We’ve all heard about or seen horror stories about anabolic steroid side effects, and for a lot of guys these can sometimes be enough to sway you away from steroids totally.
But there’s no one size fits all scenario when it comes to the side effects that steroids can cause. The first two considerations just about any would-be steroid user makes are: what results can I get, and what will the side effects be?
Not only are there dozens of different anabolic steroids out there, each with potentially different potencies and effects, but every individual user will react in their own way to the compounds. Throw in other variables like dosage, cycle length, stacking compounds together, existing health issues – and potential steroid side effects can become a lot more complex.
Author’s Note: The following guide is based on my personal experience and does NOT promote the illegal use of steroids (PEDs). I am currently using this supplement stack.
In this guide, you'll learn:
Common Side Effects of Steroid Use
Some side effects are considered fairly common among nearly all anabolic steroids. Some steroid types or groups don’t induce common or notorious side effects at all, if they for example don’t aromatize and therefore don’t bring about estrogen conversion of androgens.
These estrogenic side effects are some of the most dreaded, and often misunderstood as new users can assume that every single steroid brings about such side effects which is not the case.
With this in mind, there are still a number of side effects that can be considered common overall when considering the anabolic steroids that are most widely used. These common side effects include:
- Testosterone suppression: Suppression of hormone function in males is the one side effect that can be virtually guaranteed.
- Acne and hair loss: these androgenic related side effects can impact some individuals but not others.
- Fluid retention: retaining fluid or water can bring about a bloated look and impact your ability to achieve a lean hard body.
- Liver toxicity: oral steroids in particular can pose a risk to stress of the liver.
- Cholesterol: some steroids will raise bad cholesterol levels while suppressing good cholesterol values.
- Blood pressure: steroids which induce water retention can also lead to an increase in blood pressure.
- Erectile Dysfunction: studies show that the longer and more frequently that anabolic steroids are used, the higher the chance of a man experiencing ED.
How severe these common side effects are will still depend on the individual compound, and the person using it.
Author’s Note: For real, NO-BS information on using steroids be sure to check out Straight From the Underground (my recommended underground steroid handbook). Everything in this book is based on first hand experience, not theory.
Cardiovascular Side Effects
By far the side effects relating to the cardiovascular system are some of the most concerning ones we face when using steroids. This cardio system is the blood, oxygen and nutrient circulation system: the heart, arteries and blood vessels. When things go wrong here, it can be a matter of life and death.
Unfortunately some steroids are particularly hard on the cardiovascular system which means you must be informed about the specific side effect risk of each steroid you plan to use. Even more so if you have a history of any illness or disease relating to the cardiovascular system.
Because we are using steroids at performance enhancing doses, it’s almost impossible to escape some negative impact on the cardio system with most steroid compounds. In many cases this will involve a change in the cholesterol profile.
Many steroids will bring about a lowering of good levels of cholesterol (HDL) while raising the bad cholesterol levels (LDL). Oral steroids are known to have a greater negative effect on cholesterol compared to injectable steroids, but any steroid can pose a risk.
Users can help offset these cholesterol changes during a cycle by paying close attention to the diet, and including plenty of foods rich in omega-3 fatty acids, such as oily fish. The good news is that cholesterol will return to your normal state once steroids are stopped, and this is one of many reasons why a suitable length break between steroid cycles is critical to allow time for the body to fully recover.
Another potentially serious cardiovascular side effect to watch out for concerns is high blood pressure. Some steroids cause mild to severe water retention when estrogen levels rise. This is a result of aromatization. When this fluid is retained in the body, it can cause blood pressure to rise.
Some steroids are much more severe than others in this regard. When using compounds that aromatize, the most common way to mitigate the effects including increased blood pressure is to take an aromatase inhibitor (AI) drug like Arimidex.
As no steroid user wishes to experience water retention from an aesthetic viewpoint, AI drugs are considered almost essential whether or not blood pressure is a concern. Blood pressure can also be further improved by avoiding simple carbohydrates in the diet.
Hepatotoxicity Side Effects
The stress that some anabolic steroids cause to the liver is another major concern with some compounds. But the risk is mainly limited to oral steroids which pass directly through the liver. While liver enzymes are likely to rise when using these oral steroids, it does not necessarily mean liver damage is occurring; merely that liver stress is occurring as the liver is dealing with an unusual substance.
