Steroid abuse affects nearly every organ system in the body, from the heart and liver to the brain and reproductive organs. The most dangerous effect is on the cardiovascular system: people who abuse anabolic steroids face a nearly threefold higher risk of heart attack and are about three times more likely to die prematurely than non-users. But heart damage is only one piece of a much larger picture.
Heart Disease and Blood Clots
The cardiovascular effects of steroid abuse are the most extensively studied and the most alarming. A large study published by the American Heart Association found that steroid users had a threefold increased risk of heart attack compared to non-users. The risk of developing cardiomyopathy, a condition where the heart muscle weakens and struggles to pump blood effectively, was nearly nine times higher. Heart failure risk tripled, and abnormal heart rhythms were about twice as common among users.
Steroids also thicken the blood and promote clotting. Users had roughly 2.4 times the risk of developing venous thromboembolism, a dangerous clot that typically forms in the legs and can travel to the lungs. These aren’t risks that show up only after decades of use. Heart attacks and clotting events have been documented in steroid users in their twenties and thirties.
Liver Damage
Oral anabolic steroids are particularly hard on the liver. They cause four distinct types of injury. The mildest is a temporary spike in liver enzymes, which often produces no symptoms and resolves on its own. More serious is a condition called cholestasis, where bile flow from the liver slows or stops. This typically develops one to four months after starting use, though it can appear as late as two years in. Symptoms start with nausea, fatigue, and itching, then progress to dark urine and yellowing of the skin.
Long-term use can cause a rarer condition called peliosis hepatis, in which blood-filled cysts develop throughout the liver. These cysts may cause no symptoms for years, then rupture suddenly, leading to severe internal bleeding. The most serious liver consequence is tumor development. Both benign liver tumors and liver cancer have been linked to prolonged steroid use, along with rare cases of bile duct cancer.
Kidney Damage
Steroid abuse can quietly damage the kidneys. Researchers studying a group of bodybuilders who used steroids long-term found a pattern of kidney scarring called focal segmental glomerulosclerosis. These patients were spilling large amounts of protein into their urine (a sign of kidney filter damage) and had declining kidney function. One patient progressed to complete kidney failure requiring dialysis.
The damage appears to come from two directions: steroids drive increases in lean body mass that force the kidneys to work harder, while also exerting a direct toxic effect on the filtering cells inside the kidney. In the bodybuilders studied, those who stopped using steroids and lost weight saw their kidney function stabilize or improve. One patient who resumed steroid use relapsed.
Reproductive and Hormonal Effects
When you flood your body with synthetic testosterone, your brain responds by shutting down its own hormone production. The pituitary gland stops signaling the testes to make testosterone and sperm. The result in men is testicular shrinkage, severely reduced sperm counts (sometimes to zero), and infertility. These effects can persist for months or even years after stopping use, and recovery is not guaranteed.
In women, steroid abuse triggers masculinizing changes: facial hair growth, male-pattern hair loss, clitoral enlargement, and menstrual irregularity. Most of these effects reverse after stopping use, with one notable exception. Deepening of the voice is permanent.
Psychological and Behavioral Changes
Steroid abuse is linked to significant psychiatric symptoms. Aggression and violence are the most commonly reported, sometimes called “roid rage,” though the intensity varies between individuals. Manic episodes, characterized by grandiosity, impulsive behavior, and poor judgment, also occur. Less commonly, steroid use has triggered full psychotic episodes with delusions and paranoia. These effects tend to be dose-dependent, meaning higher doses carry greater psychiatric risk.
Withdrawal brings its own set of problems. When long-term users stop, they commonly experience depression (sometimes severe enough to include suicidal thoughts), insomnia, loss of appetite, fatigue, decreased sex drive, and muscle and joint pain. A strong craving to resume use is also typical. Withdrawal from anabolic steroids usually requires medical treatment, and the depressive phase can be the most dangerous period for users trying to quit.
Skin Problems
Steroid abuse causes a distinctive form of severe acne, sometimes called bodybuilding acne. It can range from increased oiliness of the skin to acne conglobata, a deep, painful form with interconnected nodules and abscesses, or even acne fulminans, an explosive form that includes ulceration and sometimes fever. These breakouts typically appear on the back, chest, and shoulders, and they can develop even in people who never had acne before using steroids. The scarring from severe cases is often permanent.
Stunted Growth in Adolescents
Teenagers who abuse steroids face a unique risk that adults do not. Anabolic steroids accelerate bone maturation and cause the growth plates at the ends of long bones to close prematurely. While a teen might initially notice faster growth, the early closure of these plates permanently caps their height. An adolescent in early puberty who uses steroids may end up significantly shorter than they would have been otherwise, and this effect is irreversible.
Premature Death
A large study tracking steroid users over time found they were 2.8 times more likely to die during the follow-up period than matched non-users. The risk of dying from unnatural causes (accidents, suicide, violence) was 3.6 times higher, while the risk of dying from natural causes like heart disease was 2.2 times higher. These numbers reflect the combined toll of cardiovascular damage, psychiatric instability, and organ failure that accumulates with steroid abuse.