Steroids cause a wide range of side effects depending on which type you’re taking. The word “steroids” covers two very different drugs: corticosteroids, which are anti-inflammatory medications prescribed for conditions like asthma, arthritis, and allergies, and anabolic steroids, which are synthetic versions of testosterone used to build muscle. Both carry significant risks, but the side effect profiles are almost entirely different.
Corticosteroids vs. Anabolic Steroids
Corticosteroids (like prednisone and prednisolone) reduce inflammation by mimicking cortisol, a hormone your adrenal glands produce naturally. Doctors prescribe them for autoimmune diseases, severe allergic reactions, and dozens of other inflammatory conditions. Anabolic steroids mimic testosterone and are sometimes prescribed for hormone deficiencies, but they’re far more commonly used without a prescription to increase muscle mass and athletic performance. The side effects below are organized by type so you can find what’s relevant to you.
Common Corticosteroid Side Effects
Some side effects show up almost immediately. Stomach upset, mood changes, and trouble sleeping can start within the first few days. Others, like a rounder face from fluid retention, develop over weeks or months. The most frequently reported short-term effects include increased appetite, unexpected weight gain, water retention (especially visible in the face), skin changes like easy bruising and acne, muscle weakness, and increased body hair.
Sleep disruption is one of the most common complaints. Taking the medication in the morning helps because it allows levels to drop by bedtime. Restlessness and irritability often accompany the insomnia, making the first week or two on a new course particularly difficult.
The longer you take corticosteroids, the more likely side effects become and the more serious they get. Long-term use raises the risk of developing high blood pressure, diabetes, osteoporosis, Cushing syndrome (characterized by a round face, fat deposits between the shoulders, and thin skin), and increased susceptibility to infections because the drugs suppress immune function.
Blood Sugar and Diabetes Risk
Corticosteroids make your body more resistant to insulin, which can push blood sugar to dangerous levels even if you’ve never had diabetes. In studies of hospitalized patients without a prior diabetes diagnosis, half experienced at least one blood sugar reading of 200 mg/dL or higher while on steroids. When researchers used a lower threshold, 70 to 86% of patients had at least one episode of elevated blood sugar. This happens because the drugs interfere with how your liver, muscles, and fat tissue respond to insulin, while also impairing the pancreatic cells that produce it. In healthy people, even one to seven days of corticosteroid use causes measurable insulin resistance.
For most people, blood sugar returns to normal after stopping the medication. But if you already have prediabetes or risk factors for type 2 diabetes, a course of steroids can tip the balance.
Bone Loss From Long-Term Use
Oral corticosteroid doses equivalent to 5 mg or more of prednisone daily, taken for longer than three months, are considered a risk factor for fractures. The drugs interfere with bone formation, collagen production, and the hormones that maintain bone density. For people who need corticosteroids long term, doctors typically monitor bone density and may recommend calcium, vitamin D, or other protective measures.
Children are especially vulnerable. Growth retardation is a well-documented effect of long-term corticosteroid use in kids. The drugs interfere with growth hormone secretion and the activity of growth plates, and even relatively small daily doses or inhaled corticosteroids can slow growth in some children.
Mood and Psychiatric Effects
Corticosteroids affect the brain in dose-dependent ways. At doses below 40 mg per day of prednisone, psychiatric disturbances occur in roughly 1.3% of patients. Between 41 and 80 mg per day, the rate climbs to 4.6%. Above 80 mg per day, it jumps to 18.4%. Short courses tend to produce euphoria, elevated energy, or hypomania. Longer courses are more likely to trigger depressive symptoms.
Irritability, anxiety, and difficulty concentrating are common at any dose. In rare cases, high-dose corticosteroids can cause steroid psychosis, with symptoms like confusion, hallucinations, or paranoia. These psychiatric effects generally resolve after the dose is reduced or the medication is stopped.
Anabolic Steroid Side Effects in Men
Anabolic steroids flood the body with synthetic testosterone, which causes the brain to signal the testes to stop producing their own. The result is a predictable set of hormonal side effects: shrunken testicles, reduced sperm count, infertility, and erectile dysfunction. Breast tissue development (gynecomastia) occurs because the body converts excess testosterone into estrogen. Severe acne, hair loss, and an increased risk of testicular cancer round out the profile.
The cardiovascular damage is particularly concerning. A large study published in Circulation found that anabolic steroid users had a ninefold higher incidence of cardiomyopathy compared to non-users, with more than half of those cases involving thickening of the heart muscle. Users also show unfavorable shifts in cholesterol, with higher LDL (“bad” cholesterol) and lower HDL (“good” cholesterol), along with higher rates of high blood pressure and coronary artery plaque buildup. These changes can persist for years after someone stops using.
Anabolic Steroid Side Effects in Women
Women who use anabolic steroids experience virilization, the development of traditionally male physical characteristics. This includes deepening of the voice, growth of facial and body hair, acne, male-pattern hair loss, menstrual irregularities, and enlargement of the clitoris. Most of these effects reverse after stopping the drugs, with one important exception: voice changes can be permanent. Some women are able to recover vocal range through specialized treatment at a voice center, but not all do.
Topical Steroid Side Effects
Steroid creams and ointments are prescribed for eczema, psoriasis, and other skin conditions. Used as directed, they’re generally safe, but long-term or excessive use can thin the skin, making it fragile and prone to tearing. Stretch marks, visible blood vessels, and slow wound healing are also possible.
Topical steroid withdrawal is a distinct condition that can occur after prolonged use when the cream is stopped. Symptoms include intense skin redness, burning sensations, heat dysregulation, itching, and peeling. These symptoms can appear even on parts of the body where the cream was never applied. NIH researchers have established diagnostic criteria for the condition and found that affected individuals show elevated levels of a specific metabolic marker in their blood and skin, confirming it as a measurable physiological reaction rather than a simple rebound of the original skin condition.
What Happens When You Stop
When you take corticosteroids for more than a few weeks, your adrenal glands scale back their own cortisol production because the medication is doing the job for them. If you stop suddenly, your body can’t produce enough cortisol to compensate. This is adrenal insufficiency, and it’s the reason doctors taper the dose gradually rather than stopping all at once.
Withdrawal symptoms include fatigue, muscle and joint pain, nausea, vomiting, low blood pressure, weight loss, and a general feeling of being unwell. Some people also experience fever, joint stiffness, and darkening of the skin. The severity depends on how long you were on the medication and how high the dose was. A proper taper, where the dose is reduced in steps over days or weeks, gives your adrenal glands time to wake back up and resume normal cortisol production.
Anabolic steroid withdrawal follows a different pattern. The primary issue is that natural testosterone production has been suppressed, sometimes for months. Symptoms during recovery include fatigue, depression, low sex drive, and loss of the muscle mass gained while using. Hormonal recovery can take several months, and in some cases testosterone levels don’t fully return to baseline without medical intervention.