Long term, high dose oral steroid use is where high risk of liver toxicity can be a major concern. Those who sensibly use oral steroids at moderate doses and for limited periods of time are most likely to see their liver enzyme values return to normal. But those with a pre-existing liver condition should use any potentially hepatotoxic steroids only after careful consideration.
Androgenic Side Effects
This category of side effects contains some of the most notorious negative effects of steroids. New users can often believe that they are going to experience severe androgenic side effects for certain, but in fact these effects are very individualistic. The two most common androgenic side effects are acne and male pattern baldness.
If a male suffered with acne during his teenage years, he is much more likely to develop acne when using steroids; especially those with a higher androgenic rating. Some men will not experience acne at all.
The same genetic predisposition applies to the other main form of androgenic side effect, which is male pattern baldness. If you had baldness in your genetic history, you will find that androgenic steroids can and will bring on hair loss earlier in life than you would have otherwise experienced it.
For those who are already predisposed to baldness, little can be done about this particular side effect besides using a topical androgen blocker made for hair loss if desired.
Body hair growth is another possible side effect of increased androgenic activity. With some anabolic steroids having a much higher androgenic rating than others, those who know or suspect they are going to be susceptible to these side effects are able to avoid or control the dosage of such steroids to reduce or avoid these effects.
Male-Specific Steroids Side Effects
By far the most critical and concerning side effect for men using steroids is the way the introduction of synthetic hormones into the body slows down, or often shuts down, the normal functioning that produces testosterone. This means the male body stops producing testosterone on its own. Once the steroids are stopped, the body is no longer receiving the artificial hormones, and the user is left in a state of very low or even no testosterone.
Some steroids are more potent in this effect than others, but all males will need to deal with this side effect regardless of which compound is being used.
While the body will slowly begin to regain its normal testosterone function again once steroid use comes to an end, this is almost always too slow for men to wait for; hence why the implementation of post cycle therapy is so critical following a steroid cycle.
Other male specific side effects of steroids include the development of breast tissue (gynecomastia) as a resulting increased estrogen levels.
Roid rage, or changes in anger and aggression control, can also impact on male steroid users. Not all men will experience increased aggressiveness and research has shown only a small percent ever notice this side effect.
Hair loss, while it can also potentially affect female users, is mostly a concern for men who use steroids. Those who are genetically predisposed to male pattern baldness can see this developing prematurely as a result of increased DHT. While not a health issue, hair loss can be distressing for young steroid users.
Female-Specific Steroids Side Effects
Anabolic steroids are strong androgens which have a powerful effect on the female body. These male hormones will quickly cause a woman to start developing male characteristics in a process known as virilization.
Some steroids are too powerful for a female to use even at the lowest doses, while others with a lower androgen rating can be tolerated by some females, however side effects will almost always be a cause for concern.
Women who limit their cycles to 6 weeks or less and take low doses will generally see these side effects subside on their own once the steroid cycle has ended.
These are the potential side effects for females who use anabolic steroids:
- The voice can gradually become deeper and hoarser. Some studies have shown this can be more of a long term effect that can in some cases take years to subside, if at all.
- Hair growth on the face and body can develop
- Clitoral enlargement (clitoromegaly)
- The skin will become rougher and coarser, similar to a man’s
- The breasts reduce in size
- Body fat decreases and muscle increases; while this is not considered a side effect for many steroid users, for some women these effects can extend beyond what they initially desired to achieve by using steroids
- Women are also at risk of side effects relating to acne, blood pressure, cholesterol and liver toxicity
Females who notice unwanted side effects during a steroid cycle can immediately discontinue use and expect most of these effects to fade on their own. The longer side effects are allowed to develop, the higher the risk of them becoming permanent or very difficult to reverse.
What is Estrogen?
Estrogen is the main female sex hormone, with progesterone being the second primary female sex hormone. In women, estrogen is responsible for critical functions relating to reproductive and the development of female characteristics. Estrogen is important for bone health, cardiovascular health and other important bodily systems.
Males also have a small amount of estrogen and this is a critical part of the male body, even if it is not often thought about. Many males might not even realize that they do in fact require some small amount of estrogen for normal functioning in multiple areas of health: from cardiovascular and cholesterol health, to sexual health and bone strength. Therefore male steroid users should never aim to completely eliminate all estrogen.
