Anabolic steroids are artificial analogs of testosterone – one of the main anabolic (muscle mass stimulating) hormones produced in the human body (more in men, less in women).
Despite the similarity in chemical structure, the use of anabolic steroids in sports for muscle mass gain increases the risk of serious health consequences.
In sports, steroids are used for muscle mass gain (strength sports) and increasing endurance (aerobic sports), and they are indeed effective in this.
However, this effectiveness comes at a price. Imagine a car whose engine is designed to run on fuel with an octane rating of 82, and you decide to fill it with 98 to make it go faster…
Scientific research confirms the potential harm of steroids, the presence of serious side effects, the list of which is significantly broader than popular opinions and myths. Some of the results of these studies form the basis of this article.
Main thoughts:
Approximately 30 out of 100 people who use steroids develop dependence.
Scientific data indicate that prolonged use of steroids can lead to irreversible mental deviations.
Liver intoxication is most often caused by oral steroids.
Compelling evidence of a link between steroid use and the development of cancer is lacking.
Steroid use leads to increased sensitivity to alcohol and a rise in the desire to consume it.
Why are steroids dangerous? Main reasons
There are two main reasons for the increased risk of side effects when using steroids:
- Their intake in large doses, significantly exceeding the natural level of testosterone in the body and medical prescriptions (by 10-100 times);
- Their combination with other sports pharmacology drugs, which is a common practice.
The at-risk group mainly includes amateur athletes who lack knowledge in pharmacology and are guided in their practice of using drugs by the recommendations of sellers, “cottage” experts, and often by the simple principle: “the more, the better”.
Another non-obvious reason for the increased degree of risk from steroids is their “illegality”.
The situation is very similar to that observed in the drug market. The prohibition of distribution and use always leads to the development of a black market for substances that are produced in underground laboratories in third-world countries and obviously have very low quality.
Here is how the situation in the USA is described by scientists 39:
“Over the past 20 years in the USA, thanks to the effective work of law enforcement agencies, the distribution of illegal steroids has shifted to the black market.
This, in turn, makes the use of steroids even more dangerous, as the substances available on the market (referring to the USA) are produced in other countries and smuggled in (often from Mexico) or made in underground laboratories.
In any case, they do not meet safety standards and may be chemically contaminated, making them doubly dangerous to health.“
The situation in the markets of post-Soviet countries is similar.
The majority of steroids sold on the market are produced underground or smuggled in => There is no quality control, health risks are doubled
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Specific consequences of anabolic steroid use for men and women
It is a mistake to think that a headache pill only affects the headache. After it enters the stomach and is absorbed, the active substance is distributed to every cell in the body via the bloodstream, including the brain.
Similarly, elevated testosterone levels in the body from steroid use have a total effect on the body: not only muscles are affected, but also the brain, heart, other organs, and systems.
Hence the wide range of potential side effects: from cardiovascular to psychological. The risk of which, as should already be clear, is proportional to the dosage and the duration for which the body is under their influence.
Some physiological and psychological side effects of steroid use may potentially manifest in anyone who takes them, while others are specific to men and women. The list below is not exhaustive.
Specific side effects for men:
- breast growth (mammary glands);
- shrinkage of the testicles;
- impotence;
- decreased sperm production.
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Specific side effects for women:
- deepening of the voice;
- cessation of breast development;
- hair growth on the face, abdomen, and upper back;
- enlargement of the clitoris;
- disruption of the menstrual cycle.
Consequences of steroid use characteristic of both men and women:
- acne or “pimples” (very many);
- increased risk of tendon rupture due to ligaments not strengthening in accordance with muscle mass; tendon ruptures are often observed after the end of a steroid cycle;
- baldness;
- liver dysfunction and the development of cancerous tumors;
- in the case of steroid use by adolescents – stunted growth (related to the closure of growth centers in long bones) and development (including sexual), as well as the risk of future health problems;
- increased levels of “bad” cholesterol (low-density lipoproteins);
- decreased levels of “good” cholesterol (high-density lipoproteins);
- high blood pressure (hypertension);
- cardiovascular diseases;
- aggressive behavior, anger, or violence;
- mental disorders such as depression;
- drug addiction;
- infections or diseases such as HIV or hepatitis from drug injections;
- increased aggression and sexual drive, which can lead to abnormal sexual and criminal behavior;
- withdrawal from anabolic steroids can be accompanied by depression, and in some cases, suicide.
