Anabolic steroids carry serious health risks that go well beyond the cosmetic side effects most people hear about. A large Danish study tracking over 1,000 steroid users for 11 years found they were roughly three times more likely to die than non-users of the same age. The damage spans your heart, liver, hormones, fertility, and mental health, and some of it can be permanent.
Before going further, it’s worth noting that “steroids” can mean two very different things. Anabolic steroids are synthetic versions of testosterone, used to build muscle mass and strength. Corticosteroids like prednisone are anti-inflammatory drugs prescribed for conditions like asthma and arthritis. This article focuses primarily on anabolic steroids, since that’s what most people searching this question are concerned about, but touches on corticosteroid risks as well.
The Heart Takes the Biggest Hit
Cardiovascular damage is the most dangerous consequence of anabolic steroid use. Steroids thicken the walls of the heart’s main pumping chamber, a condition called left ventricular hypertrophy. Over time, this makes the heart stiffer and less efficient at pumping blood. Multiple studies reviewed by the American College of Cardiology confirm a clear link between steroid use and increased heart wall thickness and heart mass.
About 3% of people taking anabolic steroids suffer a heart attack before age 50. That may sound small, but heart attacks in young adults are otherwise extremely rare. Steroids also raise blood pressure, increase the risk of blood clots, and alter cholesterol levels in ways that accelerate artery disease. Stroke is another documented risk. In the Danish mortality study, deaths from cardiovascular causes were 2.2 times higher among steroid users than controls, and deaths from accidents, violence, or suicide were 3.6 times higher.
Your Hormones May Not Bounce Back
Anabolic steroids flood your body with synthetic testosterone. Your brain responds by shutting down its own testosterone production, a feedback loop involving the hypothalamus, pituitary gland, and testes. With chronic use, this entire hormonal axis gets suppressed. The result: shrunken testicles, low natural testosterone, sexual dysfunction, and infertility.
If you stop using steroids, this system can recover, but it takes time. Full recovery of the hormonal axis typically requires about 12 months of abstinence. During that period, many men experience fatigue, depression, low sex drive, and muscle loss. For some long-term users, full recovery never happens.
Fertility Can Be Severely Affected
Steroids reduce sperm count and sperm motility, sometimes to zero. Your body essentially stops producing sperm when it detects high levels of synthetic hormones. The common belief that cycling on and off steroids protects fertility has no scientific support. There is no evidence that intermittent use reduces the impact on sperm production, and in some cases the damage is irreversible. Men trying to conceive after years of steroid use sometimes require specialized fertility treatment, with no guarantee of success.
Liver Damage From Oral Steroids
Oral anabolic steroids, particularly those with a specific chemical modification called 17-alpha-alkylation (which allows them to survive digestion), are directly toxic to the liver. The most common form of damage is cholestatic jaundice, where bile flow from the liver becomes blocked. In rare but serious cases, steroid use has been linked to a condition called peliosis hepatis, where blood-filled cysts form inside the liver, as well as liver tumors and liver cancer.
Injectable steroids bypass the digestive system and are generally less toxic to the liver, but they aren’t safe. They still carry all the cardiovascular, hormonal, and psychological risks.
Visible Changes You Can’t Always Reverse
Steroids cause breast tissue growth in men through a process called aromatization, where excess testosterone gets converted into estrogen. When estrogen levels rise relative to testosterone, breast gland tissue grows. This condition, gynecomastia, often requires surgery to correct once established.
Hair loss is another common and often permanent side effect. Testosterone is converted into a more potent hormone called DHT, which binds to receptors in scalp hair follicles and causes them to shrink. If you’re genetically prone to male-pattern baldness, steroids will accelerate it significantly. Severe acne, particularly on the back and shoulders, is also typical and can leave permanent scarring.
Women who use anabolic steroids experience excessive body and facial hair growth, voice deepening, and menstrual irregularities. Some of these changes are irreversible even after stopping.
Mental Health and Behavioral Effects
The psychological effects of steroids are real and measurable. Aggression, irritability, and impulsive behavior during use are well documented. The Danish study found that unnatural deaths (accidents, violent crimes, suicide) were 3.6 times more common among steroid users, suggesting the behavioral effects have real-world consequences beyond mood swings.
Depression is common both during use and after stopping, particularly during the months when natural testosterone production hasn’t yet recovered. Teenagers who use steroids show increased impulsivity and decreased attention compared to people who start using in adulthood, suggesting the developing brain is especially vulnerable.
Teenagers Face Additional Risks
Adolescents who use anabolic steroids risk stunting their own growth. High levels of synthetic hormones can cause growth plates in bones to close prematurely, permanently limiting height. The cognitive effects are also more pronounced in younger users, with research showing lasting impacts on attention and impulse control. Because the brain continues developing into the mid-20s, steroid use during adolescence can interfere with neurological development in ways that adult use does not.
Prescription Corticosteroids Are Different
Corticosteroids like prednisone work by suppressing inflammation and immune activity. They’re prescribed for legitimate medical conditions and are not the same drugs used for muscle building. That said, long-term corticosteroid use carries its own set of problems: bone thinning (osteoporosis), weight gain, elevated blood sugar, thinning skin, and suppression of the adrenal glands, which produce your body’s natural stress hormones. When you’ve been on corticosteroids for a long time, stopping abruptly can cause adrenal crisis because your body has stopped making its own cortisol.
Short courses of corticosteroids, like a week-long prescription for a bad allergic reaction, are generally well tolerated. The risks climb with dose and duration.
Dose Matters, but There’s No Safe Amount
People who misuse anabolic steroids typically take doses far higher than anything prescribed medically. They often stack multiple types of steroids at once. But even at lower doses, the hormonal disruption, cardiovascular strain, and liver stress still occur. The 2.8-fold increase in mortality from the Danish study included a range of users, not just extreme cases. There’s no established threshold below which anabolic steroid use for non-medical purposes is considered safe.