Estrogen and Anabolic Steroid Use
Estrogen becomes a subject of great concern for males who use anabolic steroids. Before using steroids, most males are unlikely to have given estrogen a thought, but once you start using aromatizable steroids at performance enhancing doses, you will have no option but to address the issue of estrogen during and after every cycle.
In fact along with your steroids, your workouts and your diet, estrogen and its related effects is going to be a priority focus while using steroids. If you fail to prevent or control estrogenic side effects, your entire steroid cycle can go out the window very quickly.
The aromatizing steroids you use will raise estrogenic activity, the severity of which will heavily depend on which compounds, the dosage, the length of your cycle and of course how well you’re able to take control of them using anti-estrogen drugs. It’s vitally important not to try and totally eliminate estrogen though, because this brings with it a whole new range of health issues. Making wise use of SERMs or AIs is the key to effectively controlling estrogen and its related side effects when using anabolic steroids.
Normal Estrogen Levels
Just as women have a small amount of testosterone, men also have tiny amounts of estrogen as part of the the normal hormone balance. In adult males, the average level of estradiol – the main form of estrogen – is measured at around 10-40 picograms per milliliter (pg/ml). Compare this to pre-menopausal females who can have estradiol levels measuring up to 350 pg/ml.
In men, estrogen is important for sexual function including the libido and erectile function. Therefore, men who mistakenly attempt to remove all estrogen through the use of anti-estrogen drugs while using steroids can suffer from adverse unexpected effects.
It’s important to consider the positive and essential effects of estrogen like maintaining healthy cardiovascular function, helping to regulate human growth hormone (HGH), assisting with sexual function and helping with sleep and avoiding fatigue.
Men who use steroids should therefore aim to maintain their normal levels of estrogen and not make the mistake of trying to eliminate all estrogen. Higher levels of estrogen that can come about from the use of steroids which aromatize, and therefore convert androgens to estrogens, cause a range of side effects.
These estrogenic side effects are some of the most common issues that male steroid users need to deal with when using gear. However it’s important to note that there are some steroids available which don’t aromatize at all; and therefore have no impact on estrogen. Another beginner mistake can be to assume that all steroids will raise estrogen when this is not the case.
Estrogen Side Effects
Side effects caused by estrogen are some of the most common and dreaded side effects of all when it comes to males who use steroids. These estrogenic side effects can not only cause setbacks with your results, but can potentially be damaging to your health too. Thankfully they are able to be controlled through the use of certain drugs that can inhibit or control estrogen.
All users should however be very aware of estrogenic side effects, because you’ll be wanting to pay close attention to the first signs of them developing so you can get them under control quickly. The more heavily aromatizing steroids are going to be the ones that raise estrogen levels the most, and thus put you at higher risk of these side effects.
The main estrogen related side effects to look out for are:
- Gynecomastia: Or just gyno for short, is the growth of male breast tissue. These so called man boobs can ruin your physique, and if left to develop unchecked, can even become a permanent problem that can only be fixed with surgery. Gyno can be very effectively prevented or stopped by using a SERM (Selective Estrogen Receptor Modulator) drugs like Nolvadex and Clomid to block the effect of estrogen specifically at the breast tissue receptors.
- Water retention: The retention of fluid both within the cells and within the circulatory system gives you a bloated look. This can mask your gains while making it near impossible to obtain that hard and toned look; making this side effect the bane of anyone doing a cutting phase or contest prep. Water retention has a more serious impact as well, because it can bring about a rise in blood pressure.
While some steroids have strong aromatizing effects, and therefore cause serious increases in estrogen, others do not aromatize at all. Trenbolone, Anavar, Masteron, Primobolan, and Winstrol fall into the second category and these are compounds that are highly favored by those doing cutting and contest preparation, where the issue of fluid retention in particular would be hazardous to results.
Men who are wanting to completely avoid estrogenic side effects can choose to use only non-aromatizing steroids. But most serious steroid users will at some point decide to use steroids that aromatize, simply because the overwhelming benefits outweigh the negative effects which can themselves be controlled.
When it comes to estrogenic steroids, it’s the process of aromatization that makes them estrogenic. This is where androgen hormones are converted to estrogen, causing overall estrogen levels to rise.
