Anabolic Steroids and the Silent Risk: Fulminant Heart Failure in a Woman After Therapeutic Nandrolone Use

Anabolic androgenic steroids (AAS) are synthetic derivatives of testosterone designed to enhance anabolic pathways while limiting androgenic effects and are prescribed for conditions such as male hypogonadism, chronic disease–associated cachexia, and age-related muscle loss (1). Nandrolone, a class II AAS, has low affinity for sex hormone–binding globulin and reduced androgenic activity, making it appealing for therapeutic use in women, particularly for bone health (2). However, AAS are linked to multiple adverse effects, including significant cardiovascular toxicity, with reports of biventricular hypertrophy and persistent ventricular dysfunction after discontinuation (2,3). Despite widespread prescribing, evidence regarding their safety remains limited.