Women and Steroids: Side Effects and Dangers
Naturally, the introduction of male hormones into the female body at supraphysiological levels for the purpose of bodybuilding, physique, and performance enhancement raises numerous concerns considering the natural female physiology. The female physiology in its natural state is not developed or ideal for such a hormonal environment, and there are some valid concerns and potential side effects associated with such a state. Side effects for females can be even more pronounced and more rapid than with male anabolic steroid users, and there are some additional unique concerns with females that are not present in males, such as the issue of female endocrine physiology in general, female-specific function of sex organs, menstrual cycle issues, and the possibility of birth defects if anabolic steroids are used during pregnancy.
Anabolic steroid use during pregnancy is an unequivocal ‘no-no’ for females, as the use of androgenic anabolic steroids during this crucial developmental period can and will result in defects and abnormalities in the developing fetus, particularly virilization of the unborn child. This includes clitoromegaly (growth of the clitoris) in a female fetus, as well as pseudohermaphroditism (the simultaneous development of male and female sex organs in the fetus). The use (or even direct contact) with anabolic steroid products of any type should be avoided at all costs by pregnant females. Birth defects as a result of male anabolic steroid use (a man fathering a child) are not possible, but the use of anabolic steroids by pregnant women is directly linked to birth defects in unborn children.
Dysphonia (Deepening of the Voice)
As androgens are responsible for the male secondary sex characteristics, the development of a deeper voice is one of them. Androgen receptors exist in the tissues of the larynx and muscles involved in the vocal function of humans. High or prolonged exposure to androgenic anabolic steroids are what cause this change into a deeper voice in males during puberty and adulthood, and the same cause is true for those females who engage in excessive or chronic anabolic steroid use. Females are not naturally exposed to this magnitude of androgen exposure, and therefore do not develop these vocal changes naturally. The introduction of exogenous androgenic anabolic steroids, however, can cause this side effect to manifest in women who use anabolic steroids. This side effect is, of course, dose and duration dependent, and is normally slow to manifest with early warning symptoms. The first of these is a noticeable cracking and hoarsening of the voice. These changes are normally identical to the same changes in pubescent males. If anabolic steroid use is not halted, the progress of these changes can be such that a distinct male-like voice in terms of pitch and tone can fully develop.
Anabolic steroids that are much stronger androgens are indeed higher-risk compounds in terms of this side effect, as the stronger androgenic nature can cause a much more rapid manifestation of dysphonia than those anabolic steroids that are not as strong in the area of androgenicity. Examples of strong androgenic compounds include Testosterone, Dianabol (Methandrostenolone), Trenbolone, Fluoxymesterone, and other similar strength compounds that can induce these rapid changes in vocal physiology   . This is not to say that ‘mild’ anabolic steroids that exhibit lower androgenic strength ratings cannot produce the same side effect, however, as studies have demonstrated that with long enough exposure, anabolic steroids such as Anavar (Oxandrolone) and Deca-Durabolin (Nandrolone Decanoate) have produced dysphonia in women even when administered at therapeutic dosages and in medical settings . The cessation of all anabolic steroid use immediately upon first sign of symptoms should ensure that no further developments of this side effect occur. Most dysphonic changes prior to a certain point can revert, though it should be noted quite clearly that some vocal changes may be permanent, especially as the development of dysphonia progresses beyond a particular stage.
Clitoral Enlargement (Clitoromegaly)
The sex organs of males and females are developmentally related in many ways, and so they share the same responses to hormonal activity in the body. In this situation, clitoromegaly is characterized by the growth of the clitoris, even though male and female sex organs differentiate during development in the womb. Female sex organs are still very responsive into adulthood to androgenic hormones, and a dramatic rise in androgen levels via exogenous sources or otherwise can result in the enlargement of the clitoris. Being quite closely related to the male penis, the clitoris can eventually enlarge to the point where it resembles a penis and can even exhibit similar characteristics at that point (such as enlargement during sexual arousal).
As with all side effects, such development is dependent on the strength of the androgen used, the dosage, and duration of use. The effect of all of these factors should be very obvious to any reader: the stronger the androgen, the higher the dosage, and the longer the duration of use will provide enough hormonal stimulation to the clitoral tissues that significant and rapid clitoral hypertrophy (growth of the clitoris) can result. Once again, stronger androgens such as Testosterone, Trenbolone, Dianabol, etc. are likely to provide significant and rapid hormonal stimulation compared to anabolic steroids that are much milder in terms of androgenic strength, such as Anavar, Primoboloan, Nandrolone, etc. Clitoromegaly can progress from very minor almost unnoticeable growth to excessive enlargement of the clitoris when androgen levels in women remain high enough for long enough periods of time to facilitate this growth. Just as with dysphonia (deepening of the voice), changes in clitoral size are reversible prior to a certain point, provided anabolic steroid use is immediately halted upon notice of the first signs and symptoms. However, if left carelessly, growth can become more and more pronounced as anabolic steroid use continues until such point that clitoral growth and development achieves an irreversible stage, after which the only possibility of reversal rests with surgical reconstruction.
