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Side effects of steroids

1. Side effects of steroids

Anabolic steroids are known for their ability to greatly increase muscle mass and strength. But not everyone knows about their side effects and how to fight them. So, the aim of this article is to describe the main side effects of steroids, and how to reduce them.

To begin with, one can prevent most of adverse effects simply by following the recommendations related to the choice of steroid, duration of a cycle, doses and Post Cycle Therapy.

The general rules for harm prevention are listed below:

  • Do not exceed the recommended doses.
  • Do not use highly androgenic steroids for more than 12-16 weeks.
  • Choose steroids that suppress secretion of endogenous testosterone to a lesser extent. Nevertheless one should understand that prolonged use of any anabolic steroid inevitably leads to its complete suppression.
  • Choose steroids that have no liver toxicity.
  • Monitor your blood count, hormonal levels and other biochemical indicators on a regular basis.
  • Take antiestrogens to prevent gynecomastia and restore testosterone production.

Contraindications to steroid usage:

  • Do not use steroids if you are under the age of 25. They can change your hormonal level and stop your growth, due to the closure of bone growth zones.
  • Women should avoid using steroids, as virilization is irreversible.
  • Do not use steroids if you have heart problems, as they can worsen the situation.
  • Renal and hepatic inefficiency.
  • Uncompensated hypertension.
  • Benign prostate tumor.
  • Atherosclerosis.

2. Suppression of endogenous testosterone production

Fall of testosterone level and restoring

As we mentioned before, the inhibition of natural testosterone is inevitable effect of prolonged steroidal usage.

When the excessive amount of testosterone is introduced into the body, the natural reaction of endocrine system is to suppress its production in testicles in order to restore the endocrine balance. This phenomenon is called feedback mechanism and it is applied to the regulation of all hormones.

The figure above shows that the concentration of testosterone drops with the increase of nandrolone concentration in the blood, and then the reverse process occurs.

2.1 Prevention

Fortunately, this adverse effect is reversible. In order to reduce the harm of steroids to a minimum, it is necessary to take gonadotropin. It can increase the natural testosterone production and prevent the atrophy of testicles.

FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are constantly produced in human organism to support the function of the testicles - spermatogenesis and testosterone production. During steroid cycle LH and FSH production decreases which causes the onset testicular atrophy.

Chorionic gonadotropin (which action is similar to LH and FSH) restores the hormonal balance and function of the testicles. The doses of gonadotropin depend on the length of steroid cycle and strength of steroids you use.

If the length of your cycle does not exceed 6 weeks and you use only one steroid in small doses, then there is no need for gonadotropin. In case your cycle exceeds 6 weeks, your dosage is high or you take two or more steroid substances, then make 2 injections of gonadotropin a week at the dosage 250-500 IU, starting from the third-forth week of your cycle.

There is an opinion that gonadotropin is required only after the end of the cycle. But this point of view is wrong – as testicles do not receive proper stimulation, the process of atrophy begins. Moreover the intake of gonadotropin in post cycle therapy may produce counterproductive effect.

Meanwhile the application of gonadotropin during your cycle will maintain the function of testicles. One should remember that the usage of gonadotropin is not for gaining mass but for your safety, therefore small dosages are enough.

To restore the natural testosterone production, a Post Cycle Therapy with antiestrogens is required.

3. Liver Damage

Lever Adenome
Lever Fat distrophy

Liver Damage is one of the most known side effects, but its real significance is rather exaggerated by the media. First of all liver damage is caused by tablet form of steroids which are methylated at position 17.

This methyl group prevents destruction of steroids in the liver, but at the same time it makes them toxic. Secondly, the liver damage occurs only when high doses of steroids are used within short period of time.

During the tests with Fluoxymesterone (Halotestin), Dianabol and Winstrol on laboratory animals, scientists have confirmed that damage to the liver occurs only when doses are 10 times higher than recommended ones.

For instance, the toxicity of methandrostenolone starts to appear only when the daily dosage exceeds 80mg/day, meanwhile the recommended dose is about 20-30 mg.

3.1 Prevention

  • Do not exceed the recommended dose.
  • Do not use 17-alkylated steroids.
  • Take injectable steroids instead of orals, they are liver friendly.

4. Gynecomastia


Gynecomastia is an enlargement of mammary glands in men. It is caused only by aromatizable steroids (prone to estrogen conversion), such as Methandrostenolone, Testosterone, Sustanon, etc. Whereas some steroids like Oral Turinabol, Boldenon, Primobolan, Winstrol, Anavar almost never cause gynecomastia. One should remember that this side effect can be easily avoided.

