HEALTH RISKS:

Cardiovascular – Anabolic steroids can have several effects that may increase the risk of cardiovascular disease or event. The most commonly discussed is the effects the drugs have on serum cholesterol, most notably a decrease in HDL (good) cholesterol. This is sometimes associated with an increase in LDL (bad) cholesterol. It is important to point out that oral anabolic/androgenic steroids tend to have a much more profound negative impact here than injectable (non 17-alkylated) steroids. Many athletes avoid oral steroids in an effort to reduce some of the negative impact steroid therapy can have on cholesterol values. Anabolic steroid using athletes also notice more LVH (Left Ventricular Hypertrophy) than non-steroid-using athletes, which is another risk for heart disease. Blood pressure can also increase with steroid use, but clinically dangerous increases in blood pressure are not common. This side effect can be more pronounced in “estrogenic” anabolic/androgenic steroids.

Brain Cancer – The death of professional football player Lyle Alzado in 1993 popularized a new side effect of steroids, brain cancer. Alzado attributed his cancer to years of steroid use, and before he died had urged people not to make the same mistakes as him and avoid the drugs. This was a very sad and tragic event, but it is also important to point out that there is no proven medical association between steroid use and brain cancer. Alzado’s physician has also stated that there is no known association between his steroid use and brain cancer.

Prostate Cancer - Androgens can increase the volume of the prostate. This is well documented and understood. These drugs need to be used with caution in people suffering from an enlarged prostate or previous prostate cancer. Medical evidence is not conclusive that androgens can promote prostate cancer, however. Currently, a great deal of attention is being given to androgen therapy in older men, and as of yet no conclusive link between supplementing androgens in aging men and prostate cancer is established. That is not to say it will not, however, but at this point prostate cancer is not accepted as a side effect of periodic steroid use in an otherwise healthy male.

Liver Cancer/Failure - This potential side effect of steroid abuse is highly overstated, however, it is also valid at some level. This is caused by the chemical structure of many oral steroids. A hormone like testosterone is too efficiently destroyed by the liver to be given orally, thus must be modified to resist metabolism before it can be used in the form of a pill or capsule. The process of steroid c-17 alkylation was developed, which eliminated the principle metabolic pathway of steroid breakdown in the liver. This has allowed the development of effective oral steroids such as Dianabol, Winstrol, and Anadrol, but also created steroids that place some strain on the liver. With severe abuse liver failure can result, but medically documented cases of this occurring in otherwise healthy athletes numbers less than 10, and usually follows a very high level of abuse. Non-alkylated injectable steroids such as nandrolone, testosterone, Primobolan, and Equipoise offer no toxicity, even in high doses.

Infertility – This is commonly stated and valid, though also a temporary side effect. What occurs is very similar to estrogen-based birth control in women. When you administer a sex steroid from an outside source, the natural hormone cycle is interrupted, blocking normal fertility. The World Health Organization has even evaluated testosterone as a potential male birth control option, deeming it to be effective, safe, and reversible. At one point in time “Testosterone Rebound Therapy” was common, which involved a 6-8 week cycle of testosterone followed by a potential window of fertility (greater sperm production) after the drug is withdrawn and the body is returning its natural hormone balance (which may include brief post-cycle spikes in hormone/sperm production). Medical intervention is sometimes necessary following long-term steroid abuse, but no case of permanent irreversible sterility due to steroids has even been documented.

Stunted Growth – This also is a valid side effect when anabolic/androgenic steroids are taken during adolescence. It is important to point out, however, that this is actually due to estrogens, not androgens. Estrogen is the reason women tend to have a shorter stature than men, and also the reason men tend to keep growing for a longer time during youth. Stunted growth is only an issue with estrogenic steroids. Some steroids have actually been used successfully to treat adolescents with constitutionally delayed growth, given their effects on the retention of calcium in the bones.

Mental Health – Male aggression is linked to androgen levels. This is well understood, and increased aggression is possible with steroid use. To give an example, it might be to the extent where someone would become angry after getting cut off in traffic, where they would otherwise just “let it go”. We are not talking to the extent of “roid rage”, which refers to violent behavior in an otherwise mentally stable person. Roid rage is largely discounted among those that closely study steroids. Suicide is also commonly discussed with relation to steroid use, due to a small number of high profile teen suicides that included steroid use. While the media may rush to concluding such a link, no such has ever been established in the medical literature, and suicide is not an accepted side effect of steroid use in an otherwise healthy individual.

Cosmetic (Acne, Hair Loss, Gynecomastia, Virilization, Water Retention) – I placed these under one category, as it is important to stress that these are all cosmetic, not health-threatening, potential side effects of steroid use. They may be of issue to the physical appearance of the user, and therefore of great interest to monitor during use, but will not result in death or illness. Acne, of course, is self-explanatory. Hair loss is possible, but only if the person is genetically predisposed to hair loss in the first place. If so, the androgenic component of steroids may accelerate the process. Gynecomastia refers to the development of female breast tissue, which usually amounts to an unsightly puffiness under the nipples before the athlete takes measures to mitigate this. This is only linked to estrogen, and not associated with non-estrogenic steroids. Sometimes drugs can correct mild gynecomastia, while at other times surgery may be required. Virilization refers to the appearance of masculine features on women, due to the taking of what are essentially male sex hormones. Side effects such as deepening of the voice, thickening of the skin, and growth of male body/facial hair can be permanent side effects if left to progress unchecked. Water retention is the simple increased holding of water in the tissues, often causing a puffy appearance in the face and body. This, again, is largely associated with estrogen, and estrogenic steroids.