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Photos and videos of side effects
Below we provide photos and videos of some side effects that occur with steroid use. Information from the website of the U.S. Anti-Doping Agency (www.usada.org).
Acne (“pimples”)
Baldness in men
Breast growth in men
Baldness in women
Growth cessation in adolescents
Facial features thickening and facial hair growth in women
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1 Cardiovascular side effects of anabolic steroid use
For decades of doping history (primarily steroids), scientists and doctors have recorded various side effects of steroids on the cardiovascular system of athletes:
- cardiomyopathy;
- myocardial infarction;
- strokes;
- vascular obstruction;
- coagulation disorders.
Recent major scientific reviews have compiled all these effects, some of which have also been confirmed by scientific experiments. We will present the most important and reliable of them.
In one recent study of the corpses of 87 men who used steroids, it was found that all of them had a significantly larger heart mass than that of ordinary people, even after adjusting for body mass and age.
Another study of 4 corpses of steroid users who died from heart failure showed ventricular hypertrophy (enlargement), which was not related to an increase in heart muscle mass, but to fibrosis (the growth of connective tissue, which is usually a result of chronic inflammation) 5.
In steroid-using athletes, heart mass is greater, but not due to an increase in heart muscle mass, but to the growth of connective tissue
Studies of the electrical conductivity of heart muscle in steroid-using athletes have shown a decrease in the electrical stability of the heart, abnormal functioning of the heart tone regulation system, and disturbances in the repolarization of the heart ventricles; the latter finding was also demonstrated in rats that were “fed” steroids.
And perhaps the most important and serious side effect: numerous studies using different methods have shown that athletes (both amateurs and professionals) “on steroids” develop cardiomyopathy – structural and functional changes in the heart muscle 6.
Another study showed decreased elasticity of the aorta in those who use steroids. Such changes can be very serious, but they may also be reversible (at least partially) after discontinuing steroid use. However, one possible reason for the loss of elasticity may be an increase in connective tissue content due to cell damage from steroids. In this case, the process is likely to be irreversible 7.
One of the most serious and dangerous consequences of steroid use is cardiomyopathy – structural and functional changes in the heart muscle
In addition to the direct effect on the heart muscle, steroids can cause dyslipidemia, i.e., a disturbance in the ratio of “bad” high-density cholesterol to “good” low-density cholesterol. This is fraught with an increased risk of developing atherosclerosis (“blockage” of blood vessels). The effect is especially characteristic of oral steroids 8.
In one study of 14 professional weightlifters who had been using steroids for a long time, a significantly higher calcium content in the coronary arteries (the vessels that supply blood to the heart itself) was found than normal. Atherosclerosis of the coronary vessels is a likely cause of many known cases of heart attacks and strokes in young men who used steroids 9.
“Blockage” of the vessels supplying the heart itself is the most likely cause of most deaths of young people “on steroids” due to heart attacks and strokes. This is especially characteristic of oral steroids.
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2 Steroids and potency: effects on sexual function in men and women
The issue of the influence of anabolic steroids on potency is discussed in detail in the materials:
- Steroids and potency in men: effects on conception, why “it’s not worth it” to be on a steroid cycle, the likelihood of testicular and prostate cancer. Scientific studies.
- Steroids and potency in women: effects on conception, regularity of menstruation, likelihood of breast cancer. Scientific studies.
3 Psychological side effects of steroid use
Modern science mainly accumulates materials on the psychological (and other) side effects of steroid use, sometimes conducting its own experiments that are not trustworthy due to the delicacy of the topic. The main sources of facts about the harm of steroids are:
- interviews with steroid users, including those who also “dabble” in drugs;
- comparisons of the mental state of athletes “on steroids” with normal athletes;
- long-term observations of the same athletes and comparisons of their mental state during intervals of steroid use and “breaks” from them.
The most common psychological consequences of steroid use include:
- hypomania or mania;
- irritability;
- aggressiveness;
- excessive self-confidence;
- hyperactivity;
- reckless behavior, and sometimes a loss of sense of reality (behavior does not match the surrounding environment);
- Symptoms of acute depression during steroid withdrawal (depressed mood, loss of interest in usual activities, increased drowsiness, loss of appetite, loss of libido, and, in extreme cases, suicidal tendencies).
The aforementioned psychological effects manifest individually; most “steroid users” exhibit only some of them, and only a very small portion show serious degrees of deviation.
Behavioral deviations are characteristic of those who use large doses of steroids, equivalent to >1000 mg of testosterone per week 10.
