Steroid Side Effects

side effects

People frown on anabolic/androgenic steroids upon, especially through the mass media. They accuse steroids of causing severe side effects. There are also ethical and moral issues. The mass media’s sensational news coverage has contributed to this negative information. During the anti-steroid campaign, the press deliberately used certain steroid cases. They also used scientific literature to warn and scare everyone taking these drugs.

To avoid negative publicity, they did not mention that in most of the cases the patients already had severe health problems. These health problems where present before steroid therapy. Steroids are prescription drugs that influence various physiological processes. There are potential side effects. When diagnosing these side effects one must tell the toxic from the hormone-induced side effects. The official authorities omit this important difference. In part, because of pure ignorance. But also on purpose to spread of lies and false information where possible.


In the category of the toxic side effects of anabolic/androgenic steroids, the potential effects on the liver are most apparent. These can manifest themselves in various dysfunctions of the liver. In the literature, some cases have been mentioned. A cholestasis (bile obstruction in the liver), a peliosis hepatis (blood filled cavities in the liver tissue, cysts), or liver cancer. Blamed on anabolic/androgenic steroids use.

It is of great importance that these manifestations could exclusively be seen in patients who previously used long-term steroid therapy. These patients already had extensive liver damage. They also suffered from other internal diseases. Of further interest that the administered steroid consisted exclusively of the 17-alpha alkylated oral steroids. Especially potentially liver-toxic substances methyl-testosterone and oxymetholone were used. Sometimes without suspension for several years. Evidence that steroids cause similar liver damage in healthy athletes could only be found in one or two rare cases. These are neither of statistic relevance nor allows for the preconception to expect liver damage by consumption of anabolic/androgenic steroids.

Tumor development?

A connection between steroid intake and tumor development could not be established. There is evidence that testosterone or a testosterone ester caused liver cancer. Testosterone and its esters are not (or are slightly) liver-toxic. We only expect toxic liver damage with 17-alpha alkyl derivatives. Once again, nearly all the liver-damaging results where found in patients prescribed steroids by physicians. These where to treat existing, serious diseases.

Although one cannot exclude the possibility of liver damage and delayed reaction in the future. Empirical data shows that even with repeated, excessive, and prolonged intake of the potentially liver-toxic 17-alpha alkylated steroids by athletes, these symptoms rarely occur. In order to avoid any possible risks, one should forego the use of 17-alpha alkylated steroids. Since a total abandonment of these steroids is impossible for most athletes one should follow strict guidelines. These deal with the duration of intake and the dosage.

Regular intervals

Far-sighted athletes will therefore interrupt their steroid regimes in regular intervals. By either stopping steroid intake altogether or switching to a (potentially) non-toxic steroid (usually injectable). In many cases the problematic steroid will be combined with one or more “milder” steroids which interact in order to keep the dosage of the first at a moderate  level without diminishing the effectiveness. In conclusion, the toxic, critical side effects on the liver occur mostly in those patients who have previously been ill. After which they have received 17-alpha-alkylated steroids as their treatment over longer periods of time.

It is recommended that athletes using oral steroids have their liver function routinely checked by a qualified physician.

The second category of undesirable side effects  deals with hormone related disorders.


Anabolic/ androgenic steroids exert an inhibiting effect on the hypothalamo-hypophyseal testicular axis. This results in a suppression of the normal testicular function which may further result in a reduced testosterone production, decreased spermatogenesis, and testicular atrophy. The degree of suppression depends on the duration of the steroid intake. Also the administered steroid, and the dosage. During the beginning of steroid administration one may often notice an increase in libido. In time this can fall below normal standards.

With the intermittent use of testosterone-stimulating substances, e.g. HCG, these problems may, in some cases, be avoided or at least reduced. Upon completion of the steroid regime, HCG is used to reactivate the testicular function. It should be mentioned that all these side effects are completely reversible. In all the cases, after the steroids were discontinued, a complete recovery to the original condition occurred. With regard to gonadotropins, size of testes, synthesis of the endogenous testosterones, and even spermatogenesis.