4.1 Prevention

If you are going to use aromatizable steroids, then you have to take aromatase inhibitors, e.g. Anastrozole at the dosage 0.5 mg every other day from the second week of your cycle. Antiestrogens will provide almost 100% safety, and besides they are freely available in the pharmacy. There is an opinion that anti-estrogens should be taken only after the end of a cycle or when the first signs of gynecomastia appear. This is a serious mistake, due to which many athletes have gynecomastia. Antiestrogens should be used throughout the cycle. Remember that gynecomastia is often irreversible, and it must be prevented, not treated! Optimally you need to make estrogen tests first and then adjust the doses of anti-estrogens.

5. Acne


Acne is also a common side effect among steroid users. As steroids increase the secretion of sebum, it leads to inflammation of hair follicles and acne formation. This effect is peculiar to highly-androgenic drugs.

5.1 Prevention

6. The increase of blood cholesterol levels

Anabolic steroids can decrease the amount of high-density lipoproteins (good cholesterol), and increase low-density lipoproteins (bad one), which can lead to atherosclerosis. However it doesn’t happen due to the short-term effect.

Eventually cholesterol returns to its original level after discontinuation of steroid usage. One should also mention that not all of steroids can increase the cholesterol levels.

6.1 Prevention

  • Take :omega-3: fatty acids during the cycle.
  • Reduce the intake of animal fat.

7. Cardiovascular problems

Anabolic steroids are usually associated with cardiovascular diseases. Probably, it is linked to increase of bad cholesterol. Besides, the abuse of steroids can lead to hypertrophy of heart ventricles. However, the usual strength training can do the same effect.

7.1 Prevention

  • Do not make long-term :cycles: and do not use high doses of steroids.
  • Include aerobic exercises into the training plan.
  • Take :omega-3: fatty acids during the cycle and reduce the intake of animal fat.
  • Take drugs for heart strengthening.

8. High blood pressure

This problem occurs due to ability of anabolic steroids to cause:

  • sodium retention in the body
  • narrowing of the vessels
  • increase of the blood volume

The normal blood pressure should be within 140/90 mm Hg (in case of diabetes, it is within 130/80 mm Hg). To avoid the problems measure the blood pressure on regular basis (two times a day).

8.1 Prevention

This side effect can be easily avoided by taking 50 mg of Metoprolol: and 5 mg of Enalapril. In emergency cases kapoten (captopril) is used. If it is not enough, you can increase the dosage of antihypertensive drugs up to the normalization of blood pressure.

9. Kidney problems

Kidneys filter the blood and remove by-products from the body. The usage of steroids can increase the burden on renal system, however they do not have a direct toxic effect. This side-effect is caused by increase of blood pressure. Besides, some steroids are used for treatment of certain kidney disorders (e.g. :nandrolone:)

9.1 Prevention

  • Normalization of blood pressure

10. Cognitive deficits

Some athletes note that their cognitive abilities and motivation to perform intellectual activity decrease during the cycle. However the reason of this effect is not entirely clear: either it happens due to inhibition of cerebral function or due to the changing of brain’s priorities in favor of aggression and physical activity

11. Mental problems

Increased aggression is a very rare side effect which occurs in less than 3-5% of cases of steroid abuse.

In recent studies it was shown that it is the temperament that plays the main role in this effect. So, if you are not inclined to aggression in usual life, then the use of anabolic steroids will not lead to this problem.

However researchers from University of Goteborg have identified that the athletes who used anabolic androgenic steroids in the past were more likely to be treated for depression, attention problems and aggressive behavior in the future.

12. Baldness

The usage of anabolic steroids can lead to baldness in men. This statement concerns only the scalp, whereas the body hair may become slightly thicker. Scientists believe that baldness is associated with a gene located in the X chromosome.

So this side-effect may appear in athletes who have genetic predisposition. Therefore if none of your ancestors had alopecia then you have nothing to worry about. In other case baldness is almost inevitable.

Besides dihydrotestosterone is considered to be the link between boldness and steroid usage, so you can take steroids that are not converted into this metabolite.

12.1 Prevention

  • Use steroids that are not converted to dihydrotestosterone.
  • Use Finasteride to prevent baldness.
  • Minoxidil (Alerna) spray is also effective in treatment of baldness.
  • Make "low androgenic" :cycles:

13. Thrombus formation

The use of anabolic steroids may lead to increase of blood clotting. Therefore in older people they can increase the risk of heart attack and stroke, which happens due to the formation of micro-thrombi in blood vessels

13.1 Prevention

To prevent this effect athletes over the age of 40 and those who have increased platelet counts in blood are recommended to use anticoagulants: Aspirin cardio at a dose 100 mg/day.

