Anabolic steroids are illegal if not prescribed by a medical doctor. Simple possession without a prescription can lead to up to a year in prison and at least 1000 USD fine, according to the DEA.
Besides, their use without medical supervision hides serious health risks.
In this article, we will reveal the current scientific evidence on the dangers and side-effects of anabolic steroids.
What Do Anabolic Steroids Cause?
Anabolic steroids are human-made derivates of the male sex hormone – testosterone (T).
They were initially developed for their medicinal uses such as testosterone replacement therapy (TRT) and muscle-sparing after surgeries, infections, cancer, etc.
However, these medications also possess powerful anabolic effects on muscle tissue coupled with catabolic effects on fat tissue.
In doses, much higher than therapeutic ones, they can have dramatic effects on improving physical performance, increasing muscle mass, and burning body fat. Despite the benefits, they can have serious negative long-term and short-term health effects.
Anabolic Steroids Short Term Effects
The proper name for anabolic steroids is anabolic-androgenic steroids (AAS). This name describes their main effects: anabolic and androgenic.
The androgenic effects of testosterone are the ones stimulating the development of male sexual characteristics. They are mediated by a direct effect on the androgen receptor in various tissues.
The prostate, skin, liver, and sebaceous glands also possess 5α-reductase activity which transforms T into dihydrotestosterone (DHT) with many times higher androgenic activity .
Generally, this is an undesired effect because it shifts the effect of the AAS from anabolic to androgenic and increases the risk for side-effects. Such side-effects include:
- prostate enlargement
- severe acne
- oily skin
- suppressed natural testosterone production leading to infertility and impotence
These effects are usually short-term but, in some cases, they can persist long after AAS use has been discontinued.
AAS can also get aromatized to estradiol by enzymes synthesized in fat tissue and lead to feminizing side effects. This effect is also highly undesired as it can lead to water retention, gynoid-type obesity, and gynecomastia.
Gynecomastia is the enlargement of the mammary glands in men. Albeit the negative cosmetic effects, it also increases the risk of breast cancer in men.
Long-term Negative Effects of Anabolic Steroids
The most dangerous long-term side effects after prolonged AAS use are increased risk of heart attack or stroke and liver or kidney failure.
The increased risk of heart attack is related to several pathogenic mechanisms including:
- Worsened lipid profile (increased LDL and decreased HDL)
- Increased blood clotting
- Left ventricular hypertrophy
Studies have found cellular pathologies in the heart similar to cases of cardiomyopathy and heart failure .
AAS in humans has been associated with hypertension, myocardial infarction, and sudden cardiac death. The elevated cardiovascular risk persists long after steroid use has been discontinued.
Liver failure is typically associated with oral AAS because to be orally active and resistant to liver metabolism they are modified into 17-α derivates .
17-α AAS can cause liver damage via a few different mechanisms including acute cholestatic syndrome (bland cholestasis), chronic vascular injury to the liver, and hepatic tumors.
Tumor occurrence has also been associated with unmodified and esterified testosterone preparations.
Are Anabolic Steroids Addictive?
Anabolic steroids can be addictive as some people keep misusing them even after they have developed severe adverse effects.
Cases of AAS addiction are especially common amongst people with bigorexia. This is an anxiety disorder also called muscle dysmorphia .
The people affected have unrealistic beliefs that they are too skinny and small, not muscular enough or not lean enough, despite this not being the reality.
If the AAS usage is suddenly discontinued this can also lead to withdrawal symptoms such as:
- Lower sex drive
- Suicidal thoughts
What Are the Types of Anabolic Steroids?
Depending on what they are used for by athletes, anabolic steroids can be classified into 3 main categories: building muscle, losing fat, or enhancing performance. In reality, all anabolic steroids possess various ratios of all 3 effects.
Another classification is determined by their route of administration – by mouth or by intramuscular injection. This also plays a role in their metabolism and typical health risks.
Below we have listed anabolic steroids examples with their specific side effects. The AAS examples are in no particular order.
Side Effects of Anabolic Steroids Pills
Winstrol (Stanozolol, Stromba)
This is one of the most popular anabolic steroid pills. It has been used in human and veterinary medicine.
The most common side effects include suppression of natural testosterone production in men, virilization in women, and liver toxicity.
There are cases of liver adenoma turning malignant after the use of Winstrol .
Winstrol is already 5α-reduced so it has lower androgenic activity compared to testosterone or DHT. Thus, it affects skin, hair, or prostate to a lesser extent.
Because of it, it’s also non-aromatizable so it doesn’t turn into estrogen and there is no risk of water retention of gynecomastia.
Still, it can lead to hypogonadism, impotence, and infertility.