Most of the aromatizable compounds we use are derived from testosterone, and these include some of the most popular anabolic steroids: Dianabol, Deca-Durabolin, Equipoise and Testosterone itself are all steroids that aromatize. They have differing levels of aromatizing activity, with Equipoise (Boldenone) being a much milder aromatizing steroid compared with Dianabol.
Even when using non-estrogenic steroids, men will almost certainly still be adding testosterone into a cycle to maintain testosterone function while natural hormones are being suppressed.
As testosterone itself is an aromatizing compound, it can be a concern that you’ll still suffer from estrogenic side effects when using testosterone stacked with any of the non-aromatizing steroids mentioned above. However, when testosterone is merely used at hormone replacement therapy doses, it does not pose a risk of increasing estrogen. Only at higher performance doses will you start to suffer the estrogenic effects of exogenous testosterone.
Anti-estrogen drugs are an essential item for most male steroid users. There are two main types of anti-estrogen drugs with an important difference between them. These are aromatase inhibitors (AI) and selective estrogen receptor modulators (SERMs).
As the name implies, SERMs are selective in the estrogen receptors they target and this is of great use to male steroid users, because the targeted estrogen receptors are in the areas where estrogenic side effects show themselves, particularly concerning the problem of breast tissue growth (gyno).
As these drugs were mostly developed to treat breast cancer in women, they have been designed to specifically target breast tissue estrogen. Aromatase inhibitors are able to reduce the conversion of testosterone to estrogen so can help to reduce overall estrogen levels in the body.
Anti-estrogens have another use to male steroid users when it comes to hormone recovery after a cycle. They are almost always used in post cycle therapy to help stimulate natural testosterone production.
Gyno is a much talked about side effect of anabolic steroids, and its possibly the side effect that men fear the most. The growth of male breast tissue can happen as a result of rising estrogen levels.
Anabolic Steroid Induced Gynecomastia
Some anabolic steroids aromatize so that androgens are converted into the female sex hormone estrogen. Men have small amounts of estrogen normally, but when levels rise one of the impacts is the development of gynecomastia.
Gyno can be mild and hardly noticeable at first, but can progress into a serious and potentially untreatable problem if you allow estrogen levels to rise excessively. Many steroids aromatize with some of the most commonly used compounds including Testosterone, Boldenone and Dianabol.
Diagnosis, Prevention, and Treatment of Gynecomastia
Gyno can be prevented by implementing proper estrogen controls into your steroid cycle. When you know the compound or compounds you’re taking are aromatizing steroids, all users should have in place proper anti-estrogen strategies; and when you do this you can completely prevent gyno from developing.
Diagnosing gyno as a steroid user is not difficult: one or both breasts can be affected, and there can be some pain or sensitivity of the area in the early stages. This can lead to swelling as it progresses, followed by full glandular development if left unchecked.
While total prevention is the most ideal scenario, if initial signs start to become noticeable (such as a tingling of the nipples or a puffy appearance, the use of a SERM to block estrogen activity directly at the breast tissue should prevent gyno from progressing any further, while reversing the symptoms. The best SERMs are Clomid and Nolvadex.
Treating fully developed gyno with SERMs or aromatase inhibitor drugs is generally not possible once it has progressed to a complete development of gynecomastia; in these cases, surgery is often the only option to reduce the breast tissue.
Steroid users can and should avoid allowing gyno to develop simply by making use of the staple drugs that are known to effectively prevent this highly undesirable side effect, in the form of SERMs (selective estrogen receptor modulators) and AIs (aromatase inhibitors).
What is Prolactin?
Prolactin is a hormone made in the pituitary gland. It is a critical hormone in females for the purpose of breast milk production. But this is far from prolactin’s only function.
It’s known that this hormone contributes to more than 300 functions involving multiple areas: reproduction, osmoregulation, immunity and metabolic systems just to name a few. Estrogen is important for regulating prolactin.
When there is too much prolactin present in men, they can suffer from a deficiency in testosterone.
Role and Effects of Prolactin in Men, and Prolactin Side Effects
Research on the specific role and effects of prolactin in men has not been widely undertaken, however what has been found is that it plays a role in function of the testicles, and when there’s too much prolactin hypogonadism can develop.
