Athletes who use performance-enhancing steroids overwhelmingly rely on testosterone and its synthetic derivatives, a class of drugs collectively called anabolic-androgenic steroids (AAS). Testosterone itself is the most popular choice among men, while stanozolol (Winstrol) leads among women who use these drugs. Beyond those two, a handful of other compounds appear again and again in athletic and bodybuilding circles, each tweaked at the molecular level to shift the balance between muscle-building effects and unwanted side effects. The specifics of which drugs get used, how they are combined, and what they do to the body are more complex than the simple “steroids = cheating” framing most people encounter.
The Core Drug and Its Derivatives
Every anabolic-androgenic steroid is, at its chemical root, a modified version of testosterone. The modifications matter because they change how quickly the body breaks the drug down, whether it can be taken as a pill or needs to be injected, and how strongly it activates androgen receptors in different tissues. Testosterone binds to androgen receptors in muscle cells, ramping up protein synthesis, stimulating satellite cell recruitment, and activating growth-signaling pathways that lead to larger and stronger muscle fibers.1Korean Journal of Sports Medicine. The Mechanisms of Anabolic Steroids, Selective Androgen Receptor Modulators and Myostatin Inhibitors – Section: Androgens Enhance Muscle Growth These effects are not limited to a single pathway. Androgens also influence gene expression for muscle-specific proteins, interact with growth factors, and trigger changes in calcium signaling inside cells.2PubMed Central. Androgens and skeletal muscle: cellular and molecular action mechanisms underlying the anabolic actions
Injectable forms of AAS are chemically modified with ester groups that slow their release into the bloodstream, giving them a longer active life in the body. Oral versions skip that step but face a different problem: the liver breaks down a large fraction of the drug before it ever reaches muscle tissue, which is why oral steroids are often designed with structural changes that resist liver metabolism, making them harder on the liver in the process.3Quality in Sport. Anabolic androgenic steroids intake and its impact on male reproductive system – systematic review
The Most Commonly Used Compounds
While dozens of AAS exist, a relatively short list dominates real-world use among athletes and bodybuilders. Here are the drugs that show up most often in the literature and in survey data from gym-going populations:
- Testosterone: Available as injectable esters (enanthate, cypionate, propionate) or transdermal preparations, testosterone is the baseline drug in most steroid regimens. A survey of resistance-training practitioners found that about 29% of male AAS users reported testosterone as their primary compound.4PubMed Central. Exploring the prevalence of anabolic steroid use among men and women resistance training practitioners after the COVID-19 pandemic
- Stanozolol (Winstrol): An oral steroid favored for its reputation for promoting lean muscle without excessive water retention. The same survey found roughly 31% of female AAS users chose Winstrol as their primary drug. Studies on stanozolol and the related compound oxandrolone have documented elevated liver enzymes in bodybuilders, a sign of liver stress.5Brieflands. Investigation of the Chronic Effects of Winstrol and Oxandrolone Anabolic Steroids on Liver Enzymes in Male Bodybuilding Athletes
- Methandrostenolone (Dianabol): One of the oldest oral steroids, Dianabol gained popularity in the mid-twentieth century and remains in wide use.6Journal of Orthopedic Science and Research. Dianabol Unveiled: A Systematic Review of Methandrostenolone An early controlled study gave subjects 10 mg per day and found significant gains in strength and body weight over just three weeks.7PubMed. Anabolic steroid: effects on strength development
- Nandrolone (Deca-Durabolin): A long-acting injectable known for promoting joint recovery alongside muscle growth, nandrolone is one of the most frequently detected substances in anti-doping tests.
- Oxandrolone (Anavar): Considered milder than many alternatives, oxandrolone is popular among women and athletes seeking modest gains with fewer androgenic side effects. It is still hepatotoxic at higher doses.
- Trenbolone: Extremely potent and available only as an injectable, trenbolone is largely confined to bodybuilding rather than competitive sport because its metabolites are detectable for extended periods.
How Athletes Combine and Cycle These Drugs
Very few users take a single steroid by itself. Up to 90% of AAS users “stack” multiple compounds simultaneously, typically at combined doses ranging from 500 to 1,500 mg per week over cycles lasting four to twelve weeks.8Fertility and Sterility. Anabolic steroid–induced hypogonadism: diagnosis and treatment A common pattern involves a testosterone base supplemented with one or two other compounds chosen for specific goals. Someone focused on raw size might add nandrolone or Dianabol, while someone cutting body fat before a competition might stack testosterone with stanozolol or trenbolone.
Cycling refers to alternating periods of use (“on-cycle”) with time off (“off-cycle”), the idea being to let the body’s hormonal system partially recover before beginning again. During and after a cycle, users frequently add ancillary drugs to manage side effects. These include human chorionic gonadotrophin (hCG) to keep the testes functioning, selective estrogen receptor modulators like tamoxifen or clomiphene to counteract estrogen-related side effects, and aromatase inhibitors to limit the conversion of testosterone into estrogen.9PubMed. Male central hypogonadism secondary to exogenous androgens: a review of the drugs and protocols highlighted by the online community of users for prevention and/or mitigation of adverse effects These “post-cycle therapy” protocols are community-driven rather than medically validated, though clinical research is starting to test them more rigorously.
Cardiovascular Damage
The most serious long-term risk of AAS use may be cardiovascular. Steroids disrupt lipid metabolism, driving up LDL cholesterol and suppressing HDL cholesterol, and these shifts increase the risk of coronary artery disease.10PubMed Central. Anabolic-androgenic steroids and cardiovascular risk Blood pressure often rises, and the heart muscle itself can thicken in ways that persist even after someone stops using.11PubMed Central. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm
A large study tracking over 1,100 AAS users against nearly 60,000 controls over an average of 11 years put hard numbers on the problem. Users faced roughly three times the risk of heart attack, about two and a half times the risk of blood clots, more than double the risk of arrhythmias, and nearly nine times the risk of cardiomyopathy compared to non-users.12PubMed. Cardiovascular Disease in Anabolic Androgenic Steroid Users The cardiomyopathy number stands out because it reflects direct structural damage to the heart, not just an indirect effect of bad cholesterol numbers. Heart failure risk was about three and a half times higher in users. These are not risks that track only with extreme abuse; they emerged across a broad population of identified users.
What Steroids Do to Hormones After You Stop
Flooding the body with external androgens causes the brain to shut down its own testosterone production. The hypothalamic-pituitary-gonadal axis, the hormonal signaling chain that tells the testes to make testosterone and sperm, goes quiet because it detects more than enough androgens already circulating. The proven consequences include suppressed fertility and, in women, excess body hair growth and loss of female secondary sex characteristics.13PubMed Central. Diagnosis and Management of Anabolic Androgenic Steroid Use
This shutdown is not always temporary. A study comparing former AAS users to men who had never used found that about 27% of former users still had testosterone levels below the clinical threshold years after quitting, while none of the controls did.14PLoS ONE. Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study Case reports have documented outright primary gonadal failure, where the testes themselves become permanently damaged, not just temporarily suppressed.15PubMed. Persistent primary hypogonadism associated with anabolic steroid abuse In practical terms, some men who use AAS end up on lifelong testosterone replacement therapy because their bodies can no longer produce adequate amounts on their own.
Liver Toxicity and Oral Steroids
Oral AAS carry an outsized share of liver risk because their chemical structures are designed to survive passage through the liver, which also means the liver bears the brunt of processing them. Testosterone and its derivatives have been linked to a specific type of bile-flow obstruction called cholestasis, to a condition called peliosis hepatis where blood-filled cysts develop in the liver tissue, and to both benign and malignant liver tumors.16PubMed Central. Anabolic androgenic steroid-induced liver injury: An update Injectable testosterone esters are generally easier on the liver because they bypass first-pass metabolism, which is one reason experienced users often favor injectables despite the inconvenience.
Mood, Aggression, and Psychological Effects
The stereotype of “roid rage” contains a kernel of truth, but the reality is more nuanced than sudden uncontrollable violence. A meta-analysis of experimental studies found that AAS administration was associated with a small but statistically real increase in self-reported aggression.17PubMed Central. Anabolic-androgenic steroid administration increases self-reported aggression in healthy males: a systematic review and meta-analysis of experimental studies The effect size was modest on average, but individual variation is enormous: some users experience little change, while others develop serious mood disturbances.
In a controlled study of 160 athletes, about 23% of steroid users reported major mood syndromes, including mania, hypomania, or major depression, during periods of steroid use. These mood disturbances were far more common during active steroid exposure than during periods without use, and far more common than in non-using athletes.18JAMA Psychiatry. Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use: A Controlled Study of 160 Athletes Separately, research has found that AAS users show more than twice the odds of exhibiting psychopathic traits and over three times the odds of engaging in substance-use risk-taking behaviors compared to non-users.19Scientific Reports. Anabolic–androgenic steroid use is associated with psychopathy, risk-taking, anger, and physical problems Whether steroids cause these traits or people with these traits are drawn to steroids is a question that cross-sectional data cannot fully answer, but the experimental evidence for aggression at least points toward a direct drug effect.
Effects Specific to Women
Women who use AAS face a distinct set of consequences because their bodies are not built around high androgen levels. The most frequently reported effects include excess body and facial hair growth, scalp hair loss, deepening of the voice, clitoral enlargement, and disrupted menstrual cycles.20PubMed Central. Do anabolic-androgenic steroids have performance-enhancing effects in female athletes? – Section: Adverse effects of AAS in female athletes Voice changes can occur even at doses that do not produce other noticeable side effects, and dose-response research in postmenopausal women has confirmed that vocal pitch drops in a measurable way with testosterone administration.
Qualitative research with women who use AAS has found that voice deepening is often the most distressing side effect because it is impossible to hide and can expose secret drug use. Some masculinizing effects like excess hair can be managed with cosmetic measures, but a changed voice cannot. Clitoral enlargement was reported to cause shame and reduced self-esteem, though the emotional impact varied depending on partner response. Many women used the return of their menstrual period after stopping a cycle as a marker that their body was returning to normal before starting again.21PubMed. Anabolic-androgenic steroid use among women – A qualitative study on experiences of masculinizing, gonadal and sexual effects A systematic review estimated that about 17% of female bodybuilders and roughly 4% of female athletes or recreational gym users have used AAS.22PubMed. What is the prevalence of anabolic-androgenic steroid use among women? A systematic review
Non-Steroidal Drugs Used Alongside AAS
Steroids rarely travel alone. Among bodybuilders who used performance-enhancing drugs in one study, 95% used AAS, but roughly 30% also used growth hormone and about 38% used insulin.23PubMed Central. Metabolic Consequences of Anabolic Steroids, Insulin, and Growth Hormone Abuse in Recreational Bodybuilders: Implications for the World Anti-Doping Agency Passport Growth hormone is believed to aid fat loss and recovery, though evidence that it directly improves performance in young healthy adults is thin. The problem with studying its effects is that it is almost always used in combination with AAS and insulin, making it difficult to tease apart what each drug contributes.24PubMed Central. Growth hormone, IGF-I and insulin and their abuse in sport Insulin use in bodybuilding carries particular danger: a miscalculated dose can cause fatal hypoglycemia within minutes.
Selective androgen receptor modulators, or SARMs, represent a newer class of drugs designed to activate androgen receptors in muscle and bone while minimizing effects in tissues like the prostate and skin. They are taken orally and have more predictable absorption than most AAS. However, despite their marketing as a safer alternative, SARMs are not approved for human use in most countries, and the available evidence still shows that they suppress the body’s own hormone production, disrupt cholesterol, and may carry liver and cardiovascular risks similar to traditional steroids.25Future Pharmacology. SARMs vs. Classic Anabolic Androgenic Steroids: Molecular, Pharmacokinetic and Safety Differences: A Narrative Review
How Anti-Doping Labs Catch Steroid Use
Detecting synthetic steroids that the body does not naturally produce is straightforward: labs look for the drug or its metabolites in urine. The challenge lies in catching athletes who use synthetic versions of hormones the body already makes, especially testosterone. Classical chemistry cannot tell synthetic testosterone apart from the kind your body produces.26The Journal of Steroid Biochemistry and Molecular Biology. Detection of the misuse of steroids in doping control The solution is carbon isotope ratio analysis, which exploits the fact that synthetic testosterone is made from plant-derived starting materials with a slightly different ratio of carbon-13 to carbon-12 than what the human body produces. This technique, using gas chromatography coupled with isotope ratio mass spectrometry, is now the gold standard for confirming testosterone doping.27PubMed. Carbon Isotope Ratio Analysis of Urinary Steroids Following Extensive Cleanup and Formylation
Modern anti-doping has also moved beyond snapshot testing toward longitudinal monitoring. The Athlete Biological Passport tracks individual steroid profiles over time, generating personalized reference ranges for each competitor. Because people vary enormously in their natural steroid ratios, a single population-based cutoff missed many users. Comparing an athlete to their own baseline is far more sensitive.28PubMed Central. Current Insights into the Steroidal Module of the Athlete Biological Passport
Despite these advances, the cat-and-mouse game continues. The first confirmed designer steroid, tetrahydrogestrinone (THG), was not discovered until 2003 when a syringe was anonymously mailed to a lab. It had been specifically engineered to evade existing testing methods.29PubMed. Tetrahydrogestrinone: the discovery of a designer steroid It is reasonable to assume that other designer compounds have circulated undetected.
Muscle Memory and Why Bans May Be Too Short
One of the most fascinating findings in steroid science is that the benefits may persist long after the drugs leave the body. In a mouse study, a brief course of steroids increased the number of nuclei inside muscle fibers, and those extra nuclei were still present three months later, a span that corresponds to roughly a decade in human terms. When the muscles were then challenged with exercise, the previously steroid-treated mice grew about 31% in fiber size over six days, compared to only 6% in mice that had never received steroids.30PubMed Central. A cellular memory mechanism aids overload hypertrophy in muscle long after an episodic exposure to anabolic steroids The extra nuclei appear to act as a permanent upgrade, giving muscle a head start on future growth. If this finding translates fully to humans, it raises uncomfortable questions about whether a two- or four-year competition ban genuinely levels the playing field.
Contaminated Supplements and Accidental Exposure
Not everyone who tests positive for AAS took them knowingly. An international study of 634 nutritional supplements purchased in 13 countries found that about 15% of products marketed as non-hormonal supplements were contaminated with undeclared anabolic steroids, mostly prohormones.31PubMed. Nutritional supplements cross-contaminated and faked with doping substances A more recent review put the figure higher, finding that anabolic steroids accounted for about 26% of supplements shown to contain undeclared banned substances.32PubMed Central. Dietary Supplements as Source of Unintentional Doping For competitive athletes, even trace contamination can produce a positive test. The supplement industry’s lack of mandatory pre-market testing in many countries makes this a persistent and largely unsolved problem.
Recovering Fertility After Steroid Use
For men trying to conceive after AAS use, the suppression of sperm production is a pressing concern. A recent study compared three approaches in recreational bodybuilders after short-term steroid cycles: watchful waiting, clomiphene citrate alone, and clomiphene combined with hCG injections. By 12 months, normal sperm counts had returned in about 88% of men on the combined treatment, compared to about 69% on clomiphene alone and 59% with no treatment. The combined therapy was independently associated with more than six times the odds of reaching normal sperm counts and about five times the odds of recovering sperm motility.33PubMed. Post-cycle therapy after short-term anabolic-androgenic steroid use: comparative outcomes in recreational bodybuilders Hormone levels normalized across all groups by about six months, but sperm recovery lagged behind, which is important for anyone whose timeline for having children is pressing. These findings give the first real clinical evidence behind what the bodybuilding community has been doing informally for years with post-cycle therapy drugs.