Steroid Side Effects: What Can They Do to Your Body?

14 min read 18. 10. 2026

When it comes to anabolic steroids, the talk is often of strength and muscle. However, not all changes are visible in the mirror: blood pressure or cholesterol levels may change without any noticeable symptoms. People therefore often type ‘steroid side effects’ into a search engine . In reality, they are interested in what might change in the body and when they should be on their guard.

The side effects of steroids do not manifest in the same way for everyone. It depends on the specific substance, the dose, the method and duration of use, any combination with other substances, and the individual’s state of health. Some changes occur whilst taking the substance, others only after stopping.

This article focuses on anabolic-androgenic steroids (AAS), substances related to testosterone. Corticosteroids, which doctors prescribe for certain inflammatory conditions, belong to a different group of medicines and have different uses and effects.

If you are taking a prescription steroid, information about the non-medical use of AAS is not a reason to stop taking it or change your treatment without consulting your doctor. Assess its effects based on your diagnosis and your doctor’s instructions.

What are the most common side effects of steroids?

The side effects of steroids can affect several systems at once. Here is a quick guide:

Hormones and reproductive health: suppression of the body’s own hormone production, changes in libido, sperm production or the menstrual cycle.
Heart and blood vessels: changes in blood pressure and blood lipid levels; with long-term use, serious cardiovascular complications are also being investigated.
Liver: some substances may cause liver damage, sometimes accompanied by jaundice and severe itching.
Skin and appearance: acne, oilier skin, hair loss, fluid retention or breast enlargement in men.
Mental health: irritability, restlessness or mood swings; their severity and link to medication use vary from person to person.

This list does not mean that all these effects will occur in everyone. However, their absence is not a reliable ‘test’ of health either – some changes can only be detected through medical examination.

A more detailed picture is provided by the HAARLEM study, which followed 100 men for one year: during the study, every participant reported at least one adverse health effect. The most common were fluid retention (56 per cent) and restlessness (36 per cent) during the cycle; after it ended, 58 per cent of men reported a reduced libido. Acne was recorded in 28 per cent and gynaecomastia in 19 per cent. The percentages refer to individual symptoms, not separate groups: the same person could have reported several complaints, so they cannot be added together. Furthermore, these are the experiences of this specific group of 100 men over the course of a year; they do not indicate what will happen to everyone, nor what the effects of repeated use over a longer period might be.

If you’re interested in more specific links between steroids and muscle gain, see also the article The strongest steroids for bulking: what do they offer and what are the risks?.

The hormonal effects of steroids

When the body receives androgens from an external source, it may suppress its own hormonal signalling. Put simply: the brain and the gonads receive a signal that there are sufficient hormones, and the body’s own production of testosterone may slow down. This can result in lower natural testosterone levels, testicular shrinkage, changes in libido or erectile dysfunction. Some men may also develop gynaecomastia – enlargement of breast tissue.

These changes may not become fully apparent whilst the treatment is ongoing. Sometimes they only become evident after treatment has ended, when the external supply of hormones has ceased and the body’s own production has not yet resumed. In the HAARLEM study , testosterone levels returned to normal in most participants within approximately three months, whilst sperm production took longer to recover. A normal testosterone level therefore does not in itself confirm that fertility has been restored. Recovery is individual, and hormone levels, libido and sperm production may not return to normal at the same time.

How steroids affect the heart and blood vessels

You may not immediately notice changes in your blood pressure or cholesterol levels. Possible cardiovascular consequences include:

higher blood pressure;
changes in blood lipids, such as a less favourable ratio of HDL to LDL cholesterol;
changes to the heart muscle and blood vessels, which may increase the risk of more serious complications.

The prospective HAARLEM study on blood pressure and blood lipids followed 100 men. During treatment, systolic (upper) blood pressure increased by an average of 6.9 mmHg and diastolic (lower) blood pressure by 3.2 mmHg; several blood lipid parameters also deteriorated. Three months after the end of the treatment cycle, blood pressure, blood lipids and other monitored parameters in this group returned to baseline levels. However, a one-year follow-up does not provide an answer as to what the consequences of repeated or long-term use might be.

