Steroids Side Effects

With steroids, as with all drugs or medications, there are inherent direct effects as well as side effects. The purpose of this article is to explore potential side effects both positive and negative. Yes, some side effects may be considered positive depending upon ones purpose for using the particular steroid. Also interestingly enough you may find some effects listed as both positive and negative.

Some side effects of steroids use occur almost across the board with all steroids to varying degrees. Some are more specific to certain steroids. First we will explore the across the board potential side effects , then try to shed some light on certain steroid type specific side effects and why they may occur.

Broad Spectrum Sides


  1.  Increased Rate of Protein Synthesis – Protein synthesis is the process by which individual cells construct proteins. Increasing this rate increases the body’s ability to not only build, but repair muscle tissue more efficiently.
  2.  Increased Nitrogen Retention– Nitrogen retention is a very important aspect in not only building, but retaining hard earned muscle tissue. Muscle is composed of nearly 20% nitrogen – increasing nitrogen retention results in an increase in muscle tissue. Also it is essential in preventing a state of muscle catabolism.
  3.  Increased Endurance – Steroids accomplish this primarily by an increase in red blood cells. These are the cells responsible for transporting oxygen throughout the body, including to muscle tissue. (note – this is one of the positive / negative side effects one need be aware of as I will touch on later)
  4.  Increased Fat Loss – Yes its true, steroids will increase your ability to lose body fat. There are several reasons for this. The simplest perhaps being due to an increase in muscle tissue (the body will support muscle with calories before it will store them as fat), as well as calories expended in the process of building/repairing muscle. Also steroids allow the body to more efficiently utilize carbohydrates as an energy source. However certain steroids offer additional effects that allow for other explanations for this effect, but that’s another article!
  5.  Sense of Well Being – Some research has shown that steroids cause a “psychosomatic state” characterized by an overall state of well being and higher tolerance to stress. It should also be mentioned that increased aggressiveness has been note so this is another potentially positive/negative effect. More on that later.


As we explore the negative side effects of steroids I will very briefly touch on commonly accepted methods to help to minimize these negative effects.

  1. High Blood Pressure – The reason for this effect is two fold. As was mentioned above steroids increase the number of red blood cells. This, in turn, results in an increase in blood pressure. The second reason is the water retention caused by the aromatization of steroids to estrogen. High estrogen levels can result in water retention, water retention also results in elevated blood pressure. To offset these effects due to increased red blood cells a general approach to blood pressure management is prudent. IE : Watching sodium intake, cardiovascular exercise, low dose aspirin therapy, and in more extreme circumstances some resort to giving blood. To offset the effects due to water retention as a result of elevated estrogen use of an aromatase inhibitor would be prudent. This is also prudent for other reason which will be mentioned later.
  2. High Cholesterol – Steroids will frequently have an adverse effect on cholesterol – how much will vary depending on the steroid and the dosage as well as lifestyle. The most prudent way to help offset this is a healthy lifestyle and a good diet. Fish oil/flax oil (omega 3 fatty acids) has also been shown to help in this area. Another factor that impacts this is estrogen levels. It would seem most prudent to keep estrogen levels within clinically normal ranges through the use of an AI (aromatase inhibitor). It is very important when it comes to cholesterol that we do not lower estrogen too much as it exerts a positive impact on lipid values.
  3. Enlarged Prostate – The effect of steroids on the prostate gland is due to 2 primary factors. One is DHT (dihydrotestosterone). DHT is a result of the 5 alpha reduction (via 5aplha-reductase enzyme) of testosterone and plays a role in a number of functions in the body (sexual development, sex drive being 2). To offset this, a 5- alpha reductase inhibitor like Finasteride can be taken. The second factor is estrogen. More and more recent studies are correlating elevated estrogen levels with enlargement of the prostate. To offset this as was previously mentioned, an aromatase inhibitor would prove useful.
  4. Testicular Atrophy/ Testosterone Suppression – This effect occurs due to the body ceasing production of endogenous testosterone when exogenous steroids are introduced. This can only be helped and is unavoidable to varying degrees depending on steroids used, cycle duration etc. On cycle HCG (human chorionic gonadotropin), can be taken to minimize testicular atrophy and many believe increase the body’s ability to resume normal testosterone production post cycle. Post cycle many employ the use of SERMs (selective estrogen receptor modulator) such as Clomid , Nolvadex and Toremifene in various protocols in an effort to “restart” natural testosterone production as quickly and efficiently as possible. HCG will maintain the function, size and spermatogenesis of the testes and aid in the recovery process once the steroid course finishes and HPTA restoration is the primary concern.
  5. Hepatoxicity or Liver damage – This is most often associated with oral steroids that are what is known as 17 alpha alkylated. In layman’s terms this is a chemical alteration to a steroid that allows it to survive what is known as “first pass” in the liver. If it were not chemically altered, or 17 alpha alkylated, the steroid itself would be removed or destroyed by the liver and would never have an opportunity to exert its effects. In order to offset these prudent dosages and durations or these oral steroids would be suggested. Also an overall healthy lifestyle devoid of prescription drug use/abuse as well as alcohol use/abuse is also important to help offset this effect. Supplements that will aid in the detoxing of the liver are milk thistle and the popular supplement Liv 52.
  6. Hair Loss – This effect is also primarily due to the previously mentioned DHT (dihydrotestosterone). It builds up in the scalp and eliminates hair follicles. This may occur via the conversion of testosterone to DHT or by taking a DHT based steroid (more on that later). The latter is the most significant but the former cannot be dismissed. This issue can be addressed by taking a 5 alpha reductase inhibitor like Finasteride and or also by using a topical treatment such as Ketoconazole shampoo (Nizoral), which has a DHT blocking or at least reducing effect.
  7. Acne – Acne is a greatly varied side effect when it comes to steroids. It hits some users hard, some virtually not at all. It seems to have a correlation with the androgenic nature of the steroid in many cases. The more androgenic – the higher the likelihood of breakouts. For this side effect cleanliness is in fact next to godliness. Also a body wash with 2% salicylic acid seems to help many with this issue. Some even have to resort to antibiotic treatments, while some remain unaffected. Other methods on controlling this nasty, though mainly cosmetic side effect, are large amounts of vitamin B5. This can be used at 2,000-3,000mg every day. Controlling estrogen will aid greatly in stopping an outbreak as it’s the primary hormone that’s increased in males when acne appears. Controlling the fluctuation of steroidal hormones, such as, injecting short esters daily or at least every other day. Finally, Isotretinion (Accutane) can be used by its use should be monitored by a doctor or physician. A dose of 10mg every day is a good starting dose, but also understand that liver values and kidney stress will occur even at low dose of Accutane. As mentioned earlier, Nizoral, the anti-androgen is also a potent weapon against controlling acne.
  8. Gynecomastia – Aka “gyno”. This is abnormal development of breast tissue in males. It is primarily due to an excess of estrogen. While other hormonal factor such as progesterone, IGF and Growth Hormone, can impact this as well, it is established that controlling estrogen mitigates the issue at its core. This can be prevented by using an AI (aromatase inhibitor) such as Exemestane or Arimidex on cycle. It is often treated by use of a SERM (selective estrogen receptor modulator) such as Nolvadex (which blocks the estrogen receptor in breast tissue) and/or a strong AI such as Letrozole. While this is a serious side effect it is one that is most often easily preventable by prudent use of an AI on cycle. It should be mentioned DHT based steroids do not aromatize to estrogen.
  9. Water Retention – This too is primarily a result of excess estrogen. It is also controllable by prudent use of an Ai (aromatase inhibitor) such as Arimidex or Exemestane on cycle. Also a factor in water retention is, has and always will be diet. Sodium as well as excess carbohydrate intake will result in additional water retention. Water retention can be limited by a few factors.
    – Regular Cardiovascular exercise. This can be either or both low/moderate intensity cardio or interval training. 20-30 minutes should be completed 3-4 times per week.
    – A diet low in sodium, this means limiting or no adding extra salt to food dishes and limiting salty foods.
    – Controlling estrogen, by use of an aromatase inhibitor (AI). Exemestane can be used at 10mg every day or Anastrozole at 0.5mg every other day.
  10. Aggression– aka “Roid Rage”. As mentioned earlier this is another potential psychological side effect. There seems to be a proportional correlation with the androgenic property in the steroid(s) being taken, and the potential for this effect. This side is often interpreted to one extreme or the other – incorrectly. Many mistakenly believe that taking steroids will turn you in to a raving lunatic – which is not the case. That being said many who take steroids deny the effect even exists. It’s important to realize that it is scientifically proven that there is a correlation between androgen levels and emotions such as patience, tolerance and anger and actions such as aggression. It seems most prudent to be aware of this so if it does rear its head you can think before you act or react.
  11. Virilization– This is the masculinizing effect steroids have on women. Such effects include clitoral enlargement, increased body hair growth, deepening of the voice, and increased sex drive. Remember steroids are derived from male hormones – use by females is subject to these potential sides. Factors such as which steroids used, dosage and duration all play a role in how prevalent these sides may be. Much like gynecomastia early detection is the key and immediate cessation is the solution. If this does not occur some of these effects are irreversible. Some prudent steroid choices for women might be Anavar or Winstrol and perhaps Primobolan all at low dosages.
  12. Sterility– This is an effect that can occur in both men and women. Most certainly it can and does occur while one is currently on a cycle of steroids. In fact, it is worth mentioning, in Europe some time ago one 250mg injection of testosterone per month was recognized as an effective form of male birth control. In women the menstrual cycle as well as ovulation may cease altogether. These effects will, as mentioned, more likely than not occur during cycle. It is also worth mentioning in some cases of abuse or in rarer cases on simple use of steroids the effect could be a permanent one. Quite often in these cases fertility drugs are required in an attempt to restore fertility to females and restore spermatogenesis in males. A common method to maintain testicular function, size and spermatogenesis is to use human chorionic gonadotropin (HCG). This can be administered subcutaneously by pinching the fat in the abdominal area and injecting international units. A preferred dose is 250-500ius injected twice per week.
  13. Teens and Steroids– Teens are subject to all the sides mentioned in this article. However it is important to realize the added potential risks that may be incurred. Many believe shutting down or inhibiting ones endogenous testosterone production prior to it reaching its peak could result in potential damage to the endocrine system and lead to future problems such as low testosterone. This is a hotly debated issue, however for obvious reasons there are very few if any case studies on the subject. I will not say which school of thought is correct but will merely present the currently held opinions on the subject. One thing that is not up for debate, that is a definitive fact, is that using steroids at a young age can cause premature fusing of growth plates – leading to stunted growth. There are many emotional and physiological factors that come into play while using steroids; needless to say the premature use of steroids by the young is probably not the most prudent idea.
  14. Injection Risks– There are inherent risks anytime you inject a substance into your body. You are essentially poking a hole in your body exposing it to any bacteria, viruses, spores or contaminant not only on your skin, but on the vial, the needle and even to a degree in the air. You also are exposing it to any potential contaminants in the substance you are injecting. Results of this contamination could result in an infection and/or an abscess. An abscess is an enclosed collection of liquefied tissue (pus). It is a result of the body’s defense to a foreign material. In order to minimize the risk of above mentioned infection and or abscess the following protocol should be followed:
    a. Wash your hands.
    b. Wipe area to be injected with alcohol swab
    c. Clean top of rubber stopper on vial with alcohol swab.
    d. Unwrap syringe with needle; inject the same amount of air into vial as you will be withdrawing. Holding vial upside down withdraw correct amount into syringe.
    e. Continue to hold syringe facing needle up and replace needle cap. Unscrew needle.
    f. Unwrap new needle and holding it by the cap screw it onto syringe.
    g. Inject into injection site holding skin taut with free hand. Inject swiftly- like punching a dart through skin.
    h. Aspirate – This is pulling back slightly on the plunger to ensure the needle isn’t in a blood vessel.
    i. If no blood inject slowly and smoothly.
    j. After injection is complete remove needle quickly and immediately apply pressure with an alcohol swab.
    k. Replace cap on needle attached to syringe and dispose of needle and syringe as well as drawing needle safely(ie: in a sharps container)
    If despite following the above procedure the area becomes itchy , red and hot to touch , it is likely an infection or abscess is setting in. Do not hesitate – seek medical attention promptly.
  15. Withdrawal– Upon cessation of use there will be physiological and psychological symptoms of withdrawal. This is not often spoken about but it is a very real scenario. Physiologically your body is going from larger than normal amounts of hormones to a point where no endogenous hormones are being produced and no exogenous hormones are being introduced. These hormones regulate several important mechanisms within the body and they are no longer present. This can create issues like lack of sex drive and lethargy. Along with these come the psychological effects which may include depression, mood swings and lack of motivation. In order to help combat this many users turn to something called Post Cycle Therapy (PCT). This involves the taking of serms like clomid , nolvadex, toremifene; or a combination of these serms, in an attempt to restore natural hormone production as quickly as possible. It is also important from a psychological standpoint what is occurring and why and that it will end.
  16. Sexual Dysfunction – Steroids are hormones. Anytime you manipulate hormones you are tampering with a delicate, balanced system. If any one factor goes out of balance sexual dysfunction such as impotence or total lack of sex drive among other issues may become can rear their ugly head. These can occur from reasons such as an excess of estrogen, too little estrogen, high prolactin levels or even an imbalance between androgens and estrogens. Most of these effects are controlled by proper management of estrogen and in some rarer cases prolactin as well. The estrogen management has been addressed numerous times here and this simply reinforces the prudent use of an AI (aromatase inhibitor) on cycle. The prolactin issue is one that is most prevalent when using steroids such as Trenbolone and Deca-Durabolin (more on that later) and can be managed by using a dopamine agonist such as Cabergoline or Pramipexole. It is also important to mention a well though out, properly structured cycle will minimize the potential for these undesired side effects.

Steroid Specific Sides

So that gives you an overview of side effects good and bad with some suggestions on how to manage or avoid them. It is important to be aware of them and be able to recognize them. It is imperative to take the necessary precautions to avoid the negative one and the necessary steps to maximize the positive ones.

This brings me to my next point that I alluded to earlier. I will only touch on it briefly but I feel it’s important. There are 3 bases steroids are derived from. Testosterone, 19 nor steroids, and DHT based steroids. I mention this because while the sides I mentioned above may occur with all 3 types of steroids to varying degrees, there are certain sides that are most associated with certain steroid types. Below I will list the most common steroids in each type and the sides most closely associated with that steroid type.

Testosterone Based Steroids:

  • Chlorodehydrotestosterone-Turinabol
  • Boldenone – Equipoise
  • Methyltestosterone
  • Methandrostenolone – D-Bol
  • Fluoxymesterone – Halotestin

Testosterone based steroids are associated with estrogen related sides, to a lesser degree elevated DHT related sides, and virtually all of the commonly shared sides I mentioned above.

19 Nor Based Steroids:

  • Nandrolone Deconoate – Deca, Deca-Durabolin
  • Nandrolone Phenylpropionate – NPP
  • Trenbolone – Tren
  • Methy Hydroxy Nandrolone – MHN

19 Nor steroids are a rather distinct group in that they are associated with progesterone and prolactin related issues. Progesterone when estrogen is managed properly should be of little to no concern. Prolactin can cause some serious sexual side effects. These types of steroids also share virtually all of the commonly shared sides mentioned above with the exception that they do NOT aromatize to estrogen (with the exception of MHN to a small degree).

DHT Based Steroids:

  • Mesterolone – Proviron
  • Drostanolone – Masteron
  • Oxymetholone – Anadrol
  • Stanozolol – Winstrol
  • Methenolone – Primobolan
  • Oxandrolone – Anavar

DHT based steroids do not aromatize to estrogen, nor do they effect progesterone or prolactin. They are most commonly associated with hair loss and prostate issues. They do to a lesser degree carry all the other common sides except the estrogen related issues.

American Medical Association, Council on Scientific Affairs. Medical and non-medical uses of anabolic-androgenic steroids. J. Amer. Med. Assoc. 264: 2923-2927, 1990.
Bahrke, M.S., C.E. Yesalosk, and J.E. Wright. Psychological and behavioural effects of endogenous testosterone levels and anabolic-androgenic steroids among males: a review. Sports Med. 10: 303-337, 1990.
Buckley, W.E., C.E. Yasalis, K.E. Friedl, W.A. Anderson, A.L. Streit, and J.E. Wright. Estimated prevalance of anabolic steroid use among male high school seniors. J. Amer. Med. Assoc. 260: 3441-3445, 1988.
Rogozkin, V. Metabolism of Anabolic Androgenic Steroids. Leningrad: Nauka, 1988.
United States Olympic Committee. USOC Drug Education Handbook. Colorado Springs: USOC, 1989.
Assessment of Aggressive Behavior and Plasma Testosterone in a Young Criminal PopulationLeo E. Kreuz, MD, MAJ, MCand Robert M. Rose, MD, June 23, 1971. Revision received December 1, 1971. 1972 American Psychosomatic Society
BEHRE, H.M., K. ABSHAGEN, M. OETTEL, D. HUBLER AND E. NIESCHLAG. Intramuscular injection of testosterone undecanoate for the treatment of male hypogonadism: phase I studies. Eur J Endocrinol 140:414 ***8211; 419. 1999