MVIIIHealth The MVIII app
← Back

Research · Medication

Anabolic-androgenic steroids

Grey marketNot approved for human use in the US, and sold anyway. This applies to the non-prescribed use.

Trials of high-dose testosterone in healthy men raised muscle size and strength. Cohorts and case series of non-prescribed users link steroids to sharply lower sperm counts during use, smaller testicles, and sperm recovery taking about a year, incomplete in some. Users had about three times the death rate of non-users and more heart attacks and heart failure.

Add to Bio HackChecked 2026-11-13
Status
Anabolic steroids are Schedule III controlled substances under US federal law [1]. Testosterone and a few other anabolic steroids are FDA-approved prescription drugs for specific medical conditions. Building muscle or improving appearance is not an approved use, and this page covers use without a prescription.
Also called
anabolic steroids, AAS, anabolic-androgenic steroids, androgens, steroids, roids, steroid cycle, testosterone enanthate, testosterone cypionate, nandrolone, Deca-Durabolin, trenbolone, oxandrolone, Anavar, oxymetholone, Anadrol, methandrostenolone, Dianabol, stanozolol, Winstrol, boldenone, drostanolone
Taken for
muscle growth, lean mass, strength, bodybuilding, fat loss, appearance, athletic performance

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help2

Reported risks12

What people take it for, and what was found

Shown to help2

ModerateStudied in men

Muscle size and strength

Shown to raise fat-free mass, muscle size and strength in healthy young men given high-dose testosterone, with larger gains alongside weight training.

Compared with placebo, with and without weight training [2]; lower testosterone doses, with the men's own testosterone suppressed [3]; men not using steroids [4]

The numbers and sources
Effect
In a 10-week trial, men given supraphysiologic testosterone without exercise gained more triceps area (424 against -81 mm²) and quadriceps area (607 against -131 mm²) than placebo, and more bench press (9 against -1 kg) and squat strength (16 against 3 kg). Men given testosterone with weight training gained 6.1 kg of fat-free mass, 22 kg on the bench press and 38 kg on the squat, more than either group without exercise [2]. In a 20-week trial of five testosterone doses, fat-free mass rose by 3.4, 5.2 and 7.9 kg at the three highest doses, and leg press strength, leg power and thigh muscle volume rose with testosterone concentration [3]. In pooled studies, steroid users had more lean mass than non-users (SMD 1.24, 95% CI 0.62 to 1.87) [4].
Population
43 healthy men [2]; 61 healthy men aged 18 to 35 [3]; male users and non-users in 5 studies for lean mass [4].
Sources
[2], [3], [4]
Caveats
The trials used testosterone alone, for 10 or 20 weeks under medical supervision. Non-prescribed use often combines several compounds for longer, and those were not tested in trials. The pooled comparison of users and non-users is cross-sectional [4].
LimitedStudied in men

Body fat

Limited evidence: fat mass fell as testosterone rose in one dose trial, and users had less fat than non-users in pooled cross-sectional studies.

Compared with lower testosterone doses, with the men's own testosterone suppressed [3]; men not using steroids [4]

The numbers and sources
Effect
In a 20-week trial, changes in fat mass were negatively correlated with testosterone concentration across five doses [3]. In pooled studies, steroid users had lower fat mass than non-users (SMD -1.07, 95% CI -1.53 to -0.61) [4].
Population
61 healthy men aged 18 to 35 [3]; male users and non-users [4].
Sources
[3], [4]
Caveats
The trial abstract reports a correlation, not a group difference [3]. Users and non-users differ in training and diet [4].

