"Steroids" can mean two very different drug classes with very different side effects. Anabolic-androgenic steroids (AAS) are lab-made variants of testosterone, and their main risks involve hormones, fertility, the heart, the liver, and mood. Corticosteroids such as prednisone are anti-inflammatory medicines that mimic cortisol, and their main risks involve sleep, mood, blood sugar, bones, eyes, infections, and the adrenal glands. Which list applies to you depends on which drug is involved, how much, for how long, and your own health.
This guide covers each group separately, explains what the research does and does not show, and lists the warning signs that need medical attention. It does not give guidance on using anabolic steroids without medical supervision.
At a Glance
- Anabolic steroids: Risks center on suppressed natural testosterone, fertility, cholesterol, heart structure and function, liver, skin, and mood. Some effects may be permanent.
- Corticosteroids: Risks depend heavily on dose, duration, and form. Short courses often cause few problems, while long oral courses carry the widest range of effects.
- The one rule that matters most for prescribed steroids: after more than a few weeks of oral use, do not stop suddenly without medical advice. Your adrenal glands may need a gradual taper.
- Not everyone gets every effect. Individual risk varies, and no single list fits every drug.
Anabolic Steroids vs. Corticosteroids: The Key Differences
| Anabolic-androgenic steroids | Corticosteroids | |
|---|---|---|
| What they are | Synthetic variants of testosterone | Synthetic versions of cortisol (prednisone, prednisolone, methylprednisolone, dexamethasone) |
| Medical uses | Low testosterone, some muscle-wasting conditions | Asthma, rheumatoid arthritis, lupus, multiple sclerosis relapses, allergic reactions, inflammatory skin and bowel disease |
| Main action | Builds muscle and alters sex hormone signaling | Reduces inflammation and suppresses immune activity |
| Typical concerns | Hormones, fertility, heart, liver, mood | Sleep, mood, blood sugar, bones, eyes, infection, adrenal suppression |
Prednisone and prednisolone are closely related: the liver converts prednisone into prednisolone, so prednisone is common in the U.S. and prednisolone in the UK, with essentially the same side effect profile.
Anabolic Steroid Side Effects
What the research can and cannot show
Most evidence on AAS harms comes from observational studies, case reports, and surveys of people who use high doses, often several drugs at once and often from unregulated sources. That makes it hard to put an exact risk on any individual. It also means many findings are associations, not proof of cause. Still, the Endocrine Society has stated that the health risks of performance-enhancing drugs are underappreciated and that most users are non-athlete weightlifters, not elite athletes (reference 1). One U.S. estimate put the number of Americans who have used supraphysiologic AAS doses at 2.9 to 4.0 million (reference 2).
Effects by body system
| Area | What is reported | Reversibility |
|---|---|---|
| Hormones and fertility (men) | Suppressed natural testosterone, smaller testicles, lower sperm count, reduced sex drive, erectile problems, breast tissue growth | Natural production often recovers over months, but recovery can be slow or incomplete. Breast tissue growth may persist. |
| Hormones (women) | Deeper voice, more facial and body hair, clitoral enlargement, irregular or absent periods | Voice changes in particular are often permanent |
| Teenagers | Possible early closing of growth plates, which may limit adult height | Height effects can be permanent |
| Cholesterol | Lower HDL ("good") and higher LDL cholesterol | Often improves after stopping, but long-term vessel effects may not |
| Heart and blood vessels | Higher blood pressure, thicker or weaker heart muscle, faster plaque buildup in arteries, thicker blood from higher red blood cell counts | Variable. Some heart changes may persist. |
| Liver | Oral forms in particular are linked to liver injury, jaundice, and rarely blood-filled liver cysts or tumors | Often improves after stopping, depending on severity |
| Kidneys | Kidney damage reported in long-term heavy users (mostly case reports and small studies) | Varies |
| Skin and hair | Acne, oily skin, faster hair loss in people prone to it | Acne often improves. Hair loss may not. |
| Mood and behavior | Irritability, aggression, mood swings, depression after stopping, and dependence in some users | Varies |
| Injection-related | Abscesses, skin infections, and bloodborne infections such as HIV and hepatitis B and C if needles are shared | Depends on the infection |
A closer look at the heart
The best-known study here compared 86 men aged 34 to 54 who reported at least two years of cumulative AAS use with 54 experienced weightlifters who had never used them. The AAS group had weaker left-ventricle pumping and relaxation on heart ultrasound and more plaque in their coronary arteries, and the plaque burden rose with longer lifetime use (reference 2). This was a cross-sectional study, so it shows a strong association rather than proving cause, but it is among the most direct evidence available. It also means a young or middle-aged man with unexplained heart changes should tell his clinician about any past AAS use.
If you are using or have used AAS
A clinician can check blood pressure, cholesterol, hormone levels, blood counts, and liver and kidney function, and can look for heart changes if your history warrants it. Being honest about what you took helps them choose the right tests. Do not try to restart your own hormone production with leftover or online-sourced drugs. Products from unregulated sources can also be mislabeled or contaminated, which adds risk beyond the steroid itself.