This substance suppresses the platelet aggregation and thus prevents blood clotting in vessels. However, people suffering from gastritis or other gastrointestinal disorder are not recommended to use aspirin.

14. Virilization

Virilization is an irreversible side-effect which is associated with appearance of masculine traits in women: lowering of voice, atrophy of the mammary glands, clitoral hypertrophy, excessive body hair growth etc.

These symptoms often occur in women using steroids with low anabolic index.

15. Growth Stopping

This is an irreversible condition which can happen only at a young age, when the bone growth zones are not yet closed. For this reason, athletes under the age of 25 are not recommended to take anabolic steroids. Easily aromatizable steroids are more prone to growth stopping.

16. Hypertrophy of prostate

Steroids may cause the increase of prostate only in rare cases – mostly in men over the age of 40 and in those who have genetic predisposition.

As well as in the case of alopecia, dihydrotestosterone is considered to be the main culprit of prostate hypertrophy.

16.1 Prevention

  • Use Finasteride as prevention and treatment.
  • Make "low androgenic" :cycles:.

17. Infertility

It would be more correct to say temporal sterility, but not infertility. This is a reversible side-effect which is associated with a change of hormonal background

17.1 Prevention

  • Anti-estrogens (Tamoxifen, Clomifen, Toremifene) are used for faster recovery.
  • Human chorionic and menopausal gonadotropins may also be helpful.

18. Testicular Atrophy

While taking steroids a feedback mechanism reduces the natural production of gonadotropin. This hormone constantly stimulates testes, and when its concentration decreases, testicles begin to atrophy.

In severe cases atrophy of testicles can be irreversible, which leads to impotence.

18.1 Prevention

Fortunately, this side-effect can be easily prevented by gonadotropin injections, which is described above. Atrophy of testicles occurs rarely, when high doses of steroids are taken for a long time.

As a rule Gonadotropin is necessary only for long cycles (more than 1,5-2 months) with high doses of steroids.

19. Myths about steroids

In this section, we listed the most popular myths about side effects of steroids

  • They reduce the length of penis.
  • Cause brain damage.
  • Side effects always occur and they are irreversible.
  • It is impossible to get muscle gain after using them.

21. Notes

  1. Follow Journal of Steroid Biochemistry and Molecular Biology. 84 (2003) 369-375)
  2. Follow Med Sci Sports Exerc. 1999 Feb;31(2):243-50, Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids. Molano F, Saborido A, Delgado J, Moran M, Megias A.
  3. Follow Int J Sports Med 1996 Aug;17(6):429-33, Body composition, cardiovascular risk factors and liver function in long-term androgenic-anabolic steroids using bodybuilders three months after drug withdrawal. Hartgens F, Kuipers H, Wijnen JA, Keizer HA.
  4. Follow GYNECOMASTIA: ETIOLOGY, DIAGNOSIS, AND TREATMENT Chapter 14 - Ronald S. Swerdloff, MD, Jason Ng, MD, and Gladys E. Palomeno, MD, March 1, 2004
  5. Follow Am J Clin Dermatol. 2002;3(8):571-8. 2. Clin Dermatol. 2004 Sep-Oct;22(5):419-28. 3. Pol Merkuriusz Lek. 2004 May;16(95):490-2.
  6. Follow Kanayama G, Kean J, Hudson JI, Pope HG, Jr. (2012): Cognitive deficits in long-term anabolic-androgenic steroid users. Drug and alcohol dependence
  7. Follow Su TP, Pagliaro M, Schmidt PJ, Pickar D, Wolkowitz O, Rubinow DR (1993): Neuropsychiatric effects of anabolic steroids in male normal volunteers. JAMA : the journal of the American Medical Association. 269:2760-2764
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  11. Follow Human Anatomy and Physiology, 6th Edition, John W. Hole jr., Wm. C. Brown Publishers.
  12. Follow Fertil Steril. 2004 Jan;81(1):226. 2. Urology. 2000 Oct 1;56(4):669.3. J Clin Endocrinol Metab. 1985 Oct;61(4):746-52 4. Fertil Steril. 1994 May;61(5):911-4. 5. Andrologia. 1985 Sep-Oct;17(5):497-501 6. Urol Clin North Am. 1986 Aug;13(3):455-63.
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