Effect of real-world androgen abuse on body composition: a prospective cohort study

CONTEXT: Androgens are widely abused by recreational athletes to improve physique, yet the durability of body composition changes after cycle cessation is poorly characterized in prospective studies. OBJECTIVE: To assess changes in body composition during and after self-initiated androgen cycles. DESIGN: Prospective cohort study conducted between 2022 and 2024 with follow-up from baseline through three months after androgen cycle cessation. SETTING: General community. PARTICIPANTS: Seventy-nine adult men (median age 30 years) planning a self-initiated androgen cycle. INTERVENTION(S): No study-assigned intervention. Self-initiated androgen abuse cycle with a median duration of 10 weeks and median weekly dose of 600 mg. MAIN OUTCOME MEASURE: Changes in total body weight, fat-free mass, and fat mass measured by dual-frequency bioelectrical impedance analysis at baseline (T0), during the cycle (T1), and three months after cessation (T2). RESULTS: From T0 to T1, body weight increased by 4.9 kg (95% CI, 3.9-5.9) and fat-free mass by 4.4 kg (95% CI, 3.7-5.1; both p<.001). At T2, gains were markedly attenuated, with mean retention of 1.6 kg body weight (95% CI, 0.5-2.6) and 1.2 kg fat-free mass (95% CI, 0.4-2.0; both p<.001). Similar patterns were observed in intermittent and continuous androgen abusers. Fat mass remained unchanged at all time points. CONCLUSION: Real-world androgen cycles produce marked short-term increases in fat-free mass, but most gains are lost within months after cessation. These findings challenge the assumption that androgen abuse results in substantial durable improvements in body composition and contextualize the magnitude of the desired effects of androgen abuse relative to its well-documented health risks.