Risks

Reported risks12

ModerateStudied in menVery common

Sperm production falls during use

Linked to sharply lower sperm counts during use. In a prospective study, 77% of men fell below 40 million sperm, and pooled studies found lower counts than in non-users.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In 100 men followed through a self-chosen steroid cycle, 77% had a total sperm count below 40 million during use [6]. Pooled studies measuring men before and during use found luteinizing hormone fell 3.37 IU/L (95% CI -5.05 to -1.70), and follicle-stimulating hormone fell 1.73 IU/L (95% CI -2.67 to -0.79), and the review reported structural and functional sperm changes [5]. Against non-users, users had total sperm counts 47.28 million lower (95% CI -79.93 to -14.62) and fewer normally shaped sperm (SMD -2.00), while concentration did not differ significantly (-39.59 million/mL, 95% CI -82.82 to 3.63) [4].
Population
100 male amateur strength athletes in the Netherlands [6]; 33 studies of 1,766 users and 2,113 non-users, mostly men [5]; men in 24 studies [4].
Sources
[6], [5], [4]
Caveats
Evidence comes from cohorts, cross-sectional studies and case series of users, who chose their own compounds and amounts. Few studies measured semen.
ModerateStudied in menVery common

Slow and sometimes incomplete sperm recovery after stopping

Linked to sperm recovery taking about a year or longer after stopping. In one prospective study, a third of men still had low counts a year after starting.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Three months after a cycle ended, total sperm count was 61.7 million below baseline (95% CI 33.7 to 90.0). One year after the cycle began, it was still 29.7 million below baseline, and 34% of men had a total count under 40 million [6]. In current and past users compared with non-users, mean recovery time was 14.1 months for sperm output and 10.7 months for LH, and longer use was linked to slower sperm recovery. Past users did not differ from non-users except for smaller testes [7]. In 1,549 healthy men given testosterone-based contraceptive regimens in medical trials, sperm concentration recovered to 20 million/mL in 67% within 6 months, 90% within 12, 96% within 16 and 100% within 24 [8].
Population
100 male amateur athletes [6]; 41 current and 31 past users and 21 non-users [7]; 1,549 healthy men in 30 contraceptive studies [8].
Sources
[6], [7], [8]
Caveats
Follow-up after the cycle was short in the prospective study [6]. The contraceptive data come from supervised medical doses and may understate recovery time after non-prescribed use of several compounds [8]. Recruitment through social media may select users [7].
ModerateStudied in menVery common

Low testosterone after stopping

Linked to low testosterone after stopping, below the reference range in 27% of former users about 2.5 years later. Most men in a prospective study recovered within 3 months.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
After stopping, gonadotropins returned to baseline within 13 to 24 weeks, while testosterone remained 9.40 nmol/L below baseline (95% CI -14.38 to -4.42), still low at 16 weeks [5]. In a prospective study, total testosterone 3 months after the cycle did not differ from baseline, and 11% of men were below normal a year after starting [6]. Former users a mean 2.5 years after stopping had lower total testosterone than controls (14.4 against 18.8 nmol/L), 27.2% were below the reference limit against none of the controls, and more had depressive symptoms (24.2%), erectile dysfunction (27.3%) and low libido (40.1%) [11]. Untreated former users had testosterone 131 ng/dL lower than non-users, five below 200 ng/dL after 3 to 26 months off [9]. Among 97 men with profound hypogonadism at a men's health clinic, prior steroid use was the most frequent cause (43%) [12].
Population
Male users in 11 pooled studies [5]; 100 male amateur athletes [6]; 33 former users, 37 current users and 30 controls [11]; 19 untreated former users [9]; 6,033 men seen for hypogonadism [12].
Sources
[5], [6], [11], [9], [12]
Caveats
Cohorts and case-control studies of users. Men with prolonged symptoms may be more likely to join studies or attend clinics.
ModerateVery common

Mania, aggression and depression

Shown to raise manic symptoms in a placebo-controlled trial, marked in 4% of men. Users reported mood syndromes with use, and depression on withdrawal is described.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In a 6-week placebo-controlled crossover trial in 56 men, supraphysiologic testosterone raised mania scores and aggressive responses. Of 50 men, 84% showed minimal change, 12% became mildly hypomanic and 4% markedly hypomanic [20]. Among 88 athletes using steroids, 23% reported mania, hypomania or major depression during use, more often than off steroids and than 68 non-users [10]. A systematic review describes hypomania with short-term use and depression with long-term use and on withdrawal [21]. In two other trials, mood did not change [2][3].
Population
56 men aged 20 to 50 [20]; 160 athletes [10]; athletes in observational studies [21]; 43 and 61 healthy men [2][3].
Sources
[20], [10], [21], [2], [3]
Caveats
Effects varied widely between men, and nothing measured at baseline predicted who reacted [20]. Users who seek steroids may differ in mental health beforehand [21].
ModerateVery common

