Do Steroid Injections Make You Gain Weight?

Steroid injections can contribute to weight gain, but the effect depends heavily on how many injections you get, where they go, and your individual physiology. The “steroids” used in joint, epidural, and soft-tissue injections are glucocorticoids, not the anabolic steroids associated with bodybuilding, and their route to weight gain runs through appetite changes, insulin disruption, and fat redistribution. A single injection for a sore knee is unlikely to move the scale in any lasting way, but repeated injections over months or years can produce measurable changes, particularly in certain people.

How a Local Injection Affects Your Whole Body

When a doctor injects a corticosteroid into your knee, shoulder, or spine, the drug is meant to stay local and calm inflammation in that specific spot. In practice, a significant portion of the drug escapes into your bloodstream. A review of the pharmacology of locally injected glucocorticoids found that both intra-articular and epidural injections can produce systemic effects lasting weeks, with complications that include elevated blood sugar, loss of bone density, and even features of Cushing syndrome in some patients.¹ How much steroid leaks into your system varies considerably from person to person, which is one reason some people notice side effects and others don’t.

The speed and degree of that systemic spillover also depend on the formulation. A pharmacokinetic study comparing a standard crystalline suspension of triamcinolone acetonide (a common injectable steroid) with an extended-release microsphere version found stark differences. The standard formulation produced a plasma peak about eleven times higher than the extended-release version within just four hours.² A higher plasma peak means more steroid circulating through your body and, potentially, more systemic side effects including those that nudge your weight upward.

The Pathways Between Glucocorticoids and Weight Gain

Glucocorticoids don’t simply add fat to your body directly. They pull several metabolic levers at once, and the combination is what leads to weight gain when exposure is high enough or prolonged enough.

The appetite pathway is probably the most intuitive. Glucocorticoid excess disrupts the hormones that regulate hunger and satiety, including leptin and ghrelin. A review in Obesity Reviews described how this hormonal disruption can lead to uncontrolled reward-related eating, essentially making food harder to resist.³ Animal research backs this up: when researchers increased corticosterone levels in the appetite-control region of the rat brain, the animals ate more and gained more weight.⁴ Behavioral changes like increased eating and disrupted sleep patterns are among the most commonly reported effects of both natural and synthetic glucocorticoids in the brain.⁵

Then there’s insulin resistance. A study in healthy volunteers given an anti-inflammatory dose of prednisone for seven days found that fasting glucose production rose significantly, and the body’s ability to use insulin dropped at every insulin level tested. The researchers traced the problem primarily to impaired glucose transport into cells, a defect that happens after insulin has already bound to its receptor.⁶ When your cells can’t take up glucose efficiently, your body compensates by pumping out more insulin, and chronically elevated insulin is a well-established driver of fat storage.

Finally, glucocorticoids don’t just increase total body fat; they rearrange where fat accumulates. Despite having an acute lipolytic (fat-burning) effect, long-term glucocorticoid exposure paradoxically promotes fat buildup in the abdomen, the back of the neck, and the cheeks while wasting fat from other areas under the skin. This pattern of central fat accumulation closely resembles what happens in metabolic syndrome.⁷ So even if someone’s total weight doesn’t change dramatically, they might notice their midsection expanding or their face rounding out.

What the Clinical Evidence Actually Shows

The real-world picture is messier than the biology might suggest. Different study designs give different answers depending on what kind of steroid use they’re tracking and over what time frame.

A large cohort study from the Lifelines project, following tens of thousands of participants over several years, found that people who started any new corticosteroid use gained slightly more weight per year compared to non-users. Among those initiating local corticosteroid use specifically (injections, inhalers, topical preparations), the weight gain was statistically significant but small in absolute terms. The more striking finding was that new systemic corticosteroid use (oral pills, for example) was associated with increased waist circumference. When people stopped corticosteroids, their waist circumference decreased.⁸ These effects were driven mainly by women and individuals whose BMI was already 25 or above; men and those with a lower BMI showed no significant change.

Contrast that with a focused study on epidural steroid injections, which found no significant weight change after a standard series of three injections.⁹ This aligns with the general principle that a short, limited course of local injections doesn’t produce enough systemic steroid exposure to meaningfully change body weight. The trouble tends to start with repeated or ongoing exposure.

