Anabolic Steroids: Risks, Not Rewards

Dr. Tzvi Doron
March 26, 2018

Anabolic Steroids: Risks, Not Rewards

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So you want to get jacked? Cool. All it takes is a strenuous weightlifting program, excellent nutrition, and plenty of sleep to get bigger, stronger muscles. If that sounds like a lot of hard work—it is. A lot of people want a shortcut to a chiseled physique, or at least a leg up on the competition. That’s where anabolic steroids, or “juice” come in. And it works.

An estimated 3-4 million people in the US have used anabolic steroids

Steroids will get you bigger, faster, and stronger than traditional training methods. But are the short-term benefits of anabolic steroids really worth the very serious health risks and lingering effects on your body? (Spoiler alert: No, they aren’t).

Here’s a comprehensive look at why people take steroids and the long-term health risks that come from a chemically enhanced physique.

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Table of Content

What Are Anabolic Steroids?

Steroid hormones are a group of fat soluble hormones made out of cholesterol. Nothing sinister there. And even though “steroid” is a four-letter word to a lot of people, it’s important to point out that your body uses steroids all the time. Steroids help you process sugar, maintain salt and water balance, moderate blood pressure, and influence sexual characteristics. The most well-known steroid hormones include testosterone, estrogen, progesterone, cortisol, aldosterone, and pregnenolone, and they’re completely normal—even essential—chemicals in your body.

However, anabolic steroids are a little different.

How Do Anabolic Steroids Work?

anabolic steroids

These synthetic chemicals are closely related to testosterone, and act on your body in three distinct ways. The anabolic, androgenic, and aromatization effects (and side effects) of steroid use are immediate and profound, so it’s important to understand how steroids work if you’re currently using steroids or contemplating steroid use.

How to Spot a Steroid Cheat Sheet: If you’re not sure if a “performance enhancing supplement” is a steroid, just remember that synthetic anabolic steroids often end in the letters “—one.” Nandrolone, oxandrolone, trenbolone, and tibolone are just a few examples.

What Are the Side Effects of Steroids?

The anabolic effects are why people take steroids in the first place. “Anabolic” just means stimulating tissue growth, and this absolutely happens when you take steroids. Usually, we associate muscle growth with steroid use, but this also includes bone growth among other organs. Steroids can even increase your red blood cell count.

Androgenic Effects are what people consider the “masculinizing” effects of using testosterone and other anabolic steroids. Basically, these are the things that make men “men.” They include body hair growth, a deeper voice, increased sebum (oil) production in the skin, and growth of the genitals (penis in men, and clitoris in women).

The final effect—aromatization—is responsible for one of the least desirable side effects of anabolic steroids. Certain cells in your body contain an enzyme called aromatase which converts testosterone into estrogen. Anabolic steroids can cause a hormonal imbalance in this enzyme leading to conditions like gynecomastia, (aka “bitch tits”) in men.

Chemists have altered the testosterone molecule to try to increase the desired anabolic effects and decrease the unwanted androgenic effects. But, so far they haven’t separated the “good” effects from the “bad.”

Anabolic Steroid Use: Professional & Recreational Athletes

recreational steroids

When you think of steroids most people think of pro athletes. However, the reality is that millions of non-competitive athletes use anabolic steroids. One study estimated that 3-4 million people in the US have used anabolic steroids, and about 1 million of them develop anabolic steroid dependence.

The truth is that the vast majority of steroid users are male, non-professional athletes.

Medical Anabolic Steroid Use

Testosterone and other anabolic steroids have even been studied for their therapeutic effects in diseases that cause tissue breakdown like HIV/AIDS, cancer, burn victims, and certain types of liver and kidney disease. While promising, these benefits need to be weighed against the risks and should only be considered under a doctor’s guidance.

Testosterone may also have potential benefits in men with hypogonadism (low testosterone). There’s currently an FDA warning against the use of testosterone in men with low T due to aging. However, many physicians (myself included) believe this warning is premature and based on flawed research. Still, it’s important to realize that there may be an increased risk of heart attack and stroke in some older men who use testosterone to treat low T.

Anabolic Steroid Risks

It’d be nice if anabolic steroids only made your muscles bigger and your bones stronger. But that’s not how these drugs work. Steroids impact receptors throughout your entire body. And while some of the side effects of anabolic steroid use are cosmetic, others can cause serious damage to your heart, brain, and other organs. Here are some of the more serious side effects of anabolic steroid use.