Atherosclerosis was also investigated in imaging study involving 140 strength athletes. In a group of 86 men with long-term experience of AAS, participants had, on average, a greater volume of plaque in their coronary arteries than the 54 non-users. A longer cumulative duration of use was associated with a higher degree of atherosclerosis. This was an observational comparison, so it does not in itself prove causation or predict what will happen to a specific individual.

A longer-term perspective is provided by a Danish population-based cohort study, which compared 1,189 men penalised for AAS use with 59,450 men from the general population. Over an average follow-up period of 11 years, the group of users was found to have a higher incidence of several conditions, including heart attack, arrhythmia, cardiomyopathy and heart failure. Due to the small number of cases, the study was unable to reliably assess the risk of stroke. The FDA also lists stroke among the potential life-threatening consequences of anabolic steroid use; however, the warning does not specify how often this occurs. As the Danish study was observational, it demonstrates an association, not proof, that steroids were the sole cause of the observed differences.

Steroids and the liver

The risk to the liver varies depending on the specific substance and method of use. It is described in particular in relation to certain anabolic steroids formulated for oral use. Possible warning signs include:

unusual tiredness or nausea;
itching;
dark urine or pale stools;
yellowing of the skin or the whites of the eyes.

Not everyone experiences all of these symptoms, and some changes may not be immediately apparent. In a review of cases of liver damage associated with AAS , jaundice and itching were common. Patients were examined at a median of 56 days after starting treatment. Bilirubin – a bile pigment in the blood – reached its highest level, on a median basis, as late as 28 days after discontinuation. In this study, bilirubin reached its highest level approximately four weeks after discontinuation. This does not mean that this will be the case for everyone – for some people, results may deteriorate sooner, for others later. That is why the doctor monitors both the symptoms and changes in blood test results.

A separate analysis of 44 men with liver damage following the use of bodybuilding supplements revealed, through laboratory analysis of certain products, the presence of anabolic steroids that were not listed on the label. In this selected group, 71 per cent of patients ended up in hospital. This does not represent the level of risk for all users, but rather the severity of the cases recorded in the study.

Changes may also be evident in blood tests. In the HAARLEM study, the average level of the liver enzyme ALT increased by 18.7 U/l. The deviation itself does not determine the extent of the damage; a healthcare professional assesses it in conjunction with other symptoms and test results.

The effect of steroids on mental health

With anabolic steroids, the term ‘roid rage’ is often used, as if aggression were an automatic consequence. The research is more complex. A meta-analysis of 12 controlled studies found a small increase in self-reported aggression among men taking AAS. However, this finding was not confirmed by observer assessments or in analyses of longer-term use of higher doses. It follows that mood changes should be taken seriously, but not every user can be labelled as aggressive.

Some people may experience irritability, tension, restlessness or changes in sleep patterns. Following discontinuation, hormonal changes and a low mood may also occur. In the HAARLEM study, four serious adverse events, including suicidal thoughts, were recorded during the follow-up period. Such an isolated case does not prove that AAS were the sole cause, but it serves as a reminder that sudden changes in mental state should not be taken lightly or ‘endured’ without help.

A systematic review of research among athletes describes mood swings and depressive states that may occur even after discontinuation of use. With regard to anxiety, study results were inconsistent, and a causal link cannot always be distinguished from pre-existing difficulties or other factors.

Steroids, fertility and sexual health

Changes in hormonal signalling can affect sperm production, testicular size, libido and fertility. However, the restoration of testosterone levels and the resumption of sperm production may not occur at the same rate.

In a study on the recovery of testicular function following androgen use , researchers compared the total sperm count with the threshold of 40 million used in this study. The results showed:

During treatment, 70 out of 91 men for whom a sample was available were below this threshold (77 per cent).
At the one-year follow-up, 25 out of 73 men with an available sample (34 per cent) were still below the threshold.

Forty million is the threshold used in this study; it is not a standalone diagnosis of infertility. Although the study followed 100 men over the course of one year, not all had a semen analysis result available at each individual follow-up. The results therefore do not predict the course of events for an individual, but they do show that sperm production may not resume immediately after discontinuing use.

In women, some androgenic manifestations may be pronounced: deepening of the voice, enlargement of the clitoris or increased body hair may not fully resolve. A qualitative study of interviews with 12 women describes concerns about such permanent changes as well as the potential impact on fertility. However, the small number of interviews does not indicate how frequently individual effects occur.

