Long-term steroid use can damage nearly every major organ system, from the heart and liver to the bones and kidneys. The specific risks depend on which type of steroid you’re talking about. Anabolic steroids, the kind used to build muscle, carry a different set of dangers than corticosteroids like prednisone, which are prescribed for inflammation and autoimmune conditions. Both types, used over months or years, can cause changes that persist long after you stop taking them.
Two Types of Steroids, Two Sets of Risks
Anabolic androgenic steroids are synthetic versions of testosterone. They’re used medically in narrow circumstances but are far more commonly obtained without a prescription for bodybuilding and athletic performance. Global prevalence of anabolic steroid use sits around 3.3% of the population, with rates among men reaching 6.4%.
Corticosteroids, on the other hand, are anti-inflammatory drugs prescribed for conditions like asthma, lupus, rheumatoid arthritis, and inflammatory bowel disease. Prednisone is the most common. These are legitimate, widely used medications, but long-term use (generally defined as more than three months) comes with serious cumulative side effects. The long-term consequences of each type overlap in some areas and diverge sharply in others.
Heart Damage and Cardiovascular Risk
Anabolic steroids are particularly hard on the heart. Long-term use causes the walls of the left ventricle to thicken, a condition called left ventricular hypertrophy. The degree of thickening correlates directly with the dose: higher doses produce more structural change. This thickening makes the heart stiffer and less efficient at pumping blood, which over time raises the risk of heart failure, arrhythmias, and sudden cardiac death.
Data from the HAARLEM study, a large prospective study of steroid-using athletes, showed that after a median recovery period of about eight months off steroids, heart wall thickness and other measures of heart function returned to baseline in many users. That’s cautiously good news for people who stop, but it’s not a guarantee. Biopsies of some long-term users have revealed diffuse scarring (fibrosis) in the heart muscle itself, a type of damage that doesn’t reverse. Anabolic steroids also shift cholesterol profiles in a dangerous direction, lowering protective HDL cholesterol and raising LDL, which accelerates plaque buildup in arteries.
Hormonal Disruption
When you take anabolic steroids, your body detects the surplus of testosterone and shuts down its own production. The entire hormonal feedback loop connecting the brain to the testes (or ovaries) goes quiet. In men, this means the testes shrink, sperm production drops, and natural testosterone can take months to recover after stopping. Some long-term users never fully recover and end up dependent on testosterone replacement therapy for life.
Corticosteroids cause a parallel problem with a different hormone: cortisol. Your adrenal glands, which normally produce cortisol on demand, can become suppressed after months of receiving it from a pill. When you stop the medication abruptly, your body can’t produce enough cortisol on its own, a potentially dangerous condition called adrenal insufficiency. This is why corticosteroids are tapered slowly rather than stopped all at once. Current guidelines recommend a faster taper while doses are still above the body’s natural production level, then a much slower reduction as you approach normal physiological range.
Liver Damage
The liver bears a heavy burden from oral anabolic steroids, especially those chemically modified to survive digestion (known as 17-alpha-alkylated compounds). The most frequently reported liver problems are cholestasis, where bile flow becomes blocked, and peliosis hepatis, a rare condition in which blood-filled cysts form throughout the liver tissue. Peliosis can be silent until a cyst ruptures, potentially causing life-threatening internal bleeding.
More alarming is the link to liver tumors. Long-term anabolic steroid use is associated with both benign liver tumors (hepatic adenomas) and liver cancer (hepatocellular carcinoma). Rarer malignancies, including bile duct cancers and angiosarcomas, have also been documented. While most of these tumors are linked to the alkylated oral steroids, cases have been reported in people using injectable, unmodified testosterone as well.
Bone Loss From Corticosteroids
One of the most well-established risks of long-term corticosteroid use is bone loss. Bone density drops most rapidly in the first six months after starting an oral steroid like prednisone. Doses as low as 5 mg per day, taken for longer than three months, are enough to significantly raise fracture risk. The higher the daily dose, the greater the danger.
Postmenopausal women on corticosteroids face the greatest risk, since they’re already losing bone density from declining estrogen. But men and younger adults aren’t immune. Vertebral compression fractures and hip fractures can occur in people who had no prior bone problems before starting steroids. The bone loss is partially reversible after stopping, but full recovery depends on how much damage accumulated and how long treatment lasted.
Blood Sugar and Diabetes
Corticosteroids interfere with how your body handles sugar. They are the leading drug cause of elevated blood sugar, and the numbers are striking: up to 46% of patients on long-term corticosteroid therapy develop clinically significant high blood sugar, with glucose levels rising as much as 68% above baseline. Among patients with no prior history of diabetes, the incidence of steroid-induced diabetes ranges from 34% to 56% depending on dose and duration. This means roughly one in three people on long-term corticosteroids will develop a new blood sugar problem they didn’t have before.
In many cases, blood sugar normalizes after the steroid is discontinued. But for some patients, the metabolic damage is lasting, especially if they had borderline glucose tolerance before starting treatment.
Kidney Scarring
The kidneys are an underappreciated casualty of long-term anabolic steroid use. A study of 10 bodybuilders who had used anabolic steroids for years found kidney biopsies showing focal segmental glomerulosclerosis (FSGS), a pattern of scarring in the kidney’s filtering units. These men had severe protein loss in their urine (averaging over 10 grams per day, compared to a normal value under 0.15 grams) and declining kidney function. Three of the ten had full-blown nephrotic syndrome. Seven had significant scarring of the kidney tissue itself, with 40% or more of the tissue showing damage.
The mechanism appears to be twofold. Anabolic steroids increase lean body mass, which forces the kidneys to filter more blood. At the same time, the steroids may directly damage the delicate cells that maintain the kidney’s filtration barrier. High-protein diets, common among steroid users, likely compound the problem by further increasing the workload on already-stressed kidneys. Once these filtering cells are lost, they don’t regenerate.
Psychiatric and Mood Effects
Anabolic steroids affect brain chemistry, and the psychological consequences can be significant. In one of the earliest structured studies, 22% of steroid-using athletes met clinical criteria for a manic or depressive episode during use or after withdrawal, and 12% experienced psychotic symptoms such as delusions or hallucinations. Aggression is one of the most commonly reported behavioral changes, sometimes severe enough to damage relationships and careers.
Interestingly, large-scale registry data paint a more nuanced picture. When researchers compared rates of diagnosed mood disorders between steroid users and non-users across a broader population, the difference was small (about 3.3% vs. 3.1%). This suggests that while a meaningful minority of users experience dramatic psychiatric effects, especially at high doses, the average long-term user may not develop a diagnosable mood disorder. The risk appears to be dose-dependent: the higher the dose and the longer the cycle, the greater the chance of mood disturbance.
Skin and Appearance Changes
Anabolic steroids stimulate oil glands and can trigger severe cystic acne, particularly on the back, shoulders, and chest. In its worst form, this becomes acne conglobata, a condition characterized by deep, interconnected inflammatory nodules that cause significant, often permanent scarring. The cosmetic and psychological impact can be substantial, and the scarring sometimes requires laser treatment to improve.
Other appearance-related effects include male pattern hair loss (which can be permanent if follicles are destroyed), excessive body hair growth, and in women, deepening of the voice and facial hair growth. Corticosteroids cause a different set of visible changes: skin thinning, easy bruising, stretch marks, and a characteristic redistribution of fat to the face (sometimes called “moon face”) and the upper back.
What Reverses and What Doesn’t
Some steroid-induced damage is reversible with time. Heart wall thickening from anabolic steroids can normalize within about eight months of stopping. Blood sugar often returns to normal once corticosteroids are tapered. Cholesterol profiles typically improve after anabolic steroid cessation.
Other changes are harder or impossible to undo. Liver fibrosis and kidney scarring are permanent. Heart muscle fibrosis doesn’t heal. Bone density may only partially recover. Hormonal production can remain suppressed for years, sometimes permanently. Severe acne scarring persists. The line between reversible and irreversible depends largely on duration and dose. The longer and higher the exposure, the more likely the damage becomes permanent.