Dependence

Linked to dependence in about 30% of users, in a pooled analysis of 10 studies.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across 10 studies of users, the mean prevalence of steroid dependence was 32.5% (95% CI 25.4% to 39.7%), median 29.5%. In 6 American studies the mean was 35.0% [22].
Population
Steroid users in 10 studies, almost all men [22].
Sources
[22]
Caveats
Studies recruited users in different ways, and some assessed lifetime and others current dependence [22].
ModerateStudied in menVery common

Acne, breast growth and erectile dysfunction

Linked to acne, breast growth and erectile dysfunction, each in more than 10% of users, more often than in non-users.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Acne, gynecomastia and erectile dysfunction each affected more than 10% of users, significantly more than matched controls (p < 0.0001) [17]. Users had more frequent gynecomastia than non-users [10], and pooled studies reported gynecomastia [5].
Population
545 male users and 5,450 controls [17]; 160 athletes [10]; users in 33 studies [5].
Sources
[17], [10], [5]
Caveats
Diagnoses came from registries and examinations, and exact rates for each effect are not given in the abstracts.
ModerateVery common

Fake and substandard products

Pooled lab analyses found 36% of steroid products from the illicit market were counterfeit and a further 37% substandard.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across 19 studies of 5,413 samples, mostly seized by authorities, 36% were counterfeit (95% CI 29% to 43%) and 37% were of substandard quality (95% CI 17% to 63%). Products contained no active ingredient, a different amount than labeled, a wrong ingredient, or more or fewer ingredients than labeled [23].
Population
Steroid samples from Europe and the Americas [23].
Sources
[23]
Caveats
Heterogeneity was high and proportions differed by region [23].
ModerateStudied in menHow often is not known

Smaller testicles

Linked to smaller testicles in users and in former users years after stopping, in pooled and cross-sectional studies.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Pooled studies reported a reduction in testicular volume with steroid use [5]. Untreated former long-term users had testes 2.3 mL smaller than non-using weightlifters (95% CI 0.1 to 4.5) after 3 to 26 months off steroids [9]. Past users had residual smaller testis volume when other measures had recovered [7]. In 88 users and 68 non-users, users had shorter mean testicular length [10].
Population
Users in 33 studies [5]; 19 untreated former users and 36 non-using weightlifters [9]; 31 past users and 21 non-users [7]; 156 athletes [10].
Sources
[5], [9], [7], [10]
Caveats
Cross-sectional comparisons cannot show how volume changed in each man.
ModerateStudied in menHow often is not known

Heart muscle and coronary artery changes

Linked to weaker heart pumping, a thicker heart wall and more coronary plaque in users. In a prospective study, the heart changes reversed within about 8 months of stopping.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Long-term users had lower left ventricular ejection fraction than non-users (52% against 63%) and more coronary plaque volume (median 3 against 0 mL³). Plaque rose with lifetime steroid use [13]. In 31 men followed through a cycle, ejection fraction fell 4.9 percentage points (95% CI -7.2 to -2.5) and left ventricular mass rose 28.3 g (95% CI 14.2 to 42.4), and all measures returned to baseline after a median 8 months off [14]. Current users had impaired systolic function and past users did not differ from non-users [7].
Population
86 male weightlifters with 2 or more years of use and 54 non-users, aged 34 to 54 [13]; 31 male amateur athletes [14]; 41 current and 31 past users and 21 non-users [7].
Sources
[13], [14], [7]
Caveats
Users chose their own compounds and amounts, and many used other drugs. The prospective study was small [14].
ModerateStudied in menHow often is not known

