What Prednisone and Anabolic Steroids Can Do to Your Body
Most people who search for "steroid side effects" plus terms like hunger, fatigue, weight gain, or "moon face" are describing a corticosteroid prescription, so that is the main focus here. A shorter section near the end covers anabolic steroids.
Key takeaways
- Prednisone-type steroids mimic cortisol, a hormone made by the adrenal glands. They reduce inflammation but affect appetite, fluid balance, sleep, mood, blood sugar, blood pressure, bones, and immunity.
- Risk depends heavily on dose, duration, and how the drug is given. Oral steroids are the most likely form to cause body-wide side effects; inhaled, topical, and injected forms mostly act locally.
- Many short-term effects, including puffiness and "moon face," tend to ease as the dose comes down. Bone loss, eye changes, and adrenal suppression need monitoring during longer treatment.
- Do not stop a steroid you have taken for more than a short course without your prescriber's plan. The adrenal glands may need time to restart.
Corticosteroids vs. anabolic steroids
The names sound alike because both are built on a steroid chemical structure, but they act on different systems and are used for different reasons.
https://www.youtube.com/watch?v=20stYiu723I
| Corticosteroids | Anabolic-androgenic steroids | |
|---|---|---|
| Examples | Prednisone, methylprednisolone, hydrocortisone | Synthetic testosterone derivatives |
| Acts like | Cortisol | Testosterone |
| Medical use | Asthma, rheumatoid arthritis, lupus, multiple sclerosis relapses, some skin conditions, vasculitis | Limited prescription uses, such as certain hormone deficiencies; non-medical use for muscle gain is illegal in many countries |
| Typical concern | Appetite, fluid retention, mood, blood sugar, bone loss, infection risk | Hormonal disruption, heart and liver effects, mood and aggression, infertility |
Why doctors prescribe corticosteroids despite the side effects
Corticosteroids calm an overactive immune response quickly. A rheumatologist at UCHealth describes them as potent anti-inflammatory drugs used to control diseases that can threaten organs, and says she plans an exit strategy whenever she starts them (UCHealth). That is the logic behind most prescribing: use the lowest dose that controls the condition for as short a time as practical.
Common prednisone side effects, and why they happen
Side effects depend on dose, treatment length, and route. Mayo Clinic notes that oral corticosteroids are the type most likely to cause side effects, and that effects depend on the dose (Mayo Clinic). Not everyone gets every effect.
| Timing | Possible effects |
|---|---|
| Days to weeks | Increased appetite, fluid retention and puffiness, trouble sleeping, mood changes (irritability, anxiety, euphoria, or low mood), higher blood sugar and blood pressure, stomach irritation |
| Months or longer | Weight gain with fat redistribution (face, upper back, abdomen), thinner skin and easy bruising, muscle weakness, bone loss, cataracts or glaucoma, more frequent infections, adrenal suppression |
Hunger, weight gain, and "moon face"
Three separate things usually drive the scale up: a bigger appetite, water retention, and, with longer use, fat moving toward the face, upper back, and abdomen. "Moon face" is simply a rounded, fuller face caused by that fat shift and fluid. It is a recognizable feature of prolonged steroid exposure, not a separate disease, and it often improves gradually once the dose is reduced, though timing varies.
A few practical steps that fit the mechanism:
- For hunger: build meals around protein and fiber, and plan snacks ahead so appetite spikes do not default to ultra-processed food.
- For fluid retention: limiting high-sodium foods can reduce puffiness. A sudden jump of several pounds in a few days is more likely water than fat; report rapid swelling in the legs or breathlessness.
- For muscle and bone: regular resistance and weight-bearing exercise is commonly recommended during steroid treatment. If you have been told you have bone loss or a fracture risk, ask your clinician which exercises to avoid.
Sleep, mood, and fatigue
Insomnia and mood shifts can start within days. Higher doses are generally associated with a greater chance of mood effects. Taking the dose in the morning, if your prescriber agrees, is a common way to reduce sleep disruption. Tell your clinician about severe agitation, depression, or thoughts of self-harm right away.
Fatigue and aches deserve a second look. They can come from the underlying illness, but after prolonged steroid use they can also signal adrenal insufficiency. An endocrinologist at UCHealth notes that clinicians now consider this possibility after about a month of use, and may check a morning cortisol level if symptoms appear.
Blood sugar, blood pressure, skin, and stomach
Corticosteroids can raise blood sugar and blood pressure, which matters most for people with diabetes, prediabetes, or hypertension. Excessive thirst and frequent urination are worth reporting. Skin may thin and bruise easily with longer use. Stomach irritation is more likely when steroids are combined with anti-inflammatory painkillers such as ibuprofen, so ask before combining them.
Long-term risks
Bone loss
Bone density falls fastest early in treatment. Guideline summaries describe a rapid decline starting within the first 3 months that peaks around 6 months, then continues more slowly with ongoing use (Korean guideline summarizing the literature). One such guideline cites roughly 6% to 12% bone loss in the first year. Fracture risk rises with both daily and cumulative dose, and can increase before a bone scan shows much change. If you expect to take a steroid for several months, ask whether you need a fracture risk assessment, calcium and vitamin D guidance, or bone-protecting medication.
Infection, eyes, and adrenal suppression
Steroids dampen immune activity, so infections can be more frequent or more severe, and fever may be blunted. Cataracts and glaucoma are recognized longer-term effects, so report blurred vision or eye pain. Ask your prescriber about vaccines before you start, since some (especially live vaccines) may need to be timed around higher doses.
With prolonged use, the adrenal glands reduce their own cortisol output. If the drug is stopped abruptly, the body can be left short of cortisol, with fatigue, weakness, nausea, dizziness, and muscle or joint pain. Steroid withdrawal can also mimic a flare of the original condition, such as arthritis pain, which is one reason people mistakenly restart or stay on the drug.
Do corticosteroids cause cancer?
Corticosteroids are not established as a major cause of cancer, but the picture is not entirely clean. Danish population studies found associations between systemