Anabolic-androgenic steroids are synthetic versions of testosterone and related hormones. In medicine they have legitimate uses, from treating hormone deficiencies to helping some patients recover from serious weight loss. Outside medicine, they are used to build muscle, increase strength or change appearance, often at amounts far higher than the body would ever produce on its own. Studies estimate that millions of people worldwide have used them at some point, and most are not professional athletes but ordinary gym-goers.
This guide gives an evidence-based overview of the health risks linked to anabolic steroids, the warning signs that need urgent attention, and why medical guidance matters so much. It is educational only and does not describe how to use any substance.
Why the risks are often underestimated
Many of the most serious effects of anabolic steroids develop silently. Cholesterol changes, rising blood pressure, thickening of the heart muscle and suppressed fertility usually cause no obvious symptoms at first. People may feel stronger, more energetic and more confident while damage is building underneath. By the time symptoms appear, some changes are harder to reverse. This gap between how someone feels and what is happening inside the body is one of the main reasons the risks are underestimated.
Heart and blood vessels
Cardiovascular effects are among the most serious risks and are a leading focus of medical research on steroid use. Effects described in studies include:
- Unfavourable cholesterol changes. HDL ("good") cholesterol often falls sharply while LDL ("bad") cholesterol can rise, a combination linked to faster build-up of plaque in the arteries.
- High blood pressure, which strains the heart and blood vessels over time.
- Thickening of the heart muscle (left ventricular hypertrophy) and, in long-term users, reduced pumping function. Imaging studies have found weaker heart function in many long-term users compared with non-users.
- Thicker blood. Steroids increase red blood cell production. A high hematocrit makes the blood more viscous and is linked to a higher risk of clots.
- Heart rhythm problems, heart attack and stroke, including reported cases in young adults with no other obvious risk factors.
Some of these changes may improve after stopping, but research suggests that heart muscle and artery changes can persist for years in some former long-term users.
Liver
The liver processes all steroids, but oral compounds that are chemically altered to survive digestion (known as 17-alpha-alkylated steroids) put it under the most strain. Reported problems include raised liver enzymes, cholestasis (blocked bile flow causing jaundice and itching), peliosis hepatis (blood-filled cysts that can rupture), and liver tumours, mainly with long-term use. Combining steroids with alcohol or other medicines that affect the liver increases the load further.
Hormones and fertility
The body tightly controls its own testosterone production. When steroids are taken, the brain detects high hormone levels and switches off the signals (LH and FSH) that tell the testes to work. As a result:
- Natural testosterone production falls, often to very low levels.
- The testes can shrink.
- Sperm production can drop sharply or stop completely, causing infertility.
After stopping, the body has to restart its own production. This can take months, and in some people it takes much longer or does not fully recover, a condition sometimes called anabolic steroid-induced hypogonadism. During this period, people can experience low mood, fatigue, low libido and erectile problems, which can push some to start using steroids again.
Breast tissue growth in men
Some steroids convert into estrogen, and others act on progesterone receptors. Either route can cause gynecomastia: the growth of breast gland tissue in men. It may start as tenderness or a small lump under the nipple. While early changes can sometimes settle, established gland tissue often does not go away on its own and may require surgery to remove.
Risks for women
Women are particularly vulnerable to the masculinising (virilizing) effects of anabolic steroids, even at low amounts. These include a deeper voice, growth of facial and body hair, male-pattern hair loss, enlargement of the clitoris, and changes to or loss of menstrual periods. Several of these effects, especially voice changes, can be permanent even after stopping. Steroids must never be used during pregnancy because they can harm a developing baby.
Risks for teenagers
In adolescents who are still growing, steroids can cause the growth plates in the bones to close early, permanently limiting final adult height. Teenagers are also more vulnerable to the hormonal and psychological effects, and early use is linked to a higher risk of continued use and other substance use later in life.
Mental health and dependence
Steroids can affect mood and behaviour. Reported effects include irritability, aggression, mood swings, anxiety and, in some people, symptoms of mania during use. When use stops and hormone levels crash, depression can follow, and in severe cases this has been linked to suicidal thoughts.
Anabolic steroids can also cause dependence. Research suggests that a substantial share of regular users, often estimated at around 30 percent, develop a dependence pattern: continuing despite harm, needing more to get the same effect, and struggling to stop because of withdrawal symptoms or fear of losing muscle. Body image concerns such as muscle dysmorphia, where someone sees themselves as too small despite being muscular, often play a role.
Skin, hair and kidneys
Acne, especially on the back and shoulders, oily skin and stretch marks are common. People genetically prone to baldness may lose hair faster, because some steroids act strongly in the scalp. Kidney problems, including damage to the kidney's filtering units, have been reported in long-term, high-dose users, sometimes alongside very high-protein diets and other supplements.
