Anavar (oxandrolone) carries real health risks, even though its reputation as a “mild” steroid leads many people to underestimate them. It can damage your liver, significantly worsen your cholesterol, suppress your natural hormone production, and harm your kidneys. Some of these effects reverse when you stop, but others can be permanent.
How Anavar Affects Your Liver
Anavar belongs to a class of steroids modified at a specific point in their chemical structure (called 17-alpha alkylation) so they can survive passing through the liver when taken as a pill. That modification is exactly what makes them toxic to the liver. The tradeoff is straightforward: oral convenience in exchange for increased liver strain.
Prolonged use of these steroids can cause a range of liver problems, from elevated liver enzymes (a sign of cellular damage) to more serious conditions. One is peliosis hepatis, where blood-filled cysts form inside the liver, making it enlarged and fragile. Others include benign liver tumors and, in rare cases, liver cancer. These risks scale with dose and duration. The FDA-approved medical dosage for Anavar is just 2.5 to 20 mg per day for courses of 2 to 4 weeks at a time, with breaks in between. People using it for physique enhancement typically take far more, for far longer, without those breaks.
Cholesterol and Heart Health
The cardiovascular impact of Anavar is one of its most consistent and well-documented harms. In a study of resistance-trained men using oxandrolone, HDL (“good”) cholesterol dropped from a median of 47 mg/dL before use to just 24 mg/dL during use. That’s a roughly 50% decline, plunging well below the minimum healthy threshold of 40 mg/dL. Some individuals saw their HDL fall as low as 11 mg/dL.
LDL (“bad”) cholesterol also rose modestly, from 102 to 111 mg/dL. After the men stopped using it, HDL bounced back to 49 mg/dL and LDL returned to baseline. So the cholesterol damage appears reversible, but only if you stop. Staying on Anavar keeps your lipid profile in a danger zone that accelerates plaque buildup in your arteries, raising the long-term risk of heart attack and stroke.
Testosterone Suppression and Recovery
Your body produces testosterone through a feedback loop between your brain and your testes (or ovaries). When you introduce an external steroid like Anavar, your brain detects the excess and shuts down its own signaling. Research shows this suppression is nearly complete regardless of which steroid you use or how much you take. Levels of the hormones that trigger testosterone production (LH and FSH) become essentially undetectable.
After stopping, most men with previously normal hormone function recover their testosterone levels within about three months, with virtually all recovering by 12 months. But men who had borderline or abnormal levels before starting sometimes don’t fully recover. In one study, about a quarter of men with abnormal baseline function still had low testosterone at the end of follow-up.
Fertility takes even longer. Sperm production can take 47 to 69 weeks to normalize, and most steroid users start another cycle before that happens. If having children is on your radar, that timeline matters.
Kidney Damage
Kidney risks from anabolic steroids are less talked about but real. Researchers at Columbia University studied bodybuilders who used anabolic steroids for years and found that all of them developed protein leaking into their urine and severe reductions in kidney function. Biopsies revealed scarring inside the kidneys, a condition called focal segmental glomerulosclerosis.
When the bodybuilders stopped, most saw improvement. One individual with advanced disease progressed to kidney failure requiring dialysis, and another who resumed steroid use relapsed severely. A complicating factor is that the standard blood test for kidney function (serum creatinine) is naturally higher in muscular people, which can mask early kidney damage. By the time problems show up on routine bloodwork, significant harm may already be done.
Mood and Psychological Effects
Anavar and other anabolic steroids affect your brain, not just your body. Reported psychiatric effects include irritability, hostility, mood swings, depression, mania, and in some cases psychosis. Sometimes subtle personality changes are the only visible sign. A study comparing 88 steroid-using athletes with 68 non-users found that 23% of users reported major mood symptoms (mania, hypomania, or depression) compared to just 6% of non-users.
About 10% of steroid users in another study developed hypomanic episodes during use, characterized by euphoria, inflated confidence, and impulsive behavior. Roughly the same percentage experienced depression after stopping. Among women, the rates were even higher: 56% reported hypomanic symptoms during use, and 40% reported depression after discontinuation. Some users also developed a distorted body image, perceiving themselves as too small despite significant muscle mass.
Hair Loss and Skin Changes
Anavar is derived from DHT, the hormone primarily responsible for male-pattern hair loss. Unlike some steroids that need to be converted into DHT by an enzyme in your body, Anavar acts directly on hair follicles without that conversion step. This means it can accelerate hair thinning in anyone genetically predisposed to it. It also means that finasteride, the common hair-loss drug that works by blocking that conversion enzyme, offers little to no protection against Anavar-related shedding.
Acne is another common side effect, particularly in women and younger users. These androgenic skin effects are driven by the same receptor activity that causes the drug’s muscle-building properties, so you can’t separate the benefit from this particular risk.
Risks Specific to Women
Anavar is often marketed in fitness circles as “female-friendly,” but the FDA label tells a different story. Virilization symptoms in women include deepening of the voice, increased facial and body hair, clitoral enlargement, menstrual irregularities, and male-pattern baldness. The FDA label is explicit: some of these changes are irreversible even after promptly stopping the drug, and taking estrogen alongside it does not prevent them.
Women are advised to watch for early signs like hoarseness or increased acne, because once virilization progresses beyond a certain point, stopping the drug won’t undo the damage. Voice changes and clitoral enlargement, in particular, tend to be permanent.
Legal Status
Oxandrolone is classified as a Schedule III controlled substance under U.S. federal law. Possessing it without a valid prescription is a criminal offense. It is FDA-approved only for specific medical conditions like involuntary weight loss, and even then, prescribed at low doses for short, intermittent courses. The gap between medical use (2.5 to 20 mg daily for a few weeks) and typical performance-enhancing use is substantial, and most of the serious side effects track closely with higher doses and longer durations.