Psychological deviations are typical for athletes who consume large doses of steroids, equivalent to >1000 mg of testosterone per week
It is impossible to predict what specific psychological consequences steroid use will lead to in a particular individual. Moreover, scientists speak of the existence of individual sensitivity to both excess testosterone in the blood and withdrawal symptoms.
Some observations of athletes “on steroids” note very aggressive or violent behavior in those who showed no signs of such behavior before starting the steroid cycle. For example: committing murder or attempted murder by previously healthy individuals or exhibiting other atypical aggressive behavior.
All the facts presented are gathered from observations “in the field” of real athletes using steroids.
Strict scientific experiments studying the effects of steroid use on the mental state of individuals have also been conducted. However, in almost all of them (likely for safety reasons for the subjects), the maximum doses of testosterone did not exceed 300 mg per week – this is significantly less than what athletes typically use during steroid cycles, which is around 500 mg per week, and often more than 1000 mg per week. Therefore, the results of such studies are not worthy of attention and trust.
The results of scientific research on the consequences of steroid use on mental health are not trustworthy, as all of them use mild doses of steroids, far from those actually taken by athletes. Only observations of athletes in the “field” are indicative.
In several experiments, psychological symptoms were studied in patients receiving 500 mg of testosterone per week. Out of 109 men, 5 (4.6%) demonstrated hypomanic or manic syndromes. Almost all men exhibited increased aggression in response to provocations 11.
Behavioral deviations when using large doses of steroids are primarily explained by their action on certain areas of the brain
In animals (rats, monkeys), the same is observed: steroids lead to defensive and aggressive behavior, dominant behavior, anxiety, sensitivity to other banned substances, drugs, particularly opioids.
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4 Development of dependencies
Approximately 30% of steroid users develop a dependency on them 2,4.
About 30 out of 100 people who use steroids develop a dependency
Unlike most other substances that cause dependency but initially provide a “high,” the intoxicating effect is absent when using steroids; the main goal for which they are taken is the delayed reward in the form of increased muscle mass and reduced fat deposits.
Despite this, dependency on steroids can become a chronic and dangerous disorder. There are three mechanisms for its development 12:
- “I want to look like Him/Her”
Many amateur athletes start taking steroids because they want to transform quickly, gain muscle mass, and lose fat. It likely begins with the desire to resemble someone (for various motives: likes, girls, etc.) against the backdrop of a strong discrepancy between the “current self” and the “desired self” 13.
This state is often the reason for starting steroid use. As they continue to use, people with such issues often fall into extreme concern and anxiety that if they stop using steroids, their muscle mass will “deflate” and everything will return to normal 12. Thus, dependency is formed.
- Suppression of natural testosterone synthesis
These are the factors influencing steroids on the nervous system and thyroid gland. The use of steroids leads to the suppression of the mechanisms of natural testosterone production, which involves certain areas of the brain and the testes. This can lead to a significant decrease in its natural synthesis in the body after the steroid cycle ends 14.
To avoid this, steroid-using athletes employ various methods to conclude their steroid cycles. In particular, they take clomiphene or human growth hormone gonadotropin at the end of the steroid cycle.
However, even with the use of these methods that actually work, the suppression of natural testosterone production is observed for several weeks or months after stopping steroid use 15.
Accompanying symptoms of fatigue, loss of libido, and depression may prompt some users to quickly resume steroid use to alleviate them.
- Steroids are drugs…
Some animal studies suggest that steroids may stimulate certain areas of the brain responsible for pleasure. This produces an effect similar to that which occurs with drug use 16.
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5 Neurotoxicity
Scientific research indicates that when testosterone levels are above natural levels, it leads to the death of certain types of cells, particularly brain neurons 17, but not only.
This has been confirmed in studies and on animals, one of which showed a clear loss of spatial memory in rats after steroid administration. Overall, scientific data strongly supports the risk of developing irreversible mental disorders in those who use steroids for a long time 18.
Scientific data suggest that prolonged steroid use may lead to irreversible mental disorders
In a study involving 31 weightlifters “on steroids” and 13 non-users, researchers found a significant deficit in visual and spatial memory among those “on steroids”; moreover, the degree of this deficit was significantly related to the overall duration of steroid use throughout life 3.
Thus, the toxicity of steroids to brain cells is evident and requires further study.