Tendons, joints and sleep
Muscle can grow and strengthen faster than the tendons that attach it to bone. Tendon tears and ruptures, particularly of the biceps, triceps and chest tendons, have been reported more often in steroid users, typically during heavy lifting. These injuries often need surgery and long rehabilitation.
Steroids can also worsen obstructive sleep apnoea, a condition where breathing repeatedly stops during sleep. Untreated sleep apnoea raises blood pressure and adds further strain to the heart, compounding the cardiovascular risks described above. Loud snoring, gasping at night and daytime sleepiness are signs worth raising with a doctor.
Who faces higher risk
Some people are more likely to be seriously harmed. This includes anyone with existing heart disease, high blood pressure, high cholesterol, liver or kidney disease, diabetes, a history of blood clots, or a personal or family history of hormone-sensitive cancers. People with a history of depression, anxiety or eating disorders face a higher risk of psychological effects. Using several substances at once, using high amounts, or using for long periods without breaks also increases risk.
Injection-related harms
Many steroids are injected, and injecting carries its own risks:
- Bacterial infections and abscesses, particularly with non-sterile products.
- Nerve and muscle injury from injecting in the wrong place.
- Oil entering a blood vessel and travelling to the lungs, causing coughing and breathlessness.
- HIV, hepatitis B and hepatitis C if needles, syringes or vials are shared.
Counterfeit and contaminated products
A large share of steroids sold outside regulated pharmacies are counterfeit. Laboratory analyses of seized products have found wrong ingredients, wrong strengths, no active ingredient at all, and contamination with bacteria or other substances. This means a person may be taking something completely different from what they think, at an unknown strength, which makes every other risk on this page harder to predict.
Combining substances and medicines
Risks rise when steroids are combined with other substances, such as other hormones, stimulants, diuretics or alcohol. Steroids can also interact with prescribed medicines. For example, they can increase the effect of blood thinners such as warfarin, raising the risk of bleeding, and they can change blood sugar control in people with diabetes. Anyone taking regular medication should be honest with their doctor or pharmacist about any steroid use.
Myths about "safe" use
- "I feel fine, so I must be fine." Many effects, including cholesterol, blood pressure and heart changes, cause no symptoms until they are advanced.
- "Short courses are harmless." Hormone suppression and cholesterol changes can begin within weeks.
- "Professional athletes use them, so they must be manageable." Elite athletes have suffered heart attacks, strokes and early deaths linked to steroid use.
- "Branded packaging means a genuine product." Counterfeiters routinely copy well-known brands.
Warning signs that need urgent medical attention
Seek emergency help or contact a doctor straight away if you experience:
- Chest pain, pressure or tightness, or a racing or irregular heartbeat.
- Sudden shortness of breath or coughing after an injection.
- Weakness or numbness on one side of the body, slurred speech or a drooping face.
- Pain, swelling and warmth in one leg, which can signal a blood clot.
- Yellowing of the skin or eyes, dark urine or severe abdominal pain.
- A severe or sudden headache, or very high blood pressure readings.
- Redness, heat, swelling or pus at an injection site, especially with fever.
- Thoughts of harming yourself or others.
Why medical guidance matters
When hormones are prescribed for a genuine medical reason, treatment comes with checks designed to catch problems early. Doctors typically look at:
- Blood pressure.
- A full blood count, including hematocrit.
- Cholesterol and other blood fats.
- Liver and kidney function.
- Hormone levels, and in older men, prostate health.
For anyone who is already using steroids, being open with a doctor is one of the most important steps they can take. Doctors are there to protect health, not to judge, and accurate information leads to safer care. In many countries, specialised harm-reduction and needle-exchange services also offer confidential advice, testing and support.
Stopping and recovery
People who want to stop should talk to a doctor first. Stopping can bring a period of low hormone levels with symptoms such as fatigue, low mood and low libido. A doctor can monitor recovery, check whether the body's own hormone production is returning, look out for depression, and offer treatment or referral where needed. Psychological support can also help, particularly where body image or dependence is part of the picture.
Legal and sporting consequences
Anabolic steroids are controlled substances or prescription-only medicines in most countries. In the United States they are Schedule III controlled substances, and in the United Kingdom they are Class C drugs. Supplying them illegally can lead to serious penalties. In sport, they are banned at all times by the World Anti-Doping Agency, and positive tests can lead to long competition bans.
Key takeaways
- Many steroid risks, especially to the heart, cholesterol and fertility, develop silently before symptoms appear.
- Serious risks include heart disease, stroke, liver damage, infertility, mental health effects and dependence.
- Women and teenagers face additional, sometimes permanent effects.
- Injections and counterfeit products add further dangers.
- Medical guidance, honest conversations and regular check-ups are the best way to reduce harm.
This article is for general information only and does not replace advice from a qualified healthcare professional. If you are worried about your health or any substance use, please speak with your doctor or a local support service.