Virilisation
Virilisation refers to the development of male characteristics following exposure to androgens. In women, changes in voice, clitoral enlargement and increased body hair growth have been reported in association with AAS. The regression of individual symptoms following discontinuation has not been adequately studied, and a safe exposure limit has not been established.
Auch bekannt als: Vermännlichung, Virilization, Klitorishypertrophie, Stimmvertiefung
What virilization means in the AAS context
Virilization refers to the appearance of masculinizing physical or functional signs when exposed to androgens. In the context considered here, we are talking about anabolic androgenic steroids, AAS for short. Voice changes, clitoral enlargement, and body hair growth have been reported in female AAS users in small, head-to-head studies.
The characters do not form a uniform pattern that runs at the same time. Voice, clitoris, body hair and menstruation were recorded using different study methods. Therefore, a single sign is not a reliable marker that other changes will also reverse.
Which signs have been described in female AAS users
A small cohort recruited through an anti-doping hotline included eight women. Five of them reported AAS-related side effects, including voice change, clitoral enlargement, and body hair growth. The median duration of use before health care contact was 58 weeks, with a range of 7 to 104 weeks. The dose was not reported; Multiple and concurrent use were recorded and a control group was missing. The results therefore support observed signs, but neither their frequency in the general public nor a dose-response relationship.
- Voice: Voice changes have been reported among users.
- Clitoris: Clitoris enlargement has been described as a clinical sign.
- Body hair: Increased body hair growth was observed.
In qualitative interviews with 16 current or former AAS-using women, a deeper voice was experienced as difficult to conceal. Clitoris enlargement was associated with shame and reduced self-esteem. The absence and return of menstruation were used by the respondents for self-monitoring. Changes in libido were discussed, but not recorded as a standardized objective marker of regression.
Why voice needs to be considered separately
A scoping review with 14 included papers examined cis women with therapeutic or off-label androgen exposure, including testosterone and AAS. Transdermal formulations showed minimal effects in the overview. Intramuscular testosterone injections, or AAS, were associated with deeper voices, voice instability, and other unwanted voice changes.
The exposures and studies were heterogeneous. There is no pooled incidence and no established safe exposure limit from which to derive a safe dose or time period.
What is known about regression after discontinuation
The qualitative reports describe a deeper voice and clitoral enlargement as masculinizing changes that are difficult to process and sometimes irreversible. However, the 16 interviews provide neither an incidence nor an objective regression rate. The return of menstruation does not prove that the voice, clitoris or body hair have also regressed.
A meta-analysis of 11 studies provides predominantly male endocrine recovery data. In the predominantly male data included, gonadotropins returned to baseline within 13 to 24 weeks after discontinuation. Serum testosterone remained reduced from baseline at 16 weeks; A weighted mean difference of -9.40 nmol/L with a 95% confidence interval of -14.38 to -4.42 nmol/L was reported.
These results concern male endocrine recovery endpoints. They do not demonstrate recovery of the female menstrual cycle, regression of voice, clitoral enlargement, body hair growth, or other clinical signs. A reliable classification of each individual character as reversible or irreversible is therefore not possible.
What dose, duration and route of administration say about the risk
The dose was not reported in the direct women's cohort. Multiple and concurrent use as well as the duration of use were recorded, but the small selected sample and the lack of a control group do not allow a reliable assignment to a single substance or dose.
The voice overview considered dose, duration and route of administration as possible influencing factors, but found heterogeneous exposures and no safe dose limit. The dose was also not standardized in the qualitative study with 16 women.
From these data, neither a reliable ranking of individual AAS according to virilization risk nor a quantified risk reduction through lower doses or supposedly milder substances can be derived.
Which can be practically deduced
New or increasing voice changes, clitoral enlargement or increased body hair should be classified professionally and not automatically treated as a temporary side effect. These signs have been observed in women, but the studies do not provide a reliable time threshold beyond which regression can be safely expected.
The return of menstruation is not a release signal for the regression of other signs of virilization. Conversely, no fixed recovery times for women can be derived from the predominantly male recovery data.
A defined early withdrawal window that reliably undoes individual characters has not been investigated. There is also no proven safe dose. Practical decisions should therefore not be based on the assumption that a lower dose or a different active ingredient eliminates the risk.
Which statements the studies do not bear
Direct primary data on female AAS users came from a cohort of eight women and qualitative interviews with 16 women. The voice overview, on the other hand, is a secondary scoping review with 14 papers included. The meta-analysis with 11 studies is also secondary evidence and is based predominantly on male data for the recovery endpoints. This describes observed clinical signs and certain patterns of voice change, but does not provide reliable frequency, individual prediction, substance-specific dose-response relationship or prognosis for regression.
There is a lack of standardized data for character-by-sign, prospective follow-up after discontinuation. In particular, it remains unclear whether menstruation, voice, clitoral changes and body hair regress independently of each other and over what period of time.
Sources
- Christou MA et al. Effects of Anabolic Androgenic Steroids on the Reproductive System of Athletes and Recreational Users: A Systematic Review and Meta-Analysis. Sports Med. 2017. PubMed
- Majeethia H et al. Voice Change as a Result of Androgen Supplementation in Cisgender Women: A Scoping Review. Laryngoscope. 2025. PubMed
- Börjesson A et al. Recruitment to doping and help-seeking behavior of eight female AAS users. Subst Abuse Treat Prev Policy. 2016. PubMed
- Havnes IA et al. Anabolic-androgenic steroid use among women - A qualitative study on experiences of masculinizing, gonadal and sexual effects. Int J Drug Policy. 2021. PubMed
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