Hormonal changes may also affect the menstrual cycle. In a qualitative study involving 16 women who were taking AAS, the women described missed periods both during and after use; for some, their cycle did not return until later. The interviews do not indicate how often this occurs in all women, nor can they distinguish the effect of steroids from other factors. If periods are missed or significantly altered, it is advisable to consult a healthcare professional.

Other physical side effects

Some changes are more obvious in the mirror than in laboratory results. They may manifest, for example, as follows:

Acne and oilier skin: your complexion may deteriorate, even if you previously had no major problems with your skin.
Thinning hair: in people with a genetic predisposition, hair loss may accelerate.
Fluid retention: swelling or rapid weight gain does not necessarily mean an increase in muscle mass – water also affects weight.
Changes in breast tissue: men may experience enlargement of the breasts, known as gynaecomastia.

In the HAARLEM study, acne was reported in 28 per cent of the men monitored, and fluid retention was among the most commonly reported side effects. However, the severity of symptoms varies depending on the substance and individual predisposition. These figures describe a specific group and do not constitute a universal prediction.

Short-term versus long-term risks

Distinguishing between short-term and long-term effects helps to provide guidance, but the line between them is not clear-cut:

Whilst taking the medication → skin changes, fluid retention, restlessness or changes in blood pressure may occur. Some of these may not be noticeable.
After stopping → hormonal balance is gradually restored. Libido, mood and sperm production may not return to normal all at once.
With prolonged or repeated use → there is a growing need to pay attention to possible effects on the heart and blood vessels, the liver, the hormonal system and fertility.

The effects may overlap: skin changes tend to be visible sooner, hormonal problems may become more pronounced after discontinuation, and changes in blood pressure or lipid levels may not be noticeable for some time. However, the time of onset alone does not determine the severity. Some effects may not subside immediately after stopping the medication, and medical care may be required in the event of serious complications.

How to interpret research findings: A short-term study may capture changes over a single cycle, but it will not answer all questions regarding long-term, repeated use. A large population-based study may show an association with diseases, but may not be able to rule out all other influences. The results also depend on what substances participants used and whether they reported them accurately; combining multiple substances makes it difficult to determine the cause. The percentages therefore describe the specific group under study, not a personal prediction.

When should you seek help? Do not wait if you experience the following symptoms:

chest pain, sudden shortness of breath, weakness or slurred speech;
jaundice, severe abdominal pain or a rapid deterioration in your health;
suicidal thoughts or a feeling that you cannot cope with the situation.

In the event of a sudden or serious condition, seek emergency help. If you experience new or persistent difficulties, tell your doctor which substances and supplements you have been taking, approximately when and for how long. Accurate information will make it easier to carry out an examination and identify the cause.

What determines the severity of side effects?

When assessing the effects, several factors come into play at once:

The specific substance, the method of administration and the composition. Different steroids do not have the same profile of effects. With products from unverified sources, the contents may not match the label.
The amount, duration and frequency of use. The risk can be influenced by both the total amount and the length of time a person uses the substance; with repeated use, the effects may accumulate.
Health status and individual sensitivity. Age, pre-existing medical conditions, genetic predisposition and other medicines being taken may alter the risk.
Combination with other substances. Taking several substances at once makes it difficult to determine the cause of any problems and may alter their course.

With products from unverified sources, the contents may not match the label. It is then difficult to estimate what a person is actually taking and how the body will react – particularly if substances are combined. Even if a person feels no symptoms, this does not necessarily mean that their blood pressure, cholesterol or hormone levels are normal. Research has not yet established what level of steroid use without medical supervision would be entirely risk-free.

Conclusion

Anabolic steroids can affect hormones, the heart and blood vessels, the liver, the skin, mental health and fertility. Some changes are visible, whilst others only become apparent upon examination; furthermore, they may not return to normal immediately after stopping use. Research does not allow us to predict the exact course of events for every individual.

If you’re looking for a different way to achieve your training goals, read the article Steroid alternatives: which ones make sense?. In our category Steroid Alternatives , you’ll find products with various compositions and intended uses. Assess each specific product based on its composition and usage information; the category name alone does not indicate the effect or risk associated with any individual substance. In the event of health problems, decisions regarding examination and treatment should be left to a healthcare professional.