Heart attack, heart failure, clots and death

Linked to about three times the rate of heart attack and death, and higher rates of heart failure, blood clots and arrhythmia, in national cohorts of men caught using steroids.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Over an average 11 years, 1,189 men sanctioned for steroid use had more heart attacks (aHR 3.00, 95% CI 1.67 to 5.39), venous blood clots (aHR 2.42, 95% CI 1.54 to 3.80), arrhythmias (aHR 2.26), cardiomyopathy (aHR 8.90, 95% CI 4.99 to 15.88) and heart failure (aHR 3.63, 95% CI 2.01 to 6.55) than 59,450 matched controls [15]. Men who tested positive had twice the cardiovascular illness and death rate of men who tested negative (aHR 2.0, 95% CI 1.2 to 3.3) [16]. Mortality was three times higher in users than matched controls (HR 3.0, 95% CI 1.3 to 7.0) [17].
Population
Men in Danish fitness center doping controls and matched controls [15][17]; 2,013 Swedish men tested for steroids [16].
Sources
[15], [16], [17]
Caveats
Observational. Men caught using steroids may use other drugs and differ in other ways from the comparison groups.
ModerateStudied in menHow often is not known

Lower HDL cholesterol

Shown to lower HDL cholesterol as testosterone rose in a dose trial. Pooled studies found lower HDL and higher LDL cholesterol in users than in non-users.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In a 20-week trial of five testosterone doses, changes in HDL cholesterol were negatively correlated with testosterone concentration [3]. Against non-users, users had HDL cholesterol 0.43 mmol/L lower (95% CI -0.56 to -0.31) and LDL cholesterol 0.63 mmol/L higher (95% CI 0.38 to 0.88). Total cholesterol and triglycerides did not differ [4].
Population
61 healthy men aged 18 to 35 [3]; male users and non-users in 4 to 5 studies [4].
Sources
[3], [4]
Caveats
The user comparison is cross-sectional [4].
LimitedHow often is not known

Liver injury and liver tumors

Case reports: steroid use for bodybuilding caused jaundice with very high bilirubin, sometimes with kidney injury, and benign liver tumors that shrank after stopping.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 25 cases of drug-induced liver injury from steroids used for bodybuilding, mostly in young men, jaundice predominated and bilirubin was higher than in liver injury from other drugs. Cholestatic cases with very high bilirubin developed acute kidney injury. No deaths occurred. Steroids rose from under 1% of cases in the Spanish registry in 2001 to 2009 to 8% in 2010 to 2013 [18]. Two bodybuilders developed hepatocellular adenomas, which tended to regress after steroids were stopped [19].
Population
25 cases in Spanish and Latin American liver injury registries [18]; 2 male bodybuilders [19].
Sources
[18], [19]
Caveats
Case series with no denominator, so no rate.

Claims tested and not found

  1. That sperm counts are back to normal within 3 months of finishing a cycle. Three months after a cycle ended, total sperm count was still 61.7 million below baseline, and a year after starting, 34% of men had counts under 40 million [6].
  2. That testosterone always returns to normal after stopping. Former users about 2.5 years after stopping had lower testosterone than controls, and 27.2% were below the reference limit [11].

