The female body produces testosterone in amounts approximately ten or more times smaller than the male body. Therefore, even a moderate, from a man's point of view, an increase in the level of androgens for a woman means a supraphysiological exposure. The most characteristic consequence is virilisation, that is, the development of male sexual characteristics. The editors explain how and in what sequence this happens and which changes remain forever.
Androgens in the female body
Testosterone is not a purely "male" hormone. In women, it is produced by the ovaries and adrenal glands, and some is formed in peripheral tissues from precursors such as androstenedione and DHEA. It takes part in maintaining libido, bone and muscle mass, affects mood and energy.
At the same time, the normal level of testosterone in women is very low compared to men's, and the female body is tuned to such concentrations. Androgen receptors in the skin, hair follicles, larynx, genitals respond to the hormone in the same way as in men, so an excess of androgens triggers the same processes that occur in boys during puberty.
Natural conditions with an excess of androgens, such as polycystic ovary syndrome or androgen-secreting tumours, are well known to physicians. Their manifestations - acne, hirsutism, cycle disorders - give an idea of how the female body reacts to the growth of androgens. Testosterone enanthate at doses used in sports produces significantly higher levels than most such diseases.
It is also important that testosterone enanthate aromatizes into oestradiol, and the female hormonal cycle is very sensitive to external signals. Exogenous androgens suppress gonadotropins, disrupt ovulation and change the balance of oestrogens and progesterone, which affects the menstrual cycle and fertility.
What is virilisation
Virilisation is the development of female characteristics characteristic of a male organism under the influence of androgens. It differs from simple hirsutism (excessive male pattern hair growth) in that it includes changes in the voice, genitals, body structure, and other signs.
- Skin: increased oiliness, acne.
- Hair: facial and body hair growth, male pattern baldness.
- Voice: lowering of timbre, coarsening, loss of upper range.
- Genital organs: enlargement of the clitoris, atrophy of the vaginal mucosa.
- Cycle: irregular menstruation up to amenorrhea.
- Body: increase in muscle mass, redistribution of fat, reduction of mammary glands.
The rate of appearance of these changes depends on the dose and duration of exposure. The most detailed data on the sequence of changes in medical conditions come from masculinizing hormone therapy for transgender men. The guidelines of the Endocrine Society (Hembree et al., 2017) indicate the estimated time of onset of effects at therapeutic doses of testosterone.
Editor's note: these terms refer to controlled medical therapy to achieve male hormone levels. In a sports context, women who do not seek masculinization often rely on "small" doses. However, individual sensitivity is extremely different, and the first signs, in particular changes in the voice, may appear imperceptibly.
Reversible and irreversible changes
The most critical point for women is that some of the changes do not disappear after the withdrawal of the drug. The most famous example is the voice. Androgens cause thickening and lengthening of the vocal folds, and this structural remodeling of the larynx usually does not return to its original state after withdrawal. For singers, teachers, announcers, this can mean professional consequences.
Clitoris enlargement, facial hair growth (follicles that have entered the terminal hair stage continue to produce hair) and androgenic alopecia are also often irreversible. Symptoms can be reduced only by cosmetic or surgical methods, such as laser hair removal.
| Change | Reversibility after stopping | Comment |
|---|---|---|
| Acne, oily skin | Usually reversible | May leave scars |
| Menstrual cycle disturbance | Usually reversible | Recovery may take months |
| Deepening of the voice | Mostly irreversible | Structural changes of the larynx |
| Enlargement of the clitoris | Mostly irreversible | â |
| Growth of facial hair | Often irreversible | Hair removal required |
| Male pattern baldness | Often irreversible | Depends on heredity |
Historical evidence supports these risks. Based on declassified documents, Franke and Berendonk (1997) described a state doping program in the GDR in which female athletes, including minors, were given androgens without their knowledge. Many of them faced virilisation, some of the changes remained for life.
A small early study by Strauss et al. (1985) among women who participated in strength sports and used anabolic steroids also recorded decreased voice pitch, increased facial hair growth, irregular cycles, and clitoral enlargement; some of the participants considered these changes undesirable.
Other risks for women
In addition to virilisation, women experience the same systemic risks as men: a decrease in HDL, an increase in blood pressure and haematocrit, negative effects on the liver when combined with oral drugs. The relative magnitude of these changes may be greater for women due to lower baseline androgen levels.
Reproductive function also suffers. Androgens suppress ovulation, causing irregular cycles or amenorrhea. The use of testosterone during pregnancy is contraindicated: androgens cross the placenta and can cause virilisation of the female fetus, which is indicated in the official instructions for testosterone preparations.
Gruber and Pope (2000), studying women who used anabolic steroids, found a high frequency of psychiatric problems: dependence on steroids, muscle dysmorphia, use of other psychoactive substances. The desire for an "ideal body" can be combined with disturbances in the perception of one's own body.
Finally, it is worth remembering the anti-doping rules. Testosterone and its esters belong to Class S1 "Anabolic Agents" on the WADA Prohibited List and are prohibited for female athletes at any time, both in-competition and out-of-competition.
Medical use of testosterone in women
In medicine, testosterone in women is used in very narrow situations. The Global Consensus Position on Testosterone Therapy in Women (Davis et al., 2019) recognizes hypoactive sexual desire disorder in postmenopausal women as the only indication with a sufficient evidence base—and only at doses that return levels to the physiological range for women.
This consensus emphasizes that drugs designed for men, including injectable testosterone esters, are not suitable for women because they do not allow women to maintain low levels of the hormone. Testosterone enanthate injections create supraphysiological concentrations for women even in small doses.
Another medical situation is masculinizing hormone therapy for transgender men, where the development of male characteristics is the goal of treatment. It is carried out according to separate protocols under the supervision of an endocrinologist with regular monitoring of haematocrit, lipids and other indicators.
Outside of these situations, the use of testosterone enanthate by women has no medical justification. The desire to improve athletic performance or appearance does not outweigh the risk of irreversible changes.
Editorial conclusions
For the female body, injectable testosterone enanthate creates concentrations of androgens many times higher than physiological ones. This triggers virilisation — the development of male sexual characteristics.
Some of the changes, primarily a lowering of the voice, enlargement of the clitoris, growth of facial hair, and baldness, often remain permanent even after the drug is discontinued.
Cycle disorders, fertility, cardiovascular and psychological risks are added to virilisation. Medical use of testosterone in women is possible only in clearly defined situations and with other medicinal forms and doses.
The editors also recommend our materials on the complete list of side effects of testosterone enanthate, on its mechanism of action and on the history of the creation of this drug.
List of used literature
- Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869â3903.
- Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660â4666.
- 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.
- Gruber AJ, Pope HG Jr. Psychiatric and medical effects of anabolic-androgenic steroid use in women. Psychother Psychosom. 2000;69(1):19â26.
- 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.
- World Anti-Doping Agency. The World Anti-Doping Code: International Standard â Prohibited List. Montreal: WADA; акÑÑалÑна ÑедакÑÑÑ.
