Side effects of anabolic steroids (anabolic-androgenic steroid hormones)

General Side Effects

Androgens and anabolic steroids affect the sebaceous glands in the skin, influencing their development and activity. Among other things, they also promote the development of acne. Reduced sodium excretion causes increased water retention in the tissues and thus leads to weight gain.

Damage to the cardiovascular system

During anabolic steroid use, the concentration of high-density lipoproteins (HDL) in blood plasma decreases, while that of low-density lipoproteins (LDL) increases. This increases the LDL-to-HDL ratio, which is considered a risk factor for the development of atherosclerosis and even heart attack.

Further studies have pointed to possible changes in blood clotting factors, the vascular system, and damage to heart muscle cells, which may increase the risk of thrombosis in steroid users compared to non-users.

Cardiac hypertrophy and capillarization

Tagarakis and Addicks demonstrated significant changes in the heart muscle due to anabolic steroid use in animal experiments on mice. This led to hypertrophy of the heart muscle cells, although improved capillarization necessary for oxygen supply did not occur. During peak athletic performance, this could result in insufficient oxygen supply to the heart muscle and lead to damage. 

Liver damage

If anabolic steroids are used over a prolonged period, irreversible liver damage can result. In this context, 17-methylated steroids such as methyltestosterone or stanozolol are believed to have a more toxic effect on liver cells than non-methylated steroids such as testosterone. Consequently, testosterone compounds are now preferred over 17-methylated steroids for therapeutic purposes.

Virilization (masculinization) in women

All anabolic steroids cause virilization in women due to their androgenic effects, which manifest as changes in the voice (irreversible), hair distribution, menstrual cycle disorders, and clitoral hypertrophy (irreversible).

Gynecomastia in men

Long-term use of anabolic steroids can lead to abnormal breast enlargement in men (gynecomastia). It is believed that aromatizable anabolic steroids are metabolized into estrogens, which trigger this effect.

Effects on height growth in adolescents

Anabolic steroids can affect height growth in adolescents by causing premature closure of the epiphyseal plates, which shortens the growth phase.

Psychotropic effects

There are numerous case studies and self-reports on the psychotropic effects of anabolic steroids, but only a few studies conducted according to scientific standards.

The results can be summarized as follows:

Psychotropic effects occur primarily with high doses of anabolic steroids (above therapeutic doses). During anabolic steroid abuse, both positive (euphoria, sexual arousal, increased energy) and negative changes (irritability, mood swings, aggression) in mood may occur.

Negative effects on cognitive factors such as memory and concentration are also described. Almost all authors report behavioral changes toward increased aggression, and several case studies link serious violent crimes to anabolic steroid use. Recent studies highlight the potential for addiction associated with anabolic steroids, which manifests itself, among other things, in depression following discontinuation of the drugs.

The extent of the psychotropic effects of anabolic steroids is said to depend not only on the dosage, the structure of the anabolic steroid, and the duration of use, but also on the abuser’s personality structure (baseline aggression, mental health conditions, concurrent alcohol and drug abuse) and environmental conditions (stressful situations, peer pressure, consequences of behavioral changes).
 

General Risks Associated with Black Market Products

Anabolic steroids are largely obtained illegally (black market) and thus contribute to acquisitive crime. With injectable preparations, there is a risk of using non-sterile syringes (transmission of hepatitis, AIDS). Since black market products are mostly counterfeits, incorrect active ingredients and incorrect dosages may be used.
 

Polypharmacy

As a rule, various anabolic steroids are used simultaneously. The additional intake of other medications, such as painkillers, ultimately leads to polypharmacy, the side effects of which are unknown.
 

Cancer risk

Male sex hormones such as testosterone are believed to promote the development of hepatocellular carcinoma. In particular, the risk appears to be significantly increased with the uncontrolled use of male sex hormones for muscle building (anabolic steroids).

The sex hormones estrogen (not relevant to doping) and testosterone can promote the growth of prostate and breast cancer if their tissues have hormone receptors.
 

Increased mortality among strength athletes who take anabolic steroids

A Finnish study shows that male strength athletes (powerlifting) who ranked among the top five in Finland between 1977 and 1982 in the 82.5–125 kg weight classes and were suspected of anabolic steroid abuse had a mortality rate 4–5 times higher over the following 12 years than men of the same age in the general population.
 

Further information

Side effects

Pärssinen M, Kujala U, Vartiainen E, Sarna S, Seppälä T. Increased premature mortality of competitive powerlifters suspected to have used anabolic agents. Int J Sports Med. 2000 Apr;21(3):225-7.
Abstract of the article in the National Library of Medicine (PubMed)

Deligiannis A, Björnstad H, Carre F, Heidbüchel H, Kouidi E, Panhuyzen-Goedkoop NM, Pigozzi F, Schänzer W, Vanhees L ESC study group of sports cardiology position paper on adverse cardiovascular effects of doping in athletes Eur J Cardiovasc Prev Rehabil. 2006 Oct;13(5):687-94.
Abstract

Kindermann W. Kardiovaskuläre Nebenwirkungen von anabol-androgenen Steroiden [Cardiovascular side effects of anabolic-androgenic steroids]. Herz. 2006 Sep;31(6):566-73.
Abstract und download