Increased Bodily and Facial Hair Growth (Hirsutism)
Hirsutism is characterized by the growth of bodily and facial hair identical to that seen in males (male-pattern hair growth). As with all side effects related to female anabolic steroid use, the intensity and rapidity of this side effect often begins with minor signs and symptoms, and is of course dependent on the strength of the androgenic anabolic steroid used, the dosage, and duration of use. As time progresses during anabolic steroid use, hirsutism can eventually result in more coarse and thick hair growth in undesirable areas on the female body. After a certain point in development, hair removal might be necessary. Other methods of prevention are available, such as the use of topical androgen blockers and other similar products.
Menstrual Cycle Disruptions and Irregularities (Amenorrhea)
The use of anabolic steroids in women can disrupt the menstrual cycle and temporarily interrupt fertility as well. This is naturally due to the disruption of endocrine balance as it relates to androgens and estrogens in the body. Menstrual cycles can end up being intermittent, absent, or very infrequent. Upon cessation of anabolic steroid use, the menstrual cycle should return to normal, though some females might require several months before the menstrual cycle is restored, and others might experience a very fast rebound to normal function.
Breast Size Reduction
Many anabolic androgenic steroids are anti-estrogenic in and of themselves, with some (such as Masteron) expressing direct anti-estrogenic effects in the body. As such, the interaction with receptor sites, enzymes, and other functions that involve Estrogen can result in a reduction in breast tissue and glandular size. Some anabolic steroids have in fact been utilized exclusively in the treatment of female breast cancer, Masteron (Drostanolone) being one of them. With excessive androgen levels and/or the use of very strong androgens, significant tissue remodeling can occur.
Post Cycle Therapy for Women: To Do or Not to Do?
To date there has been no documented or published research conducted on the use of PCT agents on females for the purpose of restoring normal hormone function following a female anabolic steroid cycle. Anecdotal evidence tells us that very few females within the anabolic steroid using community engage in PCT protocols following the conclusion of anabolic steroid cycles. Logic should also tell us that females should not require PCT protocols, as the purpose of a PCT protocol is done so as to restore the HPTA (hypothalamic pituitary testicular axis) in male anabolic steroid users. It stands to reason that females do not possess testicles, and do not have any requirement for the restoration of Testosterone levels to any levels above a bare minimum trace after an anabolic steroid cycle. PCT medications such as Tamoxifen (Nolvadex), Clomiphene (Clomid), HCG (human chorionic gonadotropin), Arimidex (Anastrozole), Aromasin (Exemestane), and the whole plethora of other related compounds were originally developed and used to fight female breast cancer. While mostly beneficial for males in the restoration of the HPTA, there is not only no need for females to use these compounds, but the use of these compounds can and will result in a further disruption of normal hormonal function and many of them are also associated with a significant number of detrimental, uncomfortable, and inconvenient side effects in females.
Thus, female anabolic steroid users should steer absolutely clear of all traditional PCT compounds unless specifically prescribed by a physician. While some of these medications can aid in promoting fertility in females (such as HCG and Clomid, for example), they pose very tricky issues with the female endocrine physiology and should therefore be administered under the supervision of a qualified physician. Otherwise, female endocrine function should restore and normalize itself naturally without assistance in due time following the cessation of an anabolic steroid cycle. The lack of need for a PCT component is one particular advantage that female anabolic steroid users have over males. Although there are reports of some females within the anabolic steroid community engaging in PCT protocols following their cycles, there is no empirical evidence to support this, and these individuals might possibly be further complicating recovery efforts by utilizing these compounds. Until studies and such clinical evidence surfaces, conventional logic and what we know about the female endocrine physiology dictates that females should steer clear of the aforementioned PCT compounds.
 Baker J. 1999. A report on alterations to the speaking and singing voices of four women following hormone therapy with virilizing agents. J Voice. 13(4):196-507.
 Vuorenkoski V, Lenko HL, Tjernlund P, Vuorenkoski L, Perheentupa J. 1978. Fundamental voice frequency during normal and abnormal growth, and after androgen treatment. Arch Dis Child. 53(3):201-209.
 Acchiardo SR, Black WD. 1977. Fluoxymesterone therapy in anemia of patients on maintenance hemodialysis: comparison between patients with kidneys and anephric patients. J Dial. 1(4):357-366.
 Abdallah RT, Simon JA. 2007. Testosterone therapy in women: its role in the management of hypoactive sexual desire disorder. Int J Impot Res. 19(5):458-463. Epub 2007 Jun 21.
 Sorgo W, Zachmann M. 1982. Virilization caused by methandrostenolone-containing cream in 2 prepubertal girls. Helv Pardiatr Acta. 37(4):401-406.
 Andersson-Wallgren Gm Albertsson-Wikland K. 1994. Change in speaking fundamental frequency in hormone-treated patients with Turner’s syndrome – a longitudinal study of four cases. Acta Paediatr. 83(4):452-455.
 Gerritsma EJ, Brocaar MP, Hakkesteegt MM, Birkenhager JC. 1994. Virilization of the voice in post-menopausal women due to the anabolic steroid nandrolone decanoate (Decadurabolin). The effects of medication for one ear. Clin Otolaryngol Allied Sci. 19(1):79-84.
 Alper Aktas. 2004. Idiopathic isolated clitoromegaly: A report of two cases. Reproductive Health. 1:4.
 Slagter M, Gooren L. 2006. Effects of long-term androgen administration on breast tissue of female-to-male transsexuals. J Histochem Cytochem. 54(8):905-910.