Related

Testosterone therapySARMs

Sources

  1. Electronic Code of Federal Regulations. 21 CFR 1308.13, Schedule III. eCFR. 2026. https://www.ecfr.gov/current/title-21/chapter-II/part-1308/section-1308.13
  2. Bhasin S, Storer TW, Berman N, et al. The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men. New England Journal of Medicine. 1996. https://doi.org/10.1056/nejm199607043350101
  3. Bhasin S, Woodhouse L, Casaburi R, et al. Testosterone dose-response relationships in healthy young men. American Journal of Physiology-Endocrinology and Metabolism. 2001. https://doi.org/10.1152/ajpendo.2001.281.6.e1172
  4. Corona G, Rastrelli G, Marchiani S, et al. Consequences of Anabolic-Androgenic Steroid Abuse in Males; Sexual and Reproductive Perspective. The World Journal of Men's Health. 2022. https://doi.org/10.5534/wjmh.210021
  5. Christou MA, Christou PA, Markozannes G, et al. Effects of Anabolic Androgenic Steroids on the Reproductive System of Athletes and Recreational Users: A Systematic Review and Meta-Analysis. Sports Medicine. 2017. https://doi.org/10.1007/s40279-017-0709-z
  6. Smit DL, Buijs MM, de Hon O, den Heijer M, de Ronde W. Disruption and recovery of testicular function during and after androgen abuse: the HAARLEM study. Human Reproduction. 2021. https://doi.org/10.1093/humrep/deaa366
  7. Shankara-Narayana N, Yu C, Savkovic S, et al. Rate and Extent of Recovery from Reproductive and Cardiac Dysfunction Due to Androgen Abuse in Men. The Journal of Clinical Endocrinology and Metabolism. 2020. https://doi.org/10.1210/clinem/dgz324
  8. Liu PY, Swerdloff RS, Christenson PD, et al. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. The Lancet. 2006. https://doi.org/10.1016/s0140-6736(06)68614-5
  9. Kanayama G, Hudson JI, DeLuca J, et al. Prolonged hypogonadism in males following withdrawal from anabolic-androgenic steroids: an under-recognized problem. Addiction. 2015. https://doi.org/10.1111/add.12850
  10. Pope HG, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use: a controlled study of 160 athletes. Archives of General Psychiatry. 1994. https://doi.org/10.1001/archpsyc.1994.03950050035004
  11. Rasmussen JJ, Selmer C, Østergren PB, et al. Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study. PLOS ONE. 2016. https://doi.org/10.1371/journal.pone.0161208
  12. Coward RM, Rajanahally S, Kovac JR, et al. Anabolic Steroid Induced Hypogonadism in Young Men. Journal of Urology. 2013. https://doi.org/10.1016/j.juro.2013.06.010
  13. Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use. Circulation. 2017. https://doi.org/10.1161/circulationaha.116.026945
  14. Smit DL, Voogel AJ, den Heijer M, de Ronde W. Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study. Frontiers in Reproductive Health. 2021. https://doi.org/10.3389/frph.2021.732318
  15. Windfeld-Mathiasen J, Heerfordt IM, Dalhoff KP, et al. Cardiovascular Disease in Anabolic Androgenic Steroid Users. Circulation. 2025. https://doi.org/10.1161/circulationaha.124.071117
  16. Thiblin I, Garmo H, Garle M, et al. Anabolic steroids and cardiovascular risk: A national population-based cohort study. Drug and Alcohol Dependence. 2015. https://doi.org/10.1016/j.drugalcdep.2015.04.013
  17. Horwitz H, Andersen JT, Dalhoff KP. Health consequences of androgenic anabolic steroid use. Journal of Internal Medicine. 2019. https://doi.org/10.1111/joim.12850
  18. Robles-Diaz M, Gonzalez-Jimenez A, Medina-Caliz I, et al. Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids. Alimentary Pharmacology and Therapeutics. 2015. https://doi.org/10.1111/apt.13023
  19. Socas L, Zumbado M, Pérez-Luzardo O, et al. Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature. British Journal of Sports Medicine. 2005. https://doi.org/10.1136/bjsm.2004.013599
  20. Pope HG, Kouri EM, Hudson JI. Effects of Supraphysiologic Doses of Testosterone on Mood and Aggression in Normal Men: A Randomized Controlled Trial. Archives of General Psychiatry. 2000. https://doi.org/10.1001/archpsyc.57.2.133
  21. Piacentino D, Kotzalidis GD, Del Casale A, et al. Anabolic-androgenic Steroid use and Psychopathology in Athletes. A Systematic Review. Current Neuropharmacology. 2015. https://doi.org/10.2174/1570159x13666141210222725
  22. Pope HG, Kanayama G, Athey A, et al. The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: Current best estimates. The American Journal on Addictions. 2014. https://doi.org/10.1111/j.1521-0391.2013.12118.x
  23. Magnolini R, Falcato L, Cremonesi A, et al. Fake anabolic androgenic steroids on the black market: a systematic review and meta-analysis on qualitative and quantitative analytical results found within the literature. BMC Public Health. 2022. https://doi.org/10.1186/s12889-022-13734-4

Everything in the library