These anabolic steroid pills were never used in the medical practice and they were never approved by the FDA as safe.
Apart from the severe liver toxicity it also leads to the typical side effects of AAS including acne, hair loss, gynecomastia, impotence, infertility, etc.
The substance is FDA approved for certain medical conditions. However, the large doses typically used to improve physique and performance by athletes can lead to liver toxicity .
It also leads to androgenic effects in sensitive tissues such as acne, hair loss, gynecomastia, and masculinization in women.
This one is no longer used in medical practice. It has both estrogenic effects such as gynecomastia and androgenic effects, such as acne, hair loss, and increased body hair growth .
The occurrence of steroid-induced liver injury has been reported even in cases of medical use which involved only moderate doses .
This is one of the first synthetic anabolic steroid pills developed and it is still used in medicine for patients with delayed puberty or menopausal symptoms.
However, some of the common side effects include liver toxicity resulting in jaundice and cholestatic hepatitis .
Metandren can also cause estrogenic and androgenic effects such as gynecomastia, acne, hair loss, etc.
Health Risks of Injectable Steroids
Testosterone and its esters
Testosterone and its many esters (testosterone undecanoate, testosterone enanthate, testosterone cypionate, testosterone propionate – Omnadren) are legal when prescribed by a medical doctor.
Testosterone is FDA approved for specific indications , such as:
- hormonal issues (delayed puberty or hypogonadism)
- specific types of anemia
- muscle wasting due to cancer, AIDS, surgeries, burns, radiation, etc.
- hereditary angioedema
Testosterone is also the oldest and most popular anabolic steroid used as a performance-enhancing drug. However, it possesses all the typical side effects which are common for most of the AAS.
They include acne, hair loss, increased facial and body hair, oily skin, etc. and suppression of the natural testosterone production which causes hypogonadism and infertility. Testosterone is actively aromatized which leads to estrogenic effects such as gynecomastia and water retention.
Even when administered as a TRT in medical conditions and lower doses, studies show that it significantly increases the risk of myocardial infarction .
This is partially related to the negative effect of testosterone on the lipid profile and HDL levels . Other large cohort studies also confirm the increased risk of heart attacks and stroke due to TRT .
Testosterone can also increase the growth of cancer in patients with prostate carcinoma .
This one was never intended for humans in the first place. It is used in veterinary medicine to promote muscle growth in cattle.
Apart from the powerful anabolic effects, Trenbolone also has a strong androgenic activity . It is about 3-5 times more androgenic than testosterone.
This causes side-effects such as acne, hair loss, increased facial and body hair, oily skin, etc. It also suppresses natural testosterone production which leads to hypogonadism.
Besides, it possesses a potent progestogenic effect as well so despite the lack of estrogenic activity gynecomastia is still possible.
Trenbolone also has one of the most dramatic effects on the lipid profile, significantly reducing HDL and increasing LDL. It is one of the most taxing steroids for the cardiovascular system .
Tren can also cause typical “tren cough” but the mechanism of occurrence is still unknown.
Nandrolone (19-nortestosterone) and its esters Durabolin & Decadurabolin
Nandrolone esters are used in medicine for the treatment of anemia and cachexia, as well as menopausal symptoms in women.
It has weaker androgenic effects and strong anabolic effects. Nandrolone esters resist aromatization so they do not have estrogenic side-effects .
However, serious long-term effects such as cardiovascular toxicity, hypogonadism, and infertility are possible. It was found to significantly lower HDL . Cases of erectile dysfunction have also been reported.
Side Effects of Anabolic Steroids in Females
The main side effect in women is called virilization . This is a condition when a female develops typical male characteristics, such as deepened voice and facial hair.
The side-effects of AAS use in women include:
- hirsutism – facial hair growth and excess body hair
- decreased breast size
- enlarged clitoris
- severe acne
- deepened voice
- changes in sex drive
- problems with periods
- hair loss and male-pattern baldness
Even the “female” steroids such as Anavar (Oxandrolon) who have very weak androgenic effects can still cause various degrees of virilization .
Women can also suffer from an increased incidence of thrombosis and cardiovascular diseases similarly to men. If used on children and adolescents, AAS can lead to stunted growth.
The Take-Home Message
Anabolic steroids can dramatically enhance athletic performance and improve body composition.
However, they carry serious risks of side effects, even when used in a controlled environment and under medical supervision.
If you’d like to increase your testosterone levels naturally, make sure to check out our article on testosterone booster foods, lifestyle changes, and supplements.
If you think you might have an addiction to steroids, make sure to see your GP, who will redirect you to trained counselors that will help you safely stop taking AAS.