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6 Steroids and the Thyroid
As we mentioned, steroids definitely suppress thyroid function 19. At the end of a long steroid cycle (several months or more), thyroid functions may remain suppressed for several months or even years 20; in some individuals, the normal natural level of testosterone may never recover.
The use of steroids leads to the suppression of thyroid function, which does not recover for months, years, and in some cases – never. This results in a low natural testosterone level.
Additionally, steroids can have a toxic effect on the testes, sometimes irreversible 21. As a result, there is a decrease or complete cessation of the production of a whole range of hormones (besides testosterone).
This condition is correctable; several studies report successful treatment using clomiphene, human growth hormone, and gonadotropin. However, there are known cases where these methods did not work.
Overall, to date, there are no systemic studies on the treatment of hormonal dysfunction due to steroid use. The suppression of hormone production naturally when using steroids can lead to impaired sperm production by the testes, infertility in men and women, and irregular menstruation in women.
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7 The Risk of Infectious Diseases from Steroid Use
In addition to the direct side effects of steroid use, steroid-using athletes are susceptible to infectious diseases related to the use of contaminated needles, tainted substances made on the black market, and more.
Although needle sharing for injections is not typical among modern athletes, a recent online survey found that 65 out of 500 steroid users (13%) confirmed needle sharing for injections, reusing needles, and sharing the same syringe with multiple doses of steroids for administration to several people.
Considering that internet users participating in surveys are generally more educated and wealthier than the overall population of “steroid” athletes, the figures above are likely far from reality 1.
Therefore, it is not surprising that various infectious complications from steroid use have been documented in the scientific literature, including:
- bloodborne pathogenic microorganisms;
- HIV;
- hepatitis B and C;
- skin infections;
- soft tissue infections.
The main cause of all of these is the bacterium Staphylococcus aureus.
The first case of HIV infection in a steroid user was recorded nearly 30 years ago, subsequently in the United States and Europe.
Cases of hepatitis B and C infection are also widespread 22.
The highest risk of HIV transmission and other diseases among steroid users is associated with the sharing of injection needles. This, in turn, is explained by the great popularity among athletes of testosterone and nandrolone, which are administered intravenously.
Among steroid-using athletes, the practice of sharing needles is common, which is a cause of HIV, hepatitis B, and C infections.
However, the unsafe practice of using needles is only one possible risk factor for HIV and other infectious diseases.
A study of homosexuals in London gyms found that steroid-using homosexual athletes, unlike non-steroid users, engage in unprotected anal sex with unknown partners significantly more often 23.
Considering that steroids are widespread among homosexuals, both illegally and by prescription for treating HIV-related wasting syndrome, the likelihood of HIV transmission among them is high, both through needles and sexual contacts.
Among steroid users, there are many who have been incarcerated, and facts indicate an increased risk of hepatitis and HIV among prisoners.
Lastly, professional athletes using steroids more frequently experience soft tissue infections and abscesses 24.
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8 The impact of steroids on other organs and systems
- Blood
The use of steroids leads to an increase in hemoglobin (which carries oxygen to cells) and the concentration of red blood cells in proportion to the dose. Steroids stimulate the production of red blood cells by increasing sensitivity to erythropoietin (a hormone released by the kidneys that regulates the rate of red blood cell formation) 25.
- Muscles
In weightlifters and bodybuilders, the use of steroids can lead to rhabdomyolysis 26 – a condition in which damaged muscle fibers break down very quickly, accompanied by muscle pain, weakness, vomiting, and confusion; urine may appear tea-colored, and heart rhythm may be irregular.
This condition, in turn, can lead to an increase in creatinine levels in urine, a decrease in kidney filtration rate, and sometimes the development of acute kidney failure 27.
In one recent study, kidney problems (inflammation) were recorded in 10 athletes who frequently used steroids 28.
- Liver
The use of steroids can sometimes lead to liver intoxication, with consequences such as Peliosis hepatis: the formation of cysts (cavities) in the liver filled with blood, as well as various types of liver tumors 29-30.
Almost all side effects related to liver intoxication are caused by oral steroids 17α-alkylated 31.
Overall, the harm of steroids to the liver and the frequency of cases of intoxication are exaggerated.
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- Tendons
The use of steroids can lead to adverse side effects on the musculoskeletal system, particularly rupture of tendons.
Tendons often rupture after the end of a steroid cycle. This is explained by the fact that the muscle strength of hypertrophied muscles increases very quickly, and the ligaments do not have time to strengthen, as well as the influence of steroids on the structure of the tendons themselves 32.
Steroids can negatively affect the immune system, lungs, as well as other organs and systems, causing abundant formation of “pimples” (acne). Science currently has limited facts in these areas.
When using steroids and after completing a cycle, tendon ruptures may occur, which do not have time to strengthen according to muscle strength
- Steroids and Cancer
There is little evidence of a link between steroid use and cancer, except for rare reports of liver, testicular, and kidney cancer. There is currently no clear evidence that steroid use causes prostate cancer.
Only two clinical cases of prostate cancer in bodybuilders are known, both recorded more than 20 years ago.
However, there is a possibility that the use of large doses of steroids during adolescence may lead to genetic changes that increase the likelihood of developing cancer (including prostate cancer) at a later age.
Compelling evidence of a relationship between steroid use and cancer development is lacking
Considering that we live in a time when those who were once pioneers in the early era of steroid use (the 1980s) are aging, science and medicine will soon be able to provide more definitive answers regarding the impact of steroids on prostate cancer and other side effects.
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9 Drugs, Steroids, and Alcohol
The use of steroids often occurs alongside other classic narcotic substances, such as opiates, for example.
For what purpose?
The effect of muscle mass gain when using steroids is significantly enhanced with intensive training. Combining steroids with drugs helps to train despite muscle and joint pain.
As a result, a narcotic dependence on opium develops. According to statistics, among all drug addicts, a large percentage are those who use steroids 33. Approximately 50% of such individuals have mental disorders 12.
Athletes on steroids often start using drugs to reduce pain during training for even greater stimulation of muscle growth
Scientists have also found a correlation between the use of steroids and alcohol in humans and rats. Chronic steroid use in rats leads to increased sensitivity to alcohol consumption.
The reason is that steroid use alters certain connections between amino acids in the part of the brain responsible for pleasure. This manifests as increased sensitivity to alcohol and increased desire to consume it 34-36. A similar effect has been observed regarding cocaine 37 and amphetamine 38 in rats pumped with large doses of steroids.
The use of steroids with analgesics (to reduce pain) or stimulants provokes training at very high loads, which can lead to serious injuries.
The use of steroids leads to increased sensitivity to alcohol and a rise in the desire to consume it
| Consequences and Side Effects of Steroid Use | |
|---|---|
| Organ/System | Severity/Probability of Manifestation |
| Cardiovascular System | |
| Atherosclerosis | ++ |
| Cardiomyopathy (heart muscle disease) | ++ |
| Disruption of electrical conductivity of the heart muscle | + |
| Disruption of blood coagulation | + |
| Polycythemia (abnormal increase in hemoglobin in the blood either due to an increase in the number of red blood cells or a decrease in blood plasma volume) | + |
| Hypertension (increased blood pressure) | + |
| Neuroendocrine System (Men) | |
| Suppression of thyroid hormonal activity, cessation or significant reduction of hormonal activity of the testes and ovaries | ++ |
| Gynecomastia (breast growth) | + |
| Prostate hypertrophy (increase in size) | +/- |
| Prostate cancer | +/- |
| Disruption of masculinization processes (manifestations of male characteristics) | + |
| Neuroendocrine system (women) | |
| Side effects on various organs and systems | ++ |
| Psychoneurological system | |
| Behavioral disorders: mania (intense excitement, euphoria, delusions, and increased activity), hypomania (moderate level of mania), depression | ++ |
| Aggression, violence | + |
| Steroid dependence | ++ |
| Death of nerve cells, impairment of cognitive ability | +/- |
| Liver | |
| Inflammation and cholestatic effect (disruption of bile flow) | + |
| Peliosis hepatitis (rare, formation of cavities in the liver filled with blood) | + |
| Tumor formation | + |
| Muscles/Skeleton | |
| Premature closure of growth plates in adolescents | + |
| Tendon rupture | + |
| Kidneys | |
| Kidney function impairment, a consequence of rhabdomyolysis (destruction of muscle cells) | + |
| Focal segmental glomerulosclerosis (disruption of kidney filtering ability) | + |
| Tumor formation | + |
| Immune system | |
| Suppression of immune function | +/- |
| Skin | |
| Acne (pimples) | + |
| Striae (stretch marks) | + |
(++) – reliably confirmed, serious consequences; (+) – reliably confirmed, but either do not always manifest or cause not very serious consequences; (+/-) – not well studied and confirmed, some probability of manifestation
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