV) of CBF in gray matter. Additionally, MRI T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences were used to analyze white matter hyperintensities as a marker of small-vessel disease. Results: AAS consumers had significantly higher sCoV than weightlifting controls (p = 0.001). Further, sCoV in total gray matter correlated with testosterone/epitestosterone ratio and total years of AAS use. No significant differences were found in CBF or white matter hyperintensity volume. Conclusion: These findings indicate that long-term AAS use may impact cerebrovascular health, evidenced by increased sCoV. Although cerebral perfusion was unaffected, elevated sCoV suggest that AAS use may pose a risk for cerebrovascular pathology later in life.