Anabolic steroid abuse has been associated with a wide range of adverse side effects ranging from some that are physically unattractive, such as acne and breast development in men, to others that are life threatening, such as heart attacks and liver cancer. Most are reversible if the abuser stops taking the drugs, but some are permanent, such as voice deepening in females.
Most data on the long-term effects of anabolic steroids in humans come from case reports rather than formal epidemiological studies. From the case reports, the incidence of lifethreatening effects appears to be low, but serious adverse effects may be underrecognized or underreported, especially since they may occur many years later. Data from animal studies seem to support this possibility. One study found that exposing male mice for one-fifth of their lifespan to steroid doses comparable to those taken by human athletes caused a high frequency of early deaths.
Hormonal system
Steroid abuse disrupts the normal production of hormones in the body, causing both reversible and irreversible changes. Changes that can be reversed include reduced sperm production and shrinking of the testicles (testicular atrophy). Irreversible changes include male-pattern baldness and breast development (gynecomastia) in men. In one study of male bodybuilders, more than half had testicular atrophy and/or gynecomastia.
In the female body, anabolic steroids cause masculinization. Breast size and body fat decrease, the skin becomes coarse, the clitoris enlarges, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects become irreversible.
Possible Health Consequences of Anabolic Steroid Abuse
Hormonal system
Men
* infertility
* breast development
* shrinking of the testicles
* male-pattern baldness
Women
* enlargement of the clitoris
* excessive growth of body hair
* male-pattern baldness
Musculoskeletal system
* short stature (if taken by adolescents)
* tendon rupture
Cardiovascular system
* increases in LDL
* decreases in HDL
* high blood pressure
* heart attacks
* enlargement of the heart’s left ventricle
Liver
* cancer
* peliosis hepatis
* tumors
Skin
* severe acne and cysts
* oily scalp
* jaundice
* fluid retention
Infection
* HIV/AIDS
* hepatitis
Psychiatric effects
* rage, aggression
* mania
* delusions
Musculoskeletal system
Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence and provide the signals to stop growth as well. When a child or adolescent takes anabolic steroids, the resulting artificially high sex hormone levels can prematurely signal the bones to stop growing.
Cardiovascular system
Steroid abuse has been associated with cardiovascular diseases (CVD), including heart attacks and strokes, even in athletes younger than 30. Steroids contribute to the development of CVD, partly by changing the levels of lipoproteins that carry cholesterol in the blood. Steroids, particularly oral steroids, increase the level of low-density lipoprotein (LDL) and decrease the level of high-density lipoprotein (HDL). High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. If blood is prevented from reaching the heart, the result can be a heart attack. If blood is prevented from reaching the brain, the result can be a stroke.
Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle so that it does not pump blood effectively.
Liver
Steroid abuse has been associated with liver tumors and a rare condition called peliosis hepatis, in which blood-filled cysts form in the liver. Both the tumors and the cysts can rupture, causing internal bleeding.
Skin
Steroid abuse can cause acne, cysts, and oily hair and skin.
Infections
Many abusers who inject anabolic steroids may use nonsterile injection techniques or share contaminated needles with other abusers. In addition, some steroid preparations are manufactured illegally under nonsterile conditions. These factors put abusers at risk for acquiring lifethreatening viral infections, such as HIV and hepatitis B and C. Abusers also can develop endocarditis, a bacterial infection that causes a potentially fatal inflammation of the inner lining of the heart. Bacterial infections also can cause pain and abscess formation at injection sites.