In women, prolactin stimulates breast milk and lactation, and this is a side effect that can in fact occur in men with excessive levels of the hormone.
Men can develop lactation from the nipples in the form of small amounts of clear fluid, and in more severe cases symptoms similar to gynecomastia can develop. It’s important for men to maintain normal levels of prolactin, ensuring they do not get too high or too low.
Prolactin & Anabolic Steroids
While prolactin is not as important as estrogen for anabolic steroid users, some users have found that steroids have increased their prolactin levels. As this can lead to low testosterone, it is of great concern to male steroid users. The details of prolactin’s relationship with steroid usage is little understood due to lack of research.
Some steroid users who have undertaken their own testing have found that particular steroids – those with progestin activity in particular like Trenbolone and Nandrolone based steroids such as Deca-Durabolin, can result in a rise of prolactin. But, countless people use these steroids and do not experience any side effects relating to an increase of prolactin. This could indicate a highly individualistic reaction to some anabolic steroids.
Control, Elimination, and Prevention of Prolactin
Ideally you will be able to control prolactin so you don’t have to deal with any of its potential negative effects. This doesn’t mean removing all prolactin from the body, as it is needed. But preventing it from increasing to above a normal level should be the goal.
If you can control estrogen effectively, this in turn will likely also control prolactin as they are linked. Therefore, to effectively control prolactin you should be aiming to control estrogen as you normally would while using anabolic steroids.
If you can do this, you’re unlikely to even be thinking about prolactin. If prolactin does start causing a problem when you’ve been unable to prevent it from increasing, there are some medications that can address the issue. In particular, a class of drugs known as dopamine agonists can stop the secretion of prolactin. However, most steroid users will not find themselves in this position as long as control of estrogen is maintained throughout the cycle.
How long do steroid side effects last?
Every steroid has a different half life and different levels of impact on the body. And some side effects can last longer than others, especially when they are left uncontrolled. For example, if gyno is allowed to persist it can become permanent. Likewise, the loss of head hair will be permanent in those men who experience that side effect. Other side effects like acne and increased aggression usually subside once the steroids are stopped.
Are anabolic steroids safe?
Many people use anabolic steroids for years without any serious impacts on their short term health. Steroids can become very unsafe when used at very high doses and/or for long periods of time without breaks in between. Those with existing health problems, such as cholesterol, heart or liver issues, can also be at higher risk of complications.
What happens when you stop taking anabolic steroids?
When a man stops taking steroids, he is left with little to no natural testosterone function. This results in a state of low or no testosterone in the body – bringing with it severe side effects that impact all areas of health. This can be avoided by implementing post cycle therapy so testosterone function is stimulated quickly, and side effects of low testosterone don’t develop.
Do steroids affect you sexually?
Steroids can have an impact on sexual function in different ways. They can boost the libido, but can also have a negative impact on sex drive and ability if you don’t maintain at least a base line level of testosterone. Since steroids suppress normal testosterone function, sex drive can be severely impacted both during and after a cycle if you aren’t making use of an external source of testosterone.
Do steroids shorten your life?
Any drug can be a risk to health and life when abused, and steroids are no different. High doses and careless use of anabolic steroids without proper procedures, hygiene and side effect mitigation measures in place can result in a huge risk to your health or life – which is why anyone thinking of using steroids should learn as much as possible before jumping in.
Can steroids change your personality?
Some steroids can increase aggression and anger in some individuals. This is a side effect that is often termed “roid rage”, but can be overstated because many guys can use steroids without ever experiencing changes in mood or personality. For those who are already prone to a short temper or angry outbursts, steroids can potentially make this worse and those are the people who need to be more aware of this particular side effect.
My Conclusion and Recommendation
Steroids can come with many negative side effects if they are not used properly and carefully monitored. These include: raising cholesterol, stressing the liver, inducing acne and hair loss, enlarging the breast tissue in men, sexual dysfunction, anger issues, and more.
Many side effects relate to rising estrogen levels in men and the associated impacts, while others are caused by the increased level of androgenic activity in the body.
If you enjoyed this guide and would like more real, NO-BS information on cycling steroids, then pick up Straight From the Underground (my recommended underground steroid handbook). Everything in this book is based on first hand experience, not theory.