Steroid Risks: Cardiovascular Disease

There are four negative changes that can happen to the cardiovascular system as a result of steroid use.

  1. Increased “bad” cholesterol
  2. Blood clots are more likely, which increases your risk of heart attacks and strokes
  3. Increase fluid retention leading to elevated blood pressure
  4. Steroids can even affect the heart muscle itself, increasing your risk of arrhythmias and sudden death

Steroid Risks: Sexual Reproduction

When hormones levels are normal, your hypothalamus makes a hormone that leads to testosterone and sperm production. If your testosterone levels get too high, this sends a message to the hypothalamus to stop testosterone production in your body. So in a strange way, too much testosterone at once (from steroids) can lead to low testosterone in long run.

This shutdown of your body’s own testosterone production can also lead to low sperm count, and even overactive clitoral growth in women (clitoromegaly), and testicular shrinkage in men.

While these effects are usually temporary and reversible when you stop using anabolic steroids, there have been cases where these side effects are irreversible. In particular, clitoral growth in women is often irreversible.

Steroid Risks: Baldness, Acne, and Man Boobs

  • Skin and Hair: Anabolic steroid use can cause severe acne all over the body including the dreaded “backne”. It also causes increased body hair growth in women and accelerating hair loss in men.
  • Breast: In a cruel twist of fate, anabolic steroid use causes breast shrinkage in women and breast growth, or gynecomastia, in men.

Steroid Risks: Brain & Liver Disease

Anabolic steroid use has been implicated in several types of liver disease and may also cause impulsive behavior and aggression (“roid rage”). Stopping steroid use has been linked to depression.

Should You Take Anabolic Steroids?

If this list of side effects hasn’t deterred you from steroid use, here’s something else to think about. The cardinal rule for medical decision making is to weigh the benefits against the risks. When it comes to anabolic steroids, the risks and benefits vary depending on the person.

If you have a wasting disease due to a serious illness, the benefits of anabolic steroids may outweigh the risks—when prescribed by a doctor. If you just want to  get “swole”, the risks far outweigh any potential short-term benefits.

Steroids will give you bigger, stronger muscles. That’s true. But at the risk of major organ failure as well as some nasty cosmetic side effects like baldness, acne, and irreparably altered genitals. Oh and anabolic steroids without a prescriptions are illegal. So there’s that.

In almost every use case, anabolic steroids simply aren’t worth the risk. If you’re still thinking about taking steroids, talk to your doctor. Hopefully she’ll have more to say about your particular case.

This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

We're roman and we treat

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He’s a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).

Dr. Tzvi Doron

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He’s a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).

All stories by:Dr. Tzvi Doron
  • any safe way to increase T in a 68 yr old male in great physical shape?

    any of these hyped supplements worthwhile?


  • Do steroids require a prescription?

  • Dr. Tzvi Doron May 22, 2018 at 6:17 pm

    Hi Jim,

    Yes. Steroids require a prescription unless you purchase them illegally on the black market. I highly recommend that if you are going to use anabolic steroids or testosterone that you work with a licensed physician and have them prescribed rather than buying them on the black market.

  • Dr. Tzvi Doron May 22, 2018 at 6:21 pm

    Hi KJ,

    Sometimes testosterone therapy is the way to go if you are having symptoms and have at least 2 low testosterone blood test results. I recommend avoiding the supplement route for this. If a supplement does increase your testosterone, it is likely tainted with pharmaceuticals. Better to go the route of knowing what you are taking.

  • Thank you very much for informing and guiding on the benefit on anabolic steroids. There are some injectable steroids online which are both fat soluble and water soluble online as we know that water soluble vitamins.

  • Interesting conversation. I took 5 mg/day of Danabol in 1983 for a lower back injury(4 weeks). The results were amazing and I retained most of my strength gains with no ill effects. I am now 65 years of age and still in good health. I however am loosing my lean muscle tissue at a normal rate. I have always considered using them again and feel that it would help me maintain my lean muscle mass. Also keep me active. We have so little research on this matter.

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Dr. Tzvi Doron

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He’s a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).

All stories by:Dr. Tzvi Doron