Corticosteroid Side Effects
The form of the medicine matters
| Form | Reach | Side effect pattern |
|---|---|---|
| Tablets or liquid | Whole body | Widest range of effects |
| Joint or other injections | Mostly local | Blood sugar and mood can still be affected for a few days |
| Inhaled or nasal | Mostly local, low absorption | Usually few or none at low doses, though not zero |
| Creams and eye drops | Local | Skin thinning or eye pressure with prolonged use |
What appears early and what appears later
| Timing | Possible effects |
|---|---|
| Days to weeks | Poor sleep, restlessness, mood changes, bigger appetite, fluid retention, indigestion, sweating, higher blood sugar |
| Weeks to months | Weight gain, rounder face, thinner skin and easier bruising, higher blood pressure, muscle weakness, more infections |
| Long-term or high-dose | Bone loss and fracture risk, cataracts or glaucoma, worse diabetes control, adrenal suppression |
The NHS lists weight gain, restlessness, sweating, sleep problems, and mild mood changes among prednisolone side effects that affect more than 1 in 100 people. It also says the higher the dose and the longer the course, the greater the chance of side effects (reference 4). Short courses of a week or so often cause few problems.
Mood and mental health
Corticosteroids can cause mood swings, anxiety, and low mood. Less commonly, especially at higher doses, they cause confusion, memory problems, hallucinations, or severe depression. Tell your prescriber if this happens, and do not stop the medicine yourself.
Adrenal suppression and stopping safely
Your adrenal glands make cortisol. Taking corticosteroids long enough can reduce that production. A 2024 joint guideline from the European Society of Endocrinology and the Endocrine Society identifies about three to four weeks or more of therapy as the duration that poses a risk, and says risk also depends on dose, potency, route, and individual susceptibility (reference 3). For rough perspective, the body naturally makes the equivalent of roughly 5 mg of prednisone a day, so higher doses are above normal cortisol levels. This is context, not dosing advice.
Example: Someone takes a daily oral steroid for six weeks to settle an asthma flare. They feel much better and stop on their own. Over the next few days they become exhausted, nauseated, dizzy, and achy. That pattern can reflect adrenal insufficiency or steroid withdrawal, and it is why clinicians usually reduce the dose gradually, faster at higher doses and slower near the body's natural level.
If you take long-term corticosteroids, ask whether you should carry a steroid card or wear medical ID. The guideline also notes that people with current or recent glucocorticoid use may need extra steroid coverage during stress such as serious illness, surgery, or injury. Your clinician decides that, so tell any treating team that you take steroids.
Common Situations and What to Do
| What you notice | Possible explanation | What to do |
|---|---|---|
| Can't sleep on a morning prednisone dose | Common early effect | Ask your prescriber about timing. Do not change the dose yourself. |
| Rapid weight gain and a rounder face | Appetite and fluid retention from corticosteroids | Mention it at your next review and ask whether the dose can be lowered |
| Feeling low, wired, or unlike yourself | Mood effects, more likely at higher doses | Contact your prescriber. Seek urgent help if you have thoughts of harming yourself. |
| Fatigue, nausea, and dizziness after stopping steroids | Possible adrenal insufficiency or withdrawal | Call your prescriber promptly |
| Low sex drive, small testicles, or breast tissue growth after AAS use | Suppressed natural testosterone | See a clinician for hormone testing. Do not self-treat. |
| Chest pain, breathlessness, or fainting during or after AAS use | Possible heart problem | Seek emergency care |
Warning Signs That Need Medical Attention
| Situation | What to do |
|---|---|
| Chest pain, severe shortness of breath, fainting, stroke signs, or swelling of the face or throat | Call emergency services (911 in the U.S., 999 in the UK) |
| Severe vomiting with weakness or confusion while on or recently off corticosteroids | Seek emergency care and tell staff you take steroids |
| Thoughts of harming yourself | Call or text 988 (U.S.) or contact emergency services or a local crisis line |
| Fever or infection signs, exposure to chickenpox, shingles, or measles while on corticosteroids, black stools or vomiting blood, new vision changes, severe stomach pain, one-sided leg swelling, or yellowing of the skin or eyes | Contact your prescriber or seek urgent care the same day |
| Wanting to stop oral corticosteroids after several weeks of use | Ask your prescriber about tapering first |
Frequently Asked Questions
Are the side effects of anabolic steroids and corticosteroids the same?
No. Anabolic steroids mainly affect sex hormones, fertility, cholesterol, the heart, the liver, and mood. Corticosteroids mainly affect blood sugar, bones, eyes, immunity, sleep, mood, and the adrenal glands.
Are anabolic steroid side effects reversible?
Some are, such as acne and, in many cases, suppressed testosterone production after a recovery period. Others may be permanent, including a deepened voice in women, enlarged breast tissue in men, and some heart changes after prolonged heavy use.
Do short courses of corticosteroids cause serious problems?
Most people tolerate courses of a week or two with few problems, but sleep changes, mood changes, and higher blood sugar can still happen, especially at higher doses or in people with diabetes.
Why can't I just stop prednisone when I feel better?
After several weeks of oral use, your adrenal glands may be suppressed. Stopping abruptly can cause withdrawal or adrenal insufficiency, and the condition you are treating can flare. Your clinician can set a tapering schedule.
Should I tell my doctor if I have used anabolic steroids?
Yes. It helps them choose appropriate blood tests and heart checks, and their role is to assess your health, not to judge you.
This article is general educational information and not a substitute for personal medical advice.
References
- Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocrine Reviews, 2014;35(3):341-375. doi.org/10.1210/er.2013-1058
- Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation, 2017;135(21):1991-2002. pmc.ncbi.nlm.nih.gov/articles/PMC5614517
- European Society of Endocrinology and Endocrine Society joint clinical guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab, 2024. endocrine.org
- NHS. Side effects of prednisolone tablets and liquid. nhs.uk
