Anabolic steroids carry serious risks to your heart, liver, hormones, and mental health. A large study published in JAMA found that anabolic steroid users had nearly three times the risk of premature death compared to non-users. These aren’t rare complications limited to extreme doses. Many of the harms begin within a single cycle of use and some are irreversible.
When most people ask “why are steroids bad,” they mean anabolic steroids, the synthetic versions of testosterone used to build muscle. These are different from corticosteroids, which are anti-inflammatory medications prescribed for conditions like asthma, lupus, and arthritis. Corticosteroids have their own side effects with long-term use, but they work in a fundamentally different way. This article focuses on anabolic steroids.
Heart Damage Starts Quickly
Anabolic steroids force the heart muscle to thicken in ways it wasn’t designed for. In the HAARLEM study, which tracked steroid users through a single cycle, the left ventricular wall of the heart thickened by roughly 1 mm and total heart muscle mass increased by about 28 grams. That may sound small, but it’s a measurable structural change happening in just weeks, and the degree of thickening correlated directly with how much steroid the person was taking.
This kind of thickening, called left ventricular hypertrophy, makes the heart stiffer and less efficient at pumping blood. Over time it raises the risk of heart failure, arrhythmias, and sudden cardiac death. Steroids also disrupt blood pressure, increase red blood cell counts to dangerous levels, and shift cholesterol in unfavorable directions. Cardiovascular disease was one of the leading natural causes of death among steroid users in the JAMA mortality study.
Your Body Stops Making Testosterone
When you flood your body with synthetic testosterone, your brain registers the excess and shuts down its own production. The signal chain works like a thermostat: hormones in the brain called GnRH, LH, and FSH normally tell the testes to produce testosterone and sperm. Anabolic steroids suppress that entire chain by acting on specialized neurons in the hypothalamus, effectively switching off the signal at the source.
The result is steroid-induced hypogonadism. Your natural testosterone drops to nearly zero while you’re on cycle, and your testes can visibly shrink. Sperm production plummets, sometimes to the point of temporary infertility. After stopping, recovery of normal hormone levels typically takes three to six months, but full recovery is not guaranteed. Some long-term users never fully regain their pre-use testosterone levels, leaving them dependent on testosterone replacement therapy for life.
Liver Damage and Tumors
Oral anabolic steroids are particularly hard on the liver because of the way they’re chemically modified to survive digestion. This modification forces the liver to process a compound it struggles to break down efficiently. The severity of liver injury ranges from mild, temporary enzyme elevations to deep, prolonged bile flow obstruction.
More concerning is a condition called peliosis hepatis, where blood-filled cysts develop throughout the liver. The organ becomes enlarged, fragile, and deep red. In some cases, these cysts rupture, causing sudden abdominal pain and internal bleeding. This condition typically reverses at least partially when steroid use stops, but the most serious liver complication does not always reverse: tumors. Long-term users can develop liver adenomas or hepatocellular carcinoma, usually after 5 to 15 years of use, though cases have appeared in as little as two years. Tumors sometimes regress after stopping, but not always, and some undergo malignant transformation.
Psychiatric Effects and Mood Instability
The psychological side effects of anabolic steroids go well beyond the “roid rage” stereotype, though aggression is certainly part of the picture. In controlled studies where healthy volunteers received high-dose steroids, participants reported increased mood swings, distractibility, and violent feelings. In a study of 41 athletes who had used steroids, 22% met diagnostic criteria for a manic or depressive episode during or after use, and 12% experienced psychotic symptoms.
The psychiatric burden extends into long-term mental health. A large study tracking steroid users over time found that compared to controls, users were prescribed anti-anxiety medications at 2.3 times the rate and antipsychotics at 2.7 times the rate. Antidepressant use was already elevated before the steroid use was officially documented, suggesting that mental health vulnerability and steroid use may reinforce each other. Anxiety, behavioral changes, and depression were the most commonly reported psychological effects in a study of 232 users.
Breast Tissue Growth in Men
One of the more visible and distressing side effects for men is the development of breast tissue, known as gynecomastia. This happens because the body converts excess testosterone into estrogen-like compounds through a process called aromatization. That estrogen then stimulates breast tissue growth. The condition is common enough among steroid users that surgical correction has become a routine procedure in cosmetic surgery practices. Depending on how long the tissue has been developing, it may not fully resolve on its own after stopping steroids.
Irreversible Changes in Women
Women who use anabolic steroids face a distinct set of risks, several of which are permanent. Excess androgens cause vocal cord thickening that deepens the voice irreversibly. Clitoral enlargement occurs and does not reverse after stopping use. Menstrual cycles become irregular or stop entirely, and fertility can be significantly impaired. These virilizing effects, along with acne and changes in body hair patterns, can begin at relatively low doses because women’s bodies are far more sensitive to androgens than men’s.
Dependence and Withdrawal
Anabolic steroids are genuinely addictive for a significant number of users, though the addiction looks different from substances like alcohol or opioids. The dependence criteria proposed for clinical diagnosis include tolerance (needing larger doses to maintain the same muscle mass), withdrawal symptoms, using for longer than planned, unsuccessful attempts to quit, and giving up important activities to maintain a steroid-centered lifestyle. Users often describe an intense anxiety about losing muscle size that keeps them cycling back on.
Withdrawal itself brings depressed mood, severe fatigue, sleep disruption, appetite loss, and low sex drive. These symptoms make sense physiologically: your body has stopped producing its own testosterone, and it takes months for that system to restart. The combination of feeling physically depleted and watching hard-earned muscle shrink creates a powerful pull to resume use, which is why many users who intend to do a single cycle end up using for years.
The Mortality Picture
The risks described above compound into a measurable increase in early death. In the JAMA study, steroid users had a hazard ratio of 2.81 for all-cause mortality, meaning they were nearly three times as likely to die during the study period as matched controls. The risk of unnatural death (primarily accidents) was 3.6 times higher, and the risk of natural death was 2.2 times higher. Among the natural deaths, cancer and cardiovascular disease were the most common causes. These numbers reflect real, population-level risk, not just worst-case scenarios from the heaviest users.