Isotretinoin and Athletic Performance: Is There an Effect

Athletes who are prescribed isotretinoin often worry that the drug will ruin their training progress. The editorial team examined how isotretinoin affects muscles, joints, endurance, and recovery, why training loads should be moderated during a course, and what is known about its doping status.

Why This Question Concerns Athletes

Acne is a common problem among young athletes. Sweat, tight gear, helmets, and friction promote flare-ups, and in strength sports the use of androgens is often an additional factor. That is why isotretinoin, the most effective remedy for severe acne, frequently comes to the attention of athletes.

Along with it come questions: will the drug interfere with training, will it reduce strength, will it make injuries more frequent, and will it cause problems with doping control. Internet forums offer contradictory answers — from «you won't feel a thing» to «your muscles will stop growing».

The editorial team analyzed what is known from package inserts, clinical guidelines, and studies. Let us note right away: there is almost no dedicated research on the effect of isotretinoin on strength or endurance in trained people, so many conclusions rely on its side-effect profile.

So the discussion will not be about «improving results», but about how the drug may indirectly affect the training process.

Muscles, Joints, and Creatine Kinase

Among common adverse reactions, isotretinoin package inserts list muscle and joint pain and back pain. For people who train, these symptoms are especially noticeable: they can worsen the quality of sessions and recovery.

A separate aspect is creatine kinase. Isotretinoin can raise CK, and the highest values are usually recorded after intense physical exertion. Landau and colleagues described a series of patients with marked CK elevation, most of whom were involved in sports; in the vast majority this was not accompanied by clinical manifestations.

Despite their rarity, the literature also describes cases of rhabdomyolysis in patients on isotretinoin after excessive exertion. That is why the inserts advise caution regarding intense physical activity during a course.

With prolonged use at high doses, retinoids can affect bone tissue — hyperostosis and ligament calcification have been described. For standard acne treatment courses this risk is considered low, but bone and tendon pain should be discussed with a doctor.

Endurance, Thermoregulation, and Mucous Membranes

Isotretinoin suppresses the sebaceous glands but not the sweat glands, so no direct impairment of sweating is expected from it. However, general dryness of the skin and mucous membranes can affect comfort during prolonged exertion.

Dryness of the nasal mucosa promotes nosebleeds, and dryness of the lips and skin worsens irritation from friction with gear. For swimmers, chlorinated water, and for winter sports, cold and wind additionally damage dry skin.

Eye dryness makes wearing contact lenses uncomfortable, and the reduced night vision described in the inserts matters for athletes who train outdoors in the evening, such as runners and cyclists.

There is no direct evidence of reduced aerobic endurance or VO₂max under the influence of isotretinoin. A possible decline in results is more likely related to discomfort, pain, and the need to reduce training intensity.

Isotretinoin and Anabolic Steroids

In strength sports, some athletes turn to isotretinoin to cope with acne caused by androgens. Acne is a well-known side effect of anabolic steroids, described, in particular, in a scientific statement of the Endocrine Society.

Such a combination creates a double burden. Both androgens (especially oral 17α-alkylated ones) and isotretinoin affect the lipid profile and liver enzymes. Their simultaneous use amplifies these changes and complicates the interpretation of test results.

The editorial team provides no schemes for combining these substances and emphasizes: the safest way to eliminate steroid acne is to stop using androgens and consult a doctor. Self-prescribing isotretinoin on top of a pharmacological course multiplies the risks rather than correcting them.

There is also a widespread myth that isotretinoin «inhibits muscle growth». There is no direct evidence of this. The sense of reduced progress is most likely related to pain, forced reduction of loads, and general discomfort.

Doping Status and Organizing Training

Isotretinoin is not on the WADA Prohibited List, so its medical use does not require a therapeutic use exemption. However, athletes should inform the team doctor about all the drugs they take.

From a practical standpoint, the editorial team offers a few general principles worth discussing with a doctor:

• do not abruptly start a new, unfamiliar training program during a course;
• avoid excessive eccentric loads and high-volume training «to failure»;
• monitor hydration;
• in case of severe muscle pain and dark urine — seek medical help immediately;
• schedule tests after 2–3 days of lighter training.

For competitive athletes, it is sometimes advisable to plan a treatment course for the off-season, to minimize the impact on important competitions. Such a decision is made together with a dermatologist.

Female athletes should remember the mandatory pregnancy prevention program: the requirements for contraception and pregnancy tests do not depend on the sporting schedule.

Editorial Conclusions

Isotretinoin does not improve and, as far as is known, does not directly worsen strength or endurance, but it can affect training through muscle and joint pain, elevated CK, and dryness of the mucous membranes.

The main sporting risk is rhabdomyolysis under extreme loads, so intensity during a course should be moderated.

The drug is not banned by WADA, but combining it with anabolic steroids multiplies the risks to the liver and lipid metabolism.

We also recommend reading our materials on tests during isotretinoin use, on contraindications, and on the history of this drug.

References

1. U.S. Food and Drug Administration. Isotretinoin capsules: prescribing information and iPLEDGE REMS. Silver Spring (MD): FDA.
2. Landau M, Mesterman R, Ophir J, et al. Clinical significance of markedly elevated serum creatine kinase levels in patients with acne on isotretinoin. Acta Derm Venereol. 2001;81(5):350–352.
3. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162–169.
4. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.
5. 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):341–375.
6. World Anti-Doping Agency. World Anti-Doping Code International Standard: Prohibited List. Montreal: WADA; 2024.