The effect of androgens/anabolics on the gonad cycle is reversible. Infertility is not always noticeable. The fear that athletes may be childless after the use of anabolics is simply not true.


Most steroids cause a water and electrolyte imbalance in the body. This results in an increased storage of water and sodium which further results in a swelling of tissue (edema). This process is desirable to a certain degree since the muscle cell, the joints, and connective tissue profit from it. The results are a quick and distinct increase of muscle size, volume and strength gain. Better leverage ratio, a stronger connective tissue, and a ”lubrication” of the joints often guarantees injury-free training. The drawback is an increased water retention in the skin and blood. The first it is more a cosmetic problem. Because tissue under the eyes and the cheeks becomes puffy. This gives the athlete the typical bloated ”off-seasonal full-moon steroid face”.

The second deposit is more serious because health problems may arise. Overloaded with additional water, the heart and blood vessels must transport more fluid than normal resulting in an elevated blood pressure. The degree of the water and salt retention depends on the type of steroid, dosage and predisposition of the individual. This factor is noticeable in both males and females.


Feminization can occur in male athletes. In the form of breast swelling (gynecomastia), increased tendency toward fatty deposits, and extremely soft muscles. These symptoms are largely due to aromatization, meaning the partial conversion of a steroid into the female sex hormones (estrogen). The development of female characteristics may take place when the estrogen level increases significantly. Especially after discontinuing the steroid regime one finds this problem aggravated. Since the athlete’s androgen level is low and at the same time, the estrogen level is elevated. In conjunction with this, it is interesting that estradiol (an estrogen) has an inhibiting effect on gonad cycle.

An elevated estrogen level reduces the body’s own testosterone production. Elevation of estrogen levels and the extent of feminization depend on the dosage and type of steroids given. Each individual is different.  Some show no gynecomastia. Others notice pain and swelling of the mammary gland on a 10mg dose of Dianabol a day. The additive intake of anti-estrogens like Nolvadex, Proviron, or Arimidex can be helpful in most cases.

In general, after the steroids have been discontinued, the gynecomastia will slowly regress by itself. Since many are on the drugs year round, an operative removal of the undesired mammary tissue is no rarity. An elevated estrogen level is the ”mortal enemy” of every competitive athlete. Even with an extremely low fatty content, one never really becomes hard. An excessive estrogen portion can also negatively influence the psyche of the male athletes.


The developing of acne is the most noticeable skin change. Existing acne may get worse or it may cause it to develop. Male athletes are less affected than female athletes. The development of acne depends largely upon the individual’s constitution, the consumed steroids, and the dosage. The receptors of the sebaceous glands have a high affinity for DHT. One assumes that steroids partially transformed into DHT is the main cause. This may also be the reason the injectable testosterone, Anadrol and Dianabol, are the number one cause of acne.

With the increased sebaceous gland production oily skin occurs and, in combination with bacteria and dead skin, the pores become clogged. This can further lead to blackheads, pimples, pustules (filled with pus), or even cysts. Males experience the acne mainly on the back, shoulders and chest. Less in the face, whereas female athletes are mainly affected in the face, back and shoulders. There is damage to the body’s largest organ, the skin. The noticeable acne is, even for an outsider, a distinct sign of steroid use.

Psychological strain

For many, acne can also be a psychological strain. Especially when small scars and holes remain in the face. They can minimize acne on the face with local applications of benzoyl peroxide or ointments containing antibiotics. Larger body areas my involve UV radiation (tanning studios). Use of oral prescription drugs such as Tetracycline (antibiotic) or Accutane may be helpful. Oral antibiotics have an anti-anabolic effect. Avoid use with sun exposure or UV radiation.

Females may permanently lose their normal, soft skin tone since the skin can become large-pored and uneven. This is because of the continued use of androgenic steroids, anti-estrogens, and excessive sun exposure. One often sees stretch marks and skin fissures on athletes using steroids. Especially in the shoulder/chest area, on the inside the upper arm, and on the buttocks. This usually results from too quick a weight increase. The skin cannot adapt quickly enough or stretch.


The use of androgenic steroids, high dosages and over long periods, can develop aggressive behavior. This is true for men and women. The advantage of this is that one can train harder and more intensely. The disadvantage is that some cannot properly cope, letting their aggressions out on others. They become easily irritated, impatient, and quick tempered and anger outbursts can occur. In extreme cases this can lead to an increase in the use of violence. This has lead to the breakup of relationships and marriages.

Remarkable is that some male athletes using steroids can become depressive. The cause may be that these athletes convert higher amounts of steroids used into estrogens. Mood swings and depressions are common when the male hypothalamus reacts to the female hormone estradiol. The supposition that steroids would make athletes psychically dependent and, after their discontinuance, evoke withdrawal symptoms, is not completely wrong.

Those who press 400 pounds on the bench with the aid of steroids and then, after discontinuing the substance, press only 360 pounds, then 320 pounds, and after a some time only 300 pounds, can suffer problems with their ego. Many athletes simply forget that the performance cannot remain at the same level without steroid use. In the traditional sense, steroids are not habit forming.


It associates these solely with the use of oral, 17-alpha alkylated steroids. Some athletes suffer from epigastric fullness, diarrhea, nausea or even vomiting. Other athletes cannot take steroids in tablet form since even with the ingestion of Winstrol or Primobolan they feel ill. Sometimes this problem can is resolved by taking the tablets with each meal.


Steroids can quicken the balding process in those with a genetic predisposition. The receptors of the scalp have a high affinity to dihydrotestosterone (DHT). Since the steroids convert largely into DHT.  This makes them the main cause of acne and hair loss. The injectable testosterone and Anadrol are the main culprits. Also, steroids that are derivatives of DHT e.g. Masteron or Primobolan, can promote baldness. This can cause a receding hairline or a general thinning of the hair.

Females can, in rare cases, also suffer from this. One must classify these side effects as irreversible since the chances of recurring hair growth are slim. Again, steroids do not automatically cause baldness. It can speed up this process in those with a hereditary predisposition for hair loss.


They also link steroids with cardiovascular defects. The facts support this theory. Steroids can actually can elevate the cholesterol and triglyceride levels. However, a decrease of the HDL value and an increase of the LDL value are possible. HDL (high density lipoprotein) protects the arteries by eliminating excess, unused cholesterol from arterial walls. Then, transported to the liver and metabolized.

For this reason a high HDL level is desirable, whereas athletes taking steroids have a low HDL level. Increasing risk of cardiovascular defects and heart disease. An increase of the LDL values is undesirable. LDL brings about exactly the opposite effect, by promoting the cholesterol deposits in the arterial walls.


Consequently, steroids can cause an overall unfavorable situation. High cholesterol level, low HDL and high LDL values. For this reason athletes should regularly have their triglyceride and cholesterol levels checked. This will avoid falling into this high risk group. In combination with the generally used mass-buildup diet (lots of calories, lots of fat, fast food, and sweets) this possible risk is also increased. Other unfavorable factors are stress, high blood pressure, weight increase, a bad aerobic predisposition, and smoking.

Here, once again, the steroid choice, the dosage, the duration of intake, and especially the constitution of the individual, play an important part in the development of defects. Changed values return to their original values within several weeks after steroid termination. Although older athletes are usually more at risk, one cannot exclude defects in younger people and females. It is still not sure if the increased intolerance and elevated cortisone level possibly brought about by steroids, contribute to the development of cardiovascular defects.


This term refers to the possible masculinization that females may sustain because of the ingestion of anabolic/androgenic steroids. As in male athletes, steroids also cause a suppression of the gonad cycle in females. It inhibits the hypophyseal excretion of HDL. This results in a secondary amenorrhea. Meaning absence or abnormal cessation of the menses. This side effect is reversible after they have discontinued the steroid.

Visible signs of a virilization can be acne vulgaris (simple acne), hirsutism (excessive bodily and facial hair), alopecia (androgen-induced loss of hair), and changes of the skin structure similar to the males’. These side effects are usually considered reversible. It depends on predisposition, consumption of high doses of mostly androgenic steroids, and extended usage. There is a possibility that these changes may remain after the steroid has been discontinued.


Possible clitoral-hypertrophy. The first sign of virilization is often a slight change in the voice in form of hoarseness. A deepening of the voice is irreversible and usually remains permanently. In women one must also take a possible increase in the libido into account. Some females become increasingly aggressive during steroid intake only to fall into a depressive state after they discontinue steroids. The increased aggressiveness is because of the elevated androgen level. Whereas the possible depression suggests an estrogen rebound which occurs after they have discontinued the steroid regime.

LH and FSH inhibition causes it to suppress estrogen production. A significant elevation in production can follow. Steroids taken during pregnancy increase the possibility of masculinization of the female fetus. The occurrence and manifestation of these side effects depends on genetic factors. Dosage, length of consumption and type of steroids given. Regardless of known performance-enhancing effects steroids in female athletes are controversial. One must weigh the risk against the gain since many of the potential side effects are not reversible.


The use of anabolic/androgenic steroids can stunt the growth potential of children and adolescents. It is interesting to note that often there is a short-term accelerated growth of the bones. With continued ingestion a premature closure of the epiphyseal cartilage will lead to growth stunting. This ultimately results in a decrease in the normal predicted height. Further growth is impossible making this an irreversible side effect. Young athletes who, because of their extreme ambition have decided to take steroids should, for this reason, reconsider. The only steroid that does not cause this serious problem is Oxandrolone.


The possibility that steroids cause a prostate enlargement or prostate cancer can be neither dismissed nor confirmed. In case studies one could not find a connection between these manifestations and the ingestion of anabolic/androgenic steroids. Prostate problems occur mainly in older males. It is advisable that athletes over forty should refrain from taking strong androgenic steroids. Most steroid manufacturers recommend prostate exams.


They often notice the occurrence of high blood pressure in athletes taking steroids. One of the major causes is probably the increased cardiovascular strain brought about by the pronounced water and salt retention. The increased body weight of many of the athletes who also eat large quantities of food adds to the problem. Workouts with heavy movements, such as squats or bench presses, can cause athletes to hold their breath. This can also be a contributing factor. One should regularly measure blood pressure to ensure the value is not higher than 130/90.


They have not yet established the existence of a direct connection between steroid consumption and a cardio-muscular hypertrophy. Athletes using steroids have an enlarged and more efficient heart than non-athletes. However, one must not forget that these athletes have an enlarged (more efficient) heart to begin with. This is due to the higher activity rate of any athlete. One problem that makes it difficult to determine whether steroids influence the cardiac hypertrophy is that the increased training already increases the heart size. This makes it hard to decide what amount of the hypertrophy was caused by steroids.


The kidneys are under more strain during steroid intake. It involves them in the filtration and excretion of toxic by-products. High blood pressure and water and electrolyte imbalances can lead to long-term changes in kidney function. In certain rare cases with athletes using steroid, they have seen certain fast-growing kidney tumors. These are normally only seen in infants and children.

It is doubtful if there is a direct connection between the two. It is certain that during steroid consumption several athletes may develop dark-colored urine. In extreme cases, even blood in the urine. Todays Trenbolone, in particular, seem to have a toxic effect on the kidney function.

Other possible side effects that may occur during the use of anabolic/androgenic steroids are a prolonged bleeding time, headaches, nausea, feeling poorly, increased risk of injuring muscles, joints and connective tissue, anaphylactic shock (life-threatening reaction), and abscesses secondary to injection.

The occurrence of side effects is different from one athlete to another. Factors such as age, gender, constitution, the respective physical and psychic condition of the individual. As well as the dosage, the length of intake, and the selection of the steroid. These all play an important part in the development and seriousness of side effects.