Women in fitness and strength sports are increasingly being offered "light" oral steroids. Metandienone is clearly not one of these: it is a powerful androgen, and for the female body, the consequences of its use can be lifelong. The editors explain what virilization is, why it develops and what changes cannot be reversed.
Why the female body is especially sensitive
In a healthy woman, the level of testosterone in the blood is about ten to twenty times lower than in a man. Androgen receptors are also present in the same tissues: in the skin, hair follicles, larynx, genitals, muscles and brain. Therefore, even a moderate additional androgen load for a woman means exceeding her physiological level several times.
Metandienone is a drug with both anabolic and androgenic properties. The ratio of these effects, obtained in old experiments on animals, does not translate directly to humans. In practice, this means that it is impossible to "build muscle" without androgenic changes: the same receptors mediate both types of effects.
An additional factor is aromatization. Part of metandienone is converted into stable estrogen 17α-methylestradiol. For a woman, this means simultaneous interference with both androgenic and estrogenic regulation, which dramatically disrupts the work of the hypothalamic-pituitary-ovarian axis.
Finally, oral 17α-alkylated steroids are hepatotoxic regardless of gender. Women are not "protected" from cholestasis or lipid profile disorders — these risks are added to those specific to women.
What is virilization and how it develops
Virilization is the acquisition by a woman of features typical of a male phenotype under the influence of an excess of androgens. In clinical endocrinology, this term is used, for example, for androgen-secreting tumors of the ovaries or adrenal glands. The use of anabolic steroids reproduces the same picture artificially.
Changes develop gradually, and the first ones are easy to miss or write off as training. Speed and severity depend on dose, duration, individual sensitivity of receptors and genetics. However, no "low dose" guarantees their absence.
| Manifestation | Early signs | Reversibility |
|---|---|---|
| Skin | Oily skin, acne | Usually reversed |
| Menstrual cycle | Irregularity, amenorrhea | Often reversible, but not always fast |
| Body and facial hair (hirsutism) | Hair growth above the lip, on the chin | Often persistent |
| Hair on head | Thinning, baldness | Often irreversible |
| Voice | Hoarseness, narrowing of the range | As a rule, irreversible |
| Clitoris | Enlargement (clitoromegaly) | As a rule, irreversible |
Early signs that women should look out for include a hoarse or "broken" voice, irregular periods, sudden onset of acne, growth of dark facial hair, increased libido, or unusual aggressiveness. These are signals that the androgen load is already affecting the tissues.
The danger is that by the time a person recognizes the changes as obvious, some of them are already fixed. That is why in medical practice, androgens are prescribed to women only with clear indications and with careful monitoring.
Irreversible changes
The most famous irreversible change is the coarsening of the voice. Under the influence of androgens, the vocal folds thicken, their mass and tissue structure change. After the withdrawal of the drug, this process does not go back, since we are talking about structural changes in the tissue, and not about swelling.
For people whose profession is related to the voice - teachers, singers, announcers - this can have serious social and professional consequences. Speech therapy correction can partially help to adapt, but does not return the original timbre.
Enlargement of the clitoris also, as a rule, does not regress after stopping the intake. Androgenic male pattern baldness in genetically predisposed women can progress even after withdrawal, since the follicles have already undergone miniaturization.
The psychological impact of these changes is often underestimated. Changes in voice, appearance, and body affect self-identity, relationships, and quality of life. Studies of female users of anabolic steroids describe that some of them regret their use precisely because of the irreversible changes.
Cycle, fertility and pregnancy
An excess of androgens and artificial estrogens disrupts the pulsatile secretion of gonadotropins. The result is irregular cycles, anovulation or complete absence of periods. This is not only an inconvenience: prolonged amenorrhea is associated with bone metabolism disorders and hormonal imbalance.
After discontinuation, the cycle in many women resumes, but this process can last months, and in some cases requires examination and treatment by a gynecologist-endocrinologist. It is impossible to predict an individual response in advance.
The use of androgens during pregnancy is especially dangerous. Anabolic steroids are contraindicated in pregnant women, as they may cause masculinization of a female fetus. A woman may not know about pregnancy in the first weeks, when the sexual differentiation of the fetal organs occurs.
It is also important to remember that androgens pass into breast milk, and the safety of metandienone during lactation has not been studied. Any hormonal drugs during this period can be taken only at the discretion of the doctor.
- Disruption of the menstrual cycle up to amenorrhea.
- Anovulation and decreased fertility.
- Risk of fetal masculinization during pregnancy.
- Lack of safety data during lactation.
Historical lessons and modern data
The most documented example of the large-scale influence of androgens on female athletes is the state doping program of the GDR. Franke and Berendonk, based on declassified documents, described how girls and women were systematically given oral anabolic steroids (mainly Oral Turinabol), often without their knowledge. Consequences include virilization, impaired reproductive health, and other long-term problems.
A small but often cited survey by Strauss et al. (1985) of women who trained with weights and used steroids described a deepening of the voice, increased facial hair growth, enlarged clitoris, and irregular cycles—the very effects discussed in this article.
A contemporary review by Huang and Basaria (2018) concludes that androgens do improve athletic performance in women, but at the cost of androgenic side effects, some of which are irreversible. The authors emphasize the lack of quality safety studies specifically in the female population.
None of these sources support the notion of "female" or "safe" doses of metandienone. The drug is included in the Prohibited List of WADA for all athletes regardless of gender.
Editorial conclusions
For women, metandienone is a drug with a high risk of virilization. The effect is due to the fact that any significant androgen load is many times higher than the female physiological level.
Some of the changes, including voice hoarseness and clitoromegaly, are usually irreversible. In addition, the menstrual cycle, fertility and liver suffer, and during pregnancy there is a risk for the fetus.
Historical and current data agree: there is no safe "female" regimen for this drug.
We recommend that you also read our articles on the history of metandienone, its estrogenic activity and analyzes that reflect the main risks.
List of used literature
- Huang G, Basaria S. Do anabolic-androgenic steroids have performance-enhancing effects in female athletes? Mol Cell Endocrinol. 2018;464:56â64.
- Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem. 1997;43(7):1262â1279.
- Strauss RH, Liggett MT, Lanese RR. Anabolic steroid use and perceived effects in ten weight-trained women athletes. JAMA. 1985;253(19):2871â2873.
- Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341â375.
- Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. 2008;154(3):502â521.
- World Anti-Doping Agency. Prohibited List. Montreal: WADA; акÑÑалÑна ÑедакÑÑÑ.
