Anabolic steroids cause damage across nearly every major organ system, from the heart and liver to the brain and reproductive organs. A large Danish study found that steroid users had a mortality rate roughly 2.8 times higher than non-users, with the risk of unnatural death (including suicide and accidents) elevated even further at 3.6 times. These aren’t risks limited to extreme doses or decades of use. Many effects begin within weeks of starting a cycle, and some never fully reverse.
Heart Damage and High Blood Pressure
The cardiovascular system takes some of the hardest hits. Anabolic steroids cause the walls of the heart’s left ventricle to thicken, a condition called left ventricular hypertrophy. This happens through direct stimulation of receptors on heart muscle cells and through disruption of the body’s blood pressure regulation system. Critically, much of this new “thickness” isn’t functional muscle. It’s largely scar-like tissue from increased collagen deposits and fibrosis, which makes the heart wall stiffer and less efficient.
The pumping ability of the heart measurably declines. In steroid users, ejection fraction (the percentage of blood the heart pushes out with each beat) drops to around 49-51%, compared to 55-57% in non-users. That may sound like a small gap, but in cardiology it represents a meaningful shift toward impaired function. Blood pressure also rises, which further accelerates heart wall thickening in a self-reinforcing cycle. The HAARLEM study found a direct relationship between higher steroid doses and greater increases in ventricular wall thickness.
Hormonal Shutdown and Infertility
When you flood your body with synthetic testosterone or its derivatives, your brain responds by shutting down its own production. The hypothalamus and pituitary gland stop signaling the testes to make testosterone and sperm. The result is testicular atrophy, plummeting natural testosterone levels, and severely impaired fertility. Sperm counts can drop to zero in some users.
After stopping use, recovery happens, but slowly and sometimes incompletely. Gonadotropins (the signaling hormones from the brain) typically normalize within three to six months. Natural testosterone levels follow a similar timeline, though users who took higher cumulative lifetime doses show significantly lower testosterone even six months after quitting. In one study, high-dose former users had mean testosterone levels roughly half those of lower-dose former users at the six-month mark. Sperm concentration takes an average of 10 months to recover, while sperm motility can take over three years. The longer someone used steroids, the longer recovery takes.
Liver Toxicity and Tumors
Oral anabolic steroids, specifically the C-17 alpha-alkylated forms designed to survive digestion, are the primary culprits for liver damage. They’ve been linked to four distinct types of liver injury: temporary spikes in liver enzymes, a cholestatic syndrome where bile flow is blocked, chronic vascular damage to liver tissue (peliosis hepatis, where blood-filled cysts form inside the liver), and liver tumors including both benign adenomas and hepatocellular carcinoma.
The most serious outcome is tumor development. While enzyme elevations are usually temporary and resolve on their own, tumors represent a potentially life-threatening complication. Injectable and topical testosterone preparations carry far less hepatic risk. To date, no hepatotoxicity has been reported from testosterone delivered via gel, patch, or intramuscular injection. The danger is concentrated in oral formulations, which are among the most commonly used in non-medical settings.
Psychological Effects and “Roid Rage”
Anabolic steroids alter brain chemistry in ways that affect mood, impulse control, and aggression. At supraphysiological doses, use is associated with depression, hypomania, and mania. The aggression commonly called “roid rage” involves sudden, exaggerated hostility triggered by minimal provocation, and it has a biological basis. Steroids activate areas of the hypothalamus involved in aggressive behavior while simultaneously altering serotonin, dopamine, and glutamate signaling, the neurotransmitter systems that regulate mood and impulse control.
Chronic use also modifies pathways connecting the amygdala to the brainstem, increasing baseline anxiety levels. Studies show anxiety disorders are more prevalent among steroid users, particularly those who also use alcohol or multiple substances. These psychological effects don’t always resolve cleanly after quitting. Former users who ran cycles lasting two years or more were significantly more likely to report anxiety (24.5% vs. 6.7%) or psychiatric illness (28.3% vs. 12.4%) compared to those with shorter use histories. Depressive and anxious symptoms are common during withdrawal, and while improvement is likely after the initial withdrawal period, it’s often incomplete.
Tendon Ruptures
Steroids create a dangerous mismatch inside the body. Muscles grow rapidly, generating greater contractile force, but tendons don’t keep pace. High doses actually disrupt collagen balance in tendons and ligaments, reducing their elasticity and load tolerance. The result is a structure being asked to handle forces it was never remodeled to withstand. This biomechanical mismatch is why tendon ruptures, particularly of the biceps, pectorals, and Achilles, are a recognized complication of steroid use. The rapid muscle strengthening combined with delayed (and impaired) tendon remodeling creates a critical vulnerability.
Kidney Damage
High-dose steroid use has been linked to focal segmental glomerulosclerosis, a form of kidney damage where scar tissue develops in the filtering units of the kidneys. This condition impairs the kidneys’ ability to filter blood properly, leading to protein leaking into urine and, in severe cases, progressive kidney failure. The connection is well-documented enough that steroid use is now considered a recognized cause of this specific kidney disease.
Effects Specific to Women
Women who use anabolic steroids face masculinizing effects, some of which are irreversible. Voice deepening is particularly difficult to reverse and was reported as one of the hardest changes for women to cope with emotionally. Clitoral enlargement is another persistent effect that caused shame and reduced self-esteem among users in qualitative research, though negative emotions could be mitigated by a supportive partner response. Other masculinizing changes like excess body or facial hair can be managed through hair removal, and breast tissue loss can be addressed surgically, but the voice and clitoral changes tend to be permanent. These irreversible effects can negatively affect social life, sexual function, and self-image long after use has stopped.
Risks for Adolescents
Teenagers face a unique danger: permanent height reduction. Androgens have a two-phase effect on bones. They initially stimulate growth, but they also trigger closure of the growth plates at the ends of long bones. Steroid use causes significant elevations in estrogen (because the body converts excess androgens into estrogen), which accelerates this closure process. Once growth plates fuse, no further height gain is possible. While documented cases of steroid-induced stunted growth in adolescents are rare in the medical literature, the biological mechanism is well established, and the risk is considered real enough that it remains a primary concern in adolescent steroid exposure.
What Recovers and What Doesn’t
Not all steroid damage is permanent, but recovery timelines vary widely by system. Testicular size returns to near-normal over months to years. Libido and erectile function typically recover over months, though many former users report that their baseline never feels as strong as it did during use. Sperm production usually comes back, but it can take well over a year, and longer use means longer recovery.
Some changes are far less forgiving. Gynecomastia (breast tissue development in men) is unlikely to reverse without surgery. Heart fibrosis and structural changes may persist. Psychological effects linger disproportionately in long-term users. And for women, voice deepening and clitoral enlargement are generally permanent. The pattern is consistent: the longer and heavier the use, the less complete the recovery across virtually every system.