The gap between these findings makes sense when you consider the dose-response relationship. Animal research with dexamethasone found that a single injection didn’t affect food intake at all, but repeated injections suppressed eating and altered body weight in a dose-dependent manner.¹⁰ In humans, the same pattern likely holds: one or two injections spaced months apart are a very different proposition from four or five injections within a single year.

Who Is Most at Risk

Not everyone who gets steroid injections will notice weight changes, and the research suggests some groups are more vulnerable than others. The Lifelines cohort study found that the weight and waist effects of corticosteroid use were concentrated among women and people who were already overweight.⁸ Men and normal-weight individuals showed no statistically significant change, which doesn’t mean they’re immune, but it does mean the effect, if present, was too small to detect in a large population.

A cross-sectional survey of over 800 patients using systemic glucocorticoids offered more nuance. The risk of weight gain increased with the duration of steroid exposure, unlike some other side effects (insomnia, for instance) that show up almost immediately. Younger patients were more likely to report weight gain, increased appetite, and changes in fat distribution than older patients. Women reported more morphological changes and skin-related side effects than men.¹¹ While this survey focused on systemic (oral) steroid users, the underlying biology is the same once the drug enters the bloodstream, so the patterns likely apply to anyone receiving enough steroid exposure through injections.

There’s also significant individual variability in how much steroid gets absorbed from a local injection and how the body responds to it.¹ Two people receiving the same injection in the same joint can have very different blood levels of steroid afterward. Genetics, the vascular supply of the injection site, the specific formulation used, and whether the injection is placed accurately all play roles.

A Practical Way to Think About Injection Frequency

Most doctors follow informal guidelines that limit cortisone shots to roughly three or four per joint per year, with some spacing between them, partly to protect the cartilage and partly to avoid cumulative systemic effects. This is where the clinical picture gets a bit uncomfortable for patients with chronic conditions like osteoarthritis or recurrent tendinitis who need repeated injections to function. Each injection adds to the total glucocorticoid load your body has to process, and the metabolic effects described above can compound over time.

If you’re someone who has gotten one or two injections for an acute problem and you’re wondering whether to worry about weight gain, the short answer is probably not. The epidural study mentioned earlier showed no weight change after three injections, and a short course of local steroid exposure is worlds apart from the chronic glucocorticoid exposure that produces Cushing-like features.⁹ But if you’re someone getting injections in multiple joints, or returning for shots several times a year over several years, the cumulative exposure starts to resemble what the Lifelines study captured: a small but real upward trend in weight and waist circumference.⁸

Managing Weight When You Need the Injections

This is, unfortunately, a corner of medicine where the evidence is thin. A review of strategies for preventing obesity in corticosteroid-treated patients found that the existing research is of poor quality, based largely on small feasibility studies in narrow populations like children with leukemia or women with lupus. Those small studies showed mixed results, and the review concluded that there is genuine clinical uncertainty about which weight-management approaches actually work for steroid-treated patients.¹²

That said, some reasonable approaches follow from the biology. Since glucocorticoids drive insulin resistance and increase appetite, strategies that address both of those make intuitive sense: reducing refined carbohydrates, staying physically active to the extent your condition allows, and being deliberately aware of appetite increases after an injection. The appetite effect can be sneaky because it doesn’t always feel like “craving” in the classic sense; some people just find themselves finishing larger portions or snacking more without noticing. Knowing that this is a pharmacological effect rather than a character flaw can help you watch for it.

The Lifelines data also offered one encouraging finding: when people stopped using corticosteroids, their waist circumference decreased.⁸ This suggests that at least some of the body composition changes are reversible once the steroid exposure ends. The fat redistribution associated with glucocorticoid excess tends to gradually correct itself as hormone levels normalize, though the timeline varies.

Non-Steroid Injection Alternatives

For people concerned about the metabolic side effects of repeated steroid injections, alternatives exist, though they come with their own trade-offs. A systematic review of non-steroidal anti-inflammatory drug (NSAID) injections for musculoskeletal pain found that, compared to corticosteroids, injected NSAIDs provided equivalent or even better pain relief for the conditions assessed. There was also weak evidence suggesting a lower rate of symptom recurrence with NSAID injections compared to steroid injections.¹³ NSAID injections don’t carry the same metabolic baggage because they work through a completely different mechanism that doesn’t involve the hypothalamic-pituitary-adrenal axis.

Other options that avoid systemic glucocorticoid effects include hyaluronic acid injections (viscosupplementation) for knee osteoarthritis, platelet-rich plasma injections, and newer extended-release steroid formulations designed to keep the drug in the joint longer and out of the bloodstream. That pharmacokinetic study comparing extended-release triamcinolone to the standard crystalline suspension showed dramatically lower systemic steroid levels with the extended-release version.² Lower systemic exposure should, in theory, mean fewer metabolic side effects, including a smaller risk of weight-related changes.

The Difference Between Corticosteroids and Anabolic Steroids

This confusion comes up constantly, and it matters because the weight effects are completely different. The steroid injections given for pain and inflammation are corticosteroids (also called glucocorticoids), synthetic versions of cortisol. They suppress the immune response and reduce swelling. The “steroids” associated with muscle gain and weight gain in athletics are anabolic-androgenic steroids, synthetic versions of testosterone. They build muscle. Different drugs, different receptors, different metabolic effects.

Corticosteroid-related weight gain tends to involve increased body fat, particularly around the midsection and face, combined with potential muscle wasting if exposure is prolonged. This is essentially the opposite of what anabolic steroids do. The long-term metabolic pattern of glucocorticoid excess includes elevated blood sugar, insulin resistance, and disrupted fat distribution.⁷ If someone tells you their cortisone shot made them gain muscle, something else is going on.

This distinction also matters when evaluating information online. Search results for “do steroid injections cause weight gain” often mix advice about corticosteroids with content about anabolic steroids, producing a confusing blend of contradictory claims. When your doctor offers you a steroid injection for a painful joint or a herniated disc, they are offering you a corticosteroid, and the weight-related concerns that apply are the ones outlined in this article: appetite changes, insulin resistance, and fat redistribution with repeated or prolonged exposure, not the muscle-building effects of testosterone derivatives.

Why Blood Sugar Spikes After Injections Matter for Weight

Even people who don’t notice a change on the scale often experience blood sugar fluctuations after a steroid injection, and these transient glucose spikes connect to the weight story in a way that’s easy to overlook. Corticosteroids increase the liver’s glucose output and impair the body’s ability to clear glucose from the blood.⁶ For people with diabetes or prediabetes, this can mean days of poorly controlled blood sugar after a single injection. Even in people with normal glucose metabolism, the temporary insulin resistance can trigger cravings for carbohydrate-rich foods as the body tries to compensate, creating a behavioral pathway to overeating that sits on top of the direct appetite-stimulating effects of the drug.

This is why some clinicians advise patients with diabetes to monitor their blood sugar more closely for one to two weeks after a steroid injection and to have a plan for adjusting their medication if needed. If you’re not diabetic but you notice unusual hunger or carb cravings in the days following an injection, the glucose disruption is a likely culprit. It’s temporary in the context of a single injection, but it adds another mechanism by which repeated injections can gradually shift your weight upward.

1
PubMed. Systemic Absorption and Side Effects of Locally Injected Glucocorticoids
2
Osteoarthritis and Cartilage. Synovial and systemic pharmacokinetics (PK) of triamcinolone acetonide (TA) following intra-articular (IA) injection of an extended-release microsphere-based formulation (FX006) or standard crystalline suspension in patients with knee osteoarthritis (OA)
3
PubMed Central. Glucocorticoids, stress and eating: The mediating role of appetite-regulating hormones
4
Molecular Metabolism. Effects of corticosterone within the hypothalamic arcuate nucleus on food intake and body weight in male rats
5
Wiley Online Library. Central nervous system effects of natural and synthetic glucocorticoids
6
The Journal of Clinical Investigation. An in vivo and in vitro study of the mechanism of prednisone-induced insulin resistance in healthy subjects
7
Bioscientifica Journals. Glucocorticoids and fatty acid metabolism in humans: fuelling fat redistribution in the metabolic syndrome
8
PubMed Central. Corticosteroid Use and Long-Term Changes in Weight and Waist Circumference: The Lifelines Cohort Study
9
PubMed. Epidural steroid injections do not induce weight gain
10
European Journal of Pharmacology. Dexamethasone reduces food intake, weight gain and the hypothalamic 5-HT concentration and increases plasma leptin in rats
11
PubMed. Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug
12
PubMed. Obesity prevention in corticosteroid-treated patients: Use and effectiveness of strategies for weight management
13
PubMed Central. Are non-steroidal anti-inflammatory drug injections an alternative to steroid injections for musculoskeletal pain?: A systematic review