Anabolic steroid abuse during the teenage years carries risks that go beyond what adults face, because steroids interfere with body systems that are still actively developing. The damage spans nearly every organ system: bones can stop growing permanently, the heart can develop lasting structural changes, and the brain’s emotional wiring can be altered during a critical window of maturation. About 1% to 1.5% of U.S. middle and high school students have tried anabolic steroids at least once, according to the 2024 Monitoring the Future survey, with boys slightly more likely to use than girls.
Permanent Height Loss From Growth Plate Closure
Teenagers are still growing because the ends of their long bones contain active growth plates, strips of cartilage that gradually lengthen bones throughout puberty. Anabolic steroids short-circuit this process. The body converts excess androgens into estrogen, and that spike in estrogen signals the growth plates to fuse shut ahead of schedule. Once a growth plate closes, it hardens into solid bone and no further lengthening is possible. A teen who might have grown several more inches can end up permanently shorter than their genetic potential. This effect is irreversible: no treatment can reopen a fused growth plate.
Heart Damage That Outlasts the Cycle
Steroid abuse during adolescence doesn’t just stress the heart temporarily. Animal research shows that exposure during the equivalent of the teen years causes the heart muscle to thicken abnormally, a condition called pathological cardiac hypertrophy. Unlike the healthy thickening that comes from exercise, this type stiffens the heart wall and makes it pump less efficiently. In rats given steroids only during puberty, the thickened heart persisted into adulthood, long after the drugs were stopped.
Beyond the structural changes, steroid use raises “bad” cholesterol, promotes blood clotting, and can trigger spasms in the coronary arteries. Together, these shifts increase the risk of heart attack, even in young people who appear outwardly fit. The combination of a thickened heart and narrowed arteries is why sudden cardiac events occasionally show up in case reports of young steroid users.
A Developing Brain at the Wrong Time
Puberty is one of the most active periods of brain remodeling in a person’s life. Key regions involved in emotion, memory, and impulse control, including the amygdala, hippocampus, and frontal cortex, are all reshaping themselves under the influence of natural hormone levels. Flooding the brain with supraphysiological doses of androgens disrupts this process in several ways.
In both human studies of genetic hormone excess and animal models, abnormally high androgen levels during puberty increase activity in the amygdala (the brain’s threat-detection center) and alter serotonin levels across multiple brain regions. Serotonin is the chemical messenger most closely tied to mood stability. Steroid exposure during puberty also increases excitatory signaling in the amygdala and hippocampus, essentially turning up the volume on emotional reactivity. These changes help explain why teen steroid users often show mood swings, heightened fear responses, and difficulty regulating anger that can persist even after they stop using.
Aggression, Depression, and “Roid Rage”
The psychological effects of steroids range from irritability to full-blown psychiatric episodes. A meta-analysis of randomized controlled trials in healthy males found a statistically significant increase in self-reported aggression during steroid administration. That increase was measured under controlled, moderate-dose conditions. Real-world steroid cycles typically involve much higher doses, stacked compounds, and months of continuous use, which likely amplifies the effect well beyond what clinical trials can ethically test.
Manic symptoms (grandiosity, reckless behavior, reduced need for sleep) and depressive episodes are both documented side effects. For teens whose brains are already navigating the emotional turbulence of normal puberty, adding steroid-induced mood disruption creates a volatile combination. Depression becomes an especially serious concern during withdrawal, when the body’s natural testosterone production is suppressed and mood crashes hard.
Reproductive System Shutdown
When a teenage boy floods his system with synthetic testosterone, his brain detects the excess and responds by dialing down its own hormone signals. The pituitary gland stops telling the testes to produce testosterone and sperm. The result is a paradox: a teen taking steroids to feel more masculine ends up with shrinking testes, low sperm count, and sometimes breast tissue growth (gynecomastia). These effects happen because the body’s hormonal feedback loop has been overridden.
For girls, steroid use triggers a different set of changes: deepening of the voice, increased facial and body hair, menstrual irregularities, and clitoral enlargement. Some of these changes, particularly voice deepening and hair growth patterns, may not fully reverse after stopping.
In boys, natural testosterone production usually recovers after stopping steroids, but recovery can take months to over a year. During that window, teens experience symptoms of low testosterone: fatigue, loss of sex drive, depression, and reduced muscle mass, which can drive them back to using.
Liver Stress and Rare but Serious Damage
Oral steroids are particularly hard on the liver. Most oral formulations are chemically modified to survive digestion, and that modification forces the liver to process a compound it struggles to break down efficiently. The consequences range from mildly elevated liver enzymes (a sign of stress) to serious conditions: prolonged bile blockage, blood-filled cysts within the liver (peliosis hepatis), and in rare cases with long-term use, liver tumors. These tumors can be benign growths or, less commonly, liver cancer.
Injectable steroids bypass the liver initially but still carry risks, including infection and scarring at injection sites. Teens who share needles face the added danger of bloodborne infections.
Visible Warning Signs
Skin changes are often the most obvious early clue. Roughly 43% to 50% of steroid users develop acne, typically on the face, chest, shoulders, and back. This isn’t ordinary teenage acne. Steroid-induced breakouts tend to appear suddenly and can progress to severe, painful, ulcerative nodules. In extreme cases, users develop acne fulminans, an eruption of hemorrhagic lesions accompanied by fever, fatigue, and joint pain.
Stretch marks (striae) are another telltale sign, appearing on the shoulders, biceps, or chest as muscle mass increases faster than the skin can accommodate. Rapid and disproportionate muscle growth, especially in the upper body, combined with new severe acne in a teenager should raise concern.
Withdrawal and the Cycle of Dependence
Steroid dependence develops through a pattern that is distinct from most recreational drugs. Users don’t get “high” in the traditional sense, but they become psychologically and physically dependent on the effects. When they stop, the body’s suppressed hormone production leaves them in a state of deficiency. The characteristic withdrawal syndrome includes depressed mood, prominent fatigue, insomnia or excessive sleeping, decreased appetite, and loss of sex drive.
For teens, the withdrawal crash is particularly dangerous because it hits at every insecurity that may have driven the use in the first place. Muscles shrink, energy plummets, and mood bottoms out. Many users describe a cycle where they intended to do one course of steroids but returned to using because they couldn’t tolerate the withdrawal period. Case reports consistently describe users who initially took steroids for muscle building but developed depression whenever they tried to stop, a pattern that can entrench long-term use during a period of life when the stakes for brain and body development are highest.