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For decades, the class of anabolic androgenic steroids has represented the mostfrequently detected doping agents in athletes’ urine samples. Roughly50% of all adverse analytical findings per year can be attributed toanabolic androgenic steroids, of which about 2/3 are synthetic exogenoussteroids, where a qualitative analytical approach is sufficient for routinedoping controls. For the remaining 1/3 of findings, caused by endogenoussteroid-derived analytical test results, a more sophisticated quantitativeapproach is required, as their sheer presence in urine cannot be directly linkedto an illicit administration. Here, the determination of urinary concentrationsand concentration ratios proved to be a suitable tool to identify abnormalsteroid profiles. Due to the large inter-individual variability of bothconcentrations and ratios, population-based thresholds demonstrated to be oflimited practicability, leading to the introduction of the steroidal module ofthe Athlete Biological Passport. The passport enabled the generation ofathlete-specific individual reference ranges for steroid profile parameters.Besides an increase in sensitivity, several other aspects like samplesubstitution or numerous confounding factors affecting the steroid profile areaddressed by the Athlete Biological Passport-based approach. This narrativereview provides a comprehensive overview on current prospects, supportingprofessionals in sports drug testing and steroid physiology.

Current Insights into the Steroidal Module of the Athlete Biological Passport