Anabolic Steroid Health Consequences
Documented Harms of Supraphysiological Androgen and AAS Use
Evidence grade 4 of 5, Strong. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- Schedule III controlled substances; non-medical use illegal
- WADA
- Prohibited (S1 Anabolic Agents)
Reference only. Not medical advice.
What can go wrong
These are the documented consequences of supraphysiological/AAS dosing, not of physiological replacement. Cardiac: left ventricular hypertrophy is well documented; reduced HDL; accelerated atherosclerosis; arrhythmia; case series of sudden cardiac death in competitive bodybuilders attribute deaths to cardiac hypertrophy, coronary disease, and arrhythmia. Hepatic effects are most pronounced with oral 17-alpha-alkylated agents (not used in standard TRT). Renal complications, severe acne, androgenetic hair loss, gynecomastia, psychiatric effects (aggression, dependence), and potentially permanent hypogonadism requiring lifelong TRT are reported.
This is something to take to a clinician. The Atlas can tell you what is known about anabolic steroid health consequences in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
At the supraphysiological doses used for performance and physique enhancement, anabolic-androgenic steroids (AAS) carry a documented profile of harm distinct from physiological TRT: concentric left ventricular hypertrophy and impaired cardiac function, sharply reduced HDL cholesterol, hepatotoxicity (particularly with oral 17-alpha-alkylated agents not used in legitimate TRT), renal effects, psychiatric effects including aggression and dependence, prolonged or permanent hypogonadism requiring lifelong therapy, and case-series reports of sudden cardiac death in bodybuilders. These harms are reported in peer-reviewed literature.
Where the line from replacement to abuse becomes a clinical hazard.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
How it works
Supraphysiological androgen exposure produces effects qualitatively different from replacement. Chronic high androgen load drives concentric left ventricular hypertrophy and, in echocardiographic studies of long-term users, impaired systolic and diastolic function and accelerated coronary atherosclerosis. Oral 17-alpha-alkylated androgens resist hepatic first-pass metabolism, which is why they are orally active but also hepatotoxic (cholestasis, peliosis hepatis, adenoma). Profound HPG suppression at high doses can produce hypogonadism that fails to recover. Androgens and the psychiatric milieu of use are linked to aggression, mood disturbance, and a recognized dependence syndrome.
Safety in detail
This intervention involves significant physiological effects and requires evaluation and monitoring by a qualified physician. Supraphysiological anabolic-steroid use carries documented risks of cardiac hypertrophy, hepatotoxicity, permanent hypogonadism, and sudden cardiac death. Self-administration without medical oversight carries documented health risks.
- Concentric left ventricular hypertrophy and impaired cardiac function (well documented)
- Marked reduction in HDL cholesterol
- Hepatotoxicity with oral 17-alpha-alkylated androgens (cholestasis, peliosis, adenoma)
- Renal complications reported
- Psychiatric effects: aggression, mood disturbance, dependence syndrome
- Prolonged or permanent hypogonadism requiring lifelong TRT
- Acne and androgenetic alopecia
- Sudden cardiac death documented in bodybuilder case series
Replacement is not the same as a cycle
Every harm in this entry is a function of supraphysiological dose, route (oral 17-aa), polypharmacy, and duration. Physiological testosterone replacement in monitored hypogonadal men has a fundamentally different and far more favorable safety profile (see TRAVERSE).
What has to be monitored
The bloodwork this needs, and the reason it belongs with a clinician rather than a website.
- Echocardiography in long-term users
- Lipid panel
- Liver function tests (especially with oral agents)
- Hematocrit
- Renal function
- Mental health assessment
What people get wrong
Often saidTRT and steroids are basically the same thing
ActuallyPhysiological TRT restores normal testosterone in deficient men under monitoring. Supraphysiological AAS dosing for physique uses many times the replacement dose and carries documented LV hypertrophy, HDL crash, hepatotoxicity, and sudden death risk.
Often saidLiver damage is a risk of all testosterone
ActuallyHepatotoxicity is largely a feature of oral 17-alpha-alkylated androgens, which are not used in legitimate injectable or transdermal TRT.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
At a glance
- Cardiac finding
- Concentric LV hypertrophy, reduced ejection fraction
- Lipid effect
- Marked HDL reduction
- Hepatic risk
- Highest with oral 17-alpha-alkylated steroids
- Endocrine
- Possible permanent hypogonadism
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Anabolic Steroid Health Consequences. A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- How it compares. We have not set it against the alternatives.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Baggish et al., Circulation, long-term AAS use and cardiac function2017
Long-term AAS users showed reduced left ventricular systolic and diastolic function and greater coronary atherosclerosis vs non-users
Pope et al., Endocrine Reviews, adverse health effects of AAS2014
Comprehensive review documenting cardiovascular, hepatic, psychiatric, and endocrine harms and a dependence syndrome
Far et al. / Montisci et al. case series, sudden cardiac death in AAS users2012
Autopsy case series of bodybuilders linking sudden cardiac death to cardiac hypertrophy, coronary disease, and arrhythmia
Rasmussen et al., PLoS ONE, persistent hypogonadism after AAS2016
Former AAS abusers showed prolonged hypogonadism and impaired HPG recovery years after cessation