Abstract
BACKGROUND: Recreational anabolic-androgenic steroid (AAS) use is common among noncompetitive adults and is strongly associated with increased cardiovascular risk. CASE SUMMARY: A 34-year-old professional dancer presented with 1 month of progressive dyspnea on exertion and orthopnea in the setting of testosterone use. Transthoracic echocardiogram revealed a left ventricular (LV) ejection fraction of 16%, global LV hypokinesis, and LV dilation. He was diagnosed with nonischemic cardiomyopathy, initiated on diuresis and guideline-directed medical therapy, and counseled on avoidance of testosterone. DISCUSSION: AAS users have a significantly higher incidence of acute myocardial infarction, coronary intervention, venous thromboembolism, arrhythmia, and heart failure compared with matched control patients. Although some markers of cardiac function recover after cessation, others remain impaired. TAKE-HOME MESSAGES: AAS use is common among adult recreational athletes and is an underrecognized cause of LV dysfunction and heart failure. Early recognition, diagnosis, and cessation of AAS can significantly improve cardiac function and at least partially reverse AAS-associated cardiotoxicities.