The effects of steroids on the body

Are steroids ever safe? We look at how steroids work, including the dangers and how to stay safe.

Author: Dr Daniel Grant - Head of Medical Education, MBBS, BSc

Published on: 21 October 2021

Historically, steroids have been used in elite sport for marginal gains over the opposition. You’ve may well have heard of Lance Armstrong, Marion Jones, and Justin Gatlin all using performance-enhancing drugs (PEDs).

Today, we find that people tend to use them for other reasons and that it’s far more common than you think. You may have used or know someone who uses steroids. We look at how steroids work, the effect of steroids on the body and whether they can ever be safe.

What are steroids?

Anabolic-androgenic steroids (AAS) are part of supplements called image and performance-enhancing drugs or IPEDs.

AAS are the synthetic derivative of the male hormone testosterone. These supplements promote muscle growth and development (anabolic) of masculine characteristics (androgenic). There are lots of different steroids out there, and some people combine multiple supplements with other medications to control their side effects. Some are oral, some are topical, and some injected.

By current estimates, between 400,000 and one million people in the UK use IPEDs. The majority are men in their early 20s, but men and women of all ages use them. In recent years, social media and reality television have influenced more people to try to sculpt the perfect body. It’s not just sport; it is societal.

A third of gym-goers are aware of steroid use in their gym, and some people even share needles and phials (it goes without saying this is a bad idea). AAS can help to promote muscle growth and increase fat loss. So, they can have both those physical and aesthetic benefits. But there can be negative physical health and psychological effects, including increased confidence and increased aggression.

The steroids replace the action of testosterone and suppress the natural production of testosterone. Hopefully, once you come off steroids, natural hormonal levels restore but, sometimes, the change is permanent, and you’ll not be able to produce testosterone naturally again, which will impact fertility, libido, and other aspects of your life.

What are the negative effects of anabolic steroids?

Target	Adverse Effect
Breasts	Gynaecomastia (‘man boobs’) and enlarged nipples in men Atrophy in women Changes are potentially permanent
Cardiovascular	Increases the risk of a heart attack or stroke Causes increase in ‘bad’ cholesterol and decrease in ‘good’ cholesterol Causes increased production of blood and thicker blood, which can clot more easily Weightlifting puts pressure on the head and chest High blood pressure Irregular heartbeats All these come together to form a perfect storm that makes you a very high risk for potentially fatal heart attacks and strokes
Psychological	Increased or decreased libido Mania Irritability Self-destructive impulses Depression Muscle dysmorphic disorder When coming off steroids – withdrawal and low libido
Hair	Increase hair growth on body and face in women, with male pattern hair loss Acceleration of baldness in men
Liver	Toxic effects on the liver. Normally reversible, but with some permanent changes and increased risk of liver tumours
Reproduction	Men - erectile dysfunction sperm suppression, shrinking testicles, growth of the prostate. Possible reduced fertility short-term, sometimes permanent Women - Amenorrhoea (absent periods), growth of the clitoris, masculinisation of a female foetus if pregnant
Skin	Acne, sometimes severe
Vocal	Deeper voice in women
Infection	Increased risk of blood-borne viruses like HIV, hepatitis B and hepatitis C from needle sharing

Is it possible to take steroids safely?

The straight answer is no. However, we recognise that many people will go on to take steroids without knowing about the side effects, meaning they may not know when to seek medical help.

If you are going to take them, the key is to know the risks, stay safe and monitor yourself.

Make sure you’re well informed and know what you’re taking. It’s not unheard of for people to think they’re taking a particular steroid but are taking something else.
Do not needle or drug share. You can visit a needle exchange for clean needles if you inject steroids.
Read around the topic as these are dangerous substances. Sometimes people rely on the ‘big guy from the gym’. Don’t do that. Rely on the science instead.
Keep on top of your health by monitoring your blood. We recommend the Sports Hormone or Advanced Sports Hormone Blood Test to monitor your hormones and organ systems. Depending on your regimen, it makes sense to test every three months. If you are competing in competitions like blast and cruise, bodybuilding expo, etc. then ask our doctors what testing frequency they’d recommend.
Let our doctors know what you take, what your regimen is and what training you’re doing. They will then be able to tailor their advice for you.
Heed the warnings. If our doctors are warning you to cut down or stop, then please follow the advice. They’re telling you this to try and stop those serious adverse effects happening to you.
Stay healthy. You can reduce your risk of steroid use by staying healthy in all other aspects of your life. Eat and drink well, cut out smoking and drinking, and if you have existing medical conditions (e.g. high blood pressure or diabetes), make sure these are under control.

Anabolic steroids and your health

Anabolic steroids can negatively impact your health, life, and fertility. If you choose to take them, minimise your risk by monitoring yourself regularly and being open with your doctor.

References:

Image and Performance Enhancing Drugs: UKAD’s status report on IPEDs in the UK. UK Anti-Doping. 2019. https://www.ukad.org.uk/sites/default/files/2020-01/UKAD%20IPED%20Report%20FINAL.pdf

Amsterdam JV, Opperhuizen A, Hartgens F. Adverse health effects of anabolic-androgenic steroids, Regulatory Toxicology and Pharmacology, Volume 57, Issue 1, 2010, Pages 117-123, https://doi.org/10.1016/j.yrtph.2010.02.001

Hartgens, F., Kuipers, H. Effects of Androgenic-Anabolic Steroids in Athletes. Sports Med 34, 513–554 (2004). https://doi.org/10.2165/00007256-200434080-00003

Kicman AT. Pharmacology of anabolic steroids. British Journal of Pharmacology. Vol 154, Issue 3, 2008, Pages 502-521 https://doi.org/10.1038/bjp.2008.165

Maravelias, A. Dona, M. Stefanidou, C. Spiliopoulou. Adverse effects of anabolic steroids in athletes: A constant threat. Toxicology Letters. Volume 158, Issue 3, 2005, Pages 167-175, https://doi.org/10.1016/j.toxlet.2005.06.005

Nieschlag, E., Vorona, E. Doping with anabolic androgenic steroids (AAS): Adverse effects on non-reproductive organs and functions. Rev Endocr Metab Disord 16, 199–211 (2015). https://doi.org/10.1007/s11154-015-9320-5

Guardian. 2018. Up to a million Britons use steroids for looks, not sport. [ONLINE] Available at: https://www.theguardian.com/society/2018/jan/21/up-to-a-million-britons-use-steroids-for-looks-not-sport. [Accessed 19 October 2021].