From Gym to Ban List: How Testosterone Contaminates Sports Nutrition

Adulteration of dietary supplements with testosterone and anabolic steroids poses major risks to athletes, affecting performance integrity, and anti-doping outcomes.

Highlights:

Hidden testosterone and steroid adulteration in supplements threatens athletes’ health and careers
Modern detection uses advanced mass spectrometry and isotope analysis to expose doping
Education, certified products, and biological fingerprint testing are key to preventing unintentional doping

Undeclared testosterone and anabolic steroid contamination in dietary supplements is putting athletes at risk of unintentional doping, health complications, and career damage. In Nutrients, authors reviewed evidence showing widespread supplement adulteration, detailed patterns of non-medical steroid use, discussed detection technologies and masking strategies, and suggested protective measures for athletes and clinicians ().

Surveys across multiple sports reveal that many so-called performance supplements contain undisclosed pharmacologically active ingredients that can transform a clean test result into a positive one.

Athletes often use supplements to fill nutritional gaps, aid recovery, or gain a legal edge, especially during heavy training. However, these products may be contaminated or intentionally spiked with testosterone analogs and prohormones, offering faster results than nutrition alone.

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TOP INSIGHT

Did You Know?
Some performance boosters secretly contain anabolic agents such as #testosterone, turning everyday supplements into potential doping traps for #athletes worldwide. #anabolicsteroids #sportsnutrition #medindia

Unseen Contaminants in Performance Supplements

Evidence cited in the review showed contamination in as many as half of the analyzed products, emphasizing how extensive this problem has become. The consequences reach beyond bans and damaged reputations, as users can experience liver stress, disrupted lipids, mood disturbances, and hormonal suppression. The fallout extends to families and teams, calling for stronger screening, wiser choices, and routine verification to prevent inadvertent doping.

This narrative review explored two major scenarios, athletes unknowingly consuming tainted supplements and those intentionally manipulating biology to cheat. It outlined testosterone synthesis from cholesterol, key metabolites used in anti-doping testing, and analytical methods used to detect abuse.

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Mapping Testosterone Metabolism and Detection

The evidence base included systematic reviews, original research, case studies, and World Anti-Doping Agency (WADA) documentation. It focused mainly on urine analysis and emerging hair detection methods, although WADA has not yet validated hair testing for official use. Chromatography and mass spectrometry remain the cornerstone of analytical techniques.

Protein-based dietary supplements are heavily marketed for visible muscle and strength changes. Because natural nutrition yields gradual results, some producers unlawfully add anabolic steroids or prohormones to achieve faster, more striking outcomes and attract consumer attention.

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Undeclared Steroids and False Safety Perceptions

Product labels often omit these illicit ingredients, leaving athletes vulnerable to penalties if test results come back positive. The availability of such supplements over the counter can also create a misleading sense of safety.

Personal losses, such as sanctions and income reduction, accompany medical complications including liver damage, acne, hormonal imbalance, and lipid disturbances, collectively eroding public confidence in fair competition.

In real-world misuse, anabolic steroids are rarely taken according to medical guidelines. “Cycling” alternates several weeks of high-dose use with breaks; “blast and cruise” maintains smaller doses between cycles; and “stacking” mixes multiple agents to amplify results.

Post-cycle regimens frequently include human chorionic gonadotropin, aromatase inhibitors, and antiestrogens to restore hormonal function and minimize estrogen-related side effects. Psychological factors such as perfectionism, social pressure, and strong athletic identity further fuel misuse.

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Advanced Technologies for Detecting Steroid Abuse

Modern detection relies on combining gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry, supported by isotope ratio mass spectrometry. The steroidal module of the Athlete Biological Passport tracks urinary levels of testosterone, epitestosterone, androsterone, etiocholanolone, and other metabolites, alongside key ratios such as the testosterone to epitestosterone ratio. Isotope analysis differentiates natural from synthetic steroids by carbon isotope patterns, increasing the accuracy of detection.

Offenders often use masking agents to alter profiles. Dehydroepiandrosterone and dihydrotestosterone modify metabolite pathways without changing testosterone ratios significantly, while estradiol co-administration can normalize these ratios.

Masking Tactics and Manipulated Test Profiles

Luteinizing hormone and human chorionic gonadotropin stimulate internal testosterone production, disguising external intake. Finasteride and dutasteride alter metabolic pathways, and aromatase inhibitors limit conversion to estradiol, reducing signs such as gynecomastia.

Agents like probenecid reduce urinary steroid levels, while diuretics dilute samples. Certain antifungal drugs inhibit steroid formation, affecting hormone ratios. Hence, effective screening now targets multiple metabolites and masking compounds simultaneously.

To safeguard honest athletes, every supplement should be treated as a potential exposure. Choosing certified batches tested for banned substances, avoiding high-risk or imported blends, and maintaining photographic records of labels and lot numbers are essential.

Preventive Strategies for Athletes and Clinicians

Before key competitions, athletes are advised to confirm a clean list of supplements with their medical and nutrition teams. If new products are required, pre-use testing using advanced tools such as capillary electrophoresis, ultra-high-performance liquid chromatography with quadrupole time-of-flight mass spectrometry, or surface-enhanced Raman spectroscopy can reveal adulteration.

Education on strict liability and awareness of physical signs like acne, mood swings, and libido changes are vital. Since psychological factors often precede risky supplement or steroid use, mental health support should be integrated into athlete care programs.

Evolving Detection Methods in Anti-Doping Science

Because masking strategies evolve faster than conventional tests, detection is becoming multi-layered. Hair testing can capture long-term use, although not yet recognized by WADA for steroids.

Emerging microRNA biomarkers of organ stress could identify steroid exposure through biological fingerprints difficult to hide. Genotype-informed panels and combined urine-blood analyses promise greater accuracy and fewer false negatives. The review emphasizes that expanding analytical diversity, including GC-MS, LC-MS, and IR-MS and integrating broader biomarker sets are critical for closing loopholes.

In conclusion, adulterated dietary supplements can transform compliant athletes into accused violators, while deliberate users exploit hormonal manipulation and masking to evade detection. The way forward combines comprehensive education, responsible sourcing, and advanced laboratory screening across multiple metabolites and isotope signatures.

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