Steroids can be harmful, but the answer depends entirely on which type you’re talking about and how they’re used. The word “steroids” covers two very different drug classes: corticosteroids, which doctors prescribe to reduce inflammation, and anabolic steroids, which mimic testosterone and are often used to build muscle. Both carry real risks, especially with long-term or high-dose use, but anabolic steroids used without medical supervision pose the more serious dangers.
Two Types of Steroids, Two Sets of Risks
All steroids share a basic chemical structure of four fused carbon rings, but that’s where the similarity ends. Corticosteroids mimic hormones produced by your adrenal glands and work by dialing down your immune system’s inflammatory response. They’re prescribed for conditions like asthma, rheumatoid arthritis, lupus, Crohn’s disease, and severe allergies. They come as pills, nasal sprays, skin creams, and injections.
Anabolic steroids are synthetic versions of testosterone. In medicine, they’re prescribed for conditions that cause abnormally low testosterone, such as certain pituitary disorders or testicular injuries. Outside of medicine, they’re used at much higher doses to accelerate muscle growth and athletic performance. This non-medical use is where most of the serious health consequences show up.
Heart Damage From Anabolic Steroids
The cardiovascular risks of anabolic steroids are among the most dangerous and well-documented. An estimated 3% of people using anabolic steroids suffer a heart attack before age 50. A study comparing 86 long-term users (averaging seven years of use) to 54 non-users found that steroid users had significantly more plaque buildup in their coronary arteries and higher rates of early heart attacks.
Steroids also physically change the heart muscle itself. Multiple studies show that use is linked to thicker heart walls, increased heart mass, and a pattern of growth called concentric hypertrophy. Most of that extra mass comes from scar-like collagen deposits and fibrosis rather than healthy muscle tissue, which can lead to a weakened heart over time. Researchers have also found impaired heart function, both in how forcefully the heart pumps and how well it relaxes between beats.
Liver Toxicity
Oral anabolic steroids are particularly hard on the liver. They’ve been linked to four distinct types of liver injury: temporary spikes in liver enzymes, a form of bile blockage called cholestasis, a condition where blood-filled cysts form in the liver (peliosis hepatis), and liver tumors including cancer.
Cholestasis typically develops gradually, starting with nausea, fatigue, and itching before progressing to dark urine and yellowing of the skin. Even after stopping the steroids, jaundice and itching can persist for weeks. Peliosis hepatis is rarer but more alarming: blood-filled cavities develop inside the liver, and if one ruptures, it can cause sudden abdominal pain and internal bleeding. Liver tumors can grow silently, sometimes only discovered on imaging because routine blood tests often appear normal until the disease is advanced.
Hormones, Fertility, and Recovery
When you flood your body with synthetic testosterone, your brain responds by shutting down its own production. This creates a state of hormone suppression that directly impacts fertility. In one study, 66% of participants were diagnosed with severely low or absent sperm counts by the end of a steroid cycle, with an average loss of 120 million sperm. Research on high-dose testosterone found that roughly 95% of men developed absent or near-absent sperm counts within six months. Sperm shape also deteriorated, though motility was less affected.
The good news is that recovery happens for most men after stopping. Testosterone levels generally return to near-normal within three to six months, though the timeline varies widely, from as little as two weeks in some studies to over a year in others. The less encouraging finding is that full recovery may not happen. Research suggests testosterone levels after cessation often remain somewhat lower than they were before use, even months or years later. For men concerned about future fertility, this is one of the most consequential risks to weigh.
Mental Health Effects
The stereotype of “roid rage” oversimplifies things, but anabolic steroids do have real psychiatric effects. Users report irritability, mood swings, violent feelings, anger, hostility, difficulty concentrating, forgetfulness, and confusion. In a study comparing male bodybuilders who used steroids to those who didn’t, 28% of steroid users showed symptoms of mild anxiety, compared to zero in the control group. Similarly, 28% of users showed depressive symptoms (ranging from mild to moderate), while no non-users did. These differences were statistically significant.
These mood changes can strain relationships and daily functioning in ways users don’t always connect to the drugs themselves, particularly since irritability and cognitive fog creep in gradually.
Risks of Long-Term Corticosteroid Use
Prescribed corticosteroids are genuinely useful medications, but long-term use carries its own cost. The most significant risk is bone loss. Fractures occur in as many as 50% of people on long-term corticosteroid therapy. Even low doses, the equivalent of just 2.5 mg of prednisone daily, have been shown to cause more than an 8% decrease in bone density in the spine after only 20 weeks.
Corticosteroids can also slow growth in children and teenagers. They work by directly suppressing the growth plate, the cartilage zone near the ends of bones where new bone forms. Specifically, they inhibit the multiplication and enlargement of cartilage cells and reduce the production of the matrix those cells need to build bone. For young people on long-term corticosteroid therapy, this can mean measurably shorter adult height.
Other well-known side effects of prolonged corticosteroid use include weight gain (particularly around the face and midsection), elevated blood sugar, thinning skin, cataracts, and increased susceptibility to infections due to immune suppression.
SARMs Are Not a Safer Alternative
Selective androgen receptor modulators, commonly called SARMs, are marketed online as a safer alternative to anabolic steroids. The evidence does not support that claim. Clinical trials have shown that SARMs cause dose-dependent drops in HDL (protective cholesterol), increases in blood pressure, and elevations in hemoglobin that thicken the blood. That combination is a recipe for cardiovascular problems. Liver injury signals have appeared in clinical trials, and case reports of people taking SARMs at typical recreational doses (four to ten times the amounts studied in trials) describe more severe liver damage.
There have also been case reports of tendon ruptures and muscle breakdown in SARM users. Because SARMs produce many metabolites and have high potential for off-target effects throughout the body, their actual risk profile remains poorly understood. They are not FDA-approved for recreational use, and buying them online means getting an unregulated product with no guarantee of purity or dosage accuracy.
Prescribed vs. Non-Medical Use
Context matters enormously when asking whether steroids are “bad.” A short course of corticosteroids for a severe asthma flare, or a low-dose testosterone prescription for a man with clinically low levels, involves careful dosing, medical monitoring, and a clear benefit that outweighs the risks. The dangers escalate dramatically when anabolic steroids are used without medical oversight, at doses far beyond what the body produces naturally, and for extended periods. Most of the serious cardiovascular, liver, hormonal, and psychiatric consequences described above come from this pattern of use. The risks are real, cumulative, and in some cases only partially reversible.