Anabolic steroid use and ischaemic stroke in a young fitness enthusiast

Anabolic steroid use and ischaemic stroke in a young fitness enthusiast / James Choulerton, Nishan Guha, Rebecca Squires. - (BMJ Case Reports 14 (2021) 2 (4 February))

  • PMID: 33542023
  • PMCID: PMC7868212 (available on 2023-02-04)
  • DOI: 10.1136/bcr-2020-234241


We report a case of ischaemic stroke in a 34-year-old male recreational bodybuilder following a 3-month period of anabolic androgenic steroid (AAS) use and 1-month period of 'post-cycle therapy' (tamoxifen and clomiphene citrate), the latter treatments aimed at restoring normal endogenous testosterone production after initial AAS use. We hypothesise a transient drug-related prothrombotic state with paradoxical embolisation via an atrial septal defect which was later found on bubble echocardiogram. We highlight a rare but important cause of stroke in younger patients which is relevant given the increasing use of AAS misuse among casual fitness enthusiasts. We explore the various possible mechanisms by which AAS use can increase ischaemic stroke risk in such patients.


Case report
4 February 2021
Choulerton, James
Guha, Nishan
Squires, Rebecca
United Kingdom
Other organisations
John Radcliffe Hospital (JR)
Royal United Hospitals Bath NHS Foundation Trust
Doping classes
S1. Anabolic Agents
S4. Hormone And Metabolic Modulators
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Cardiovascular diseases
Health effects
Gym/fitness environment
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Date generated
18 March 2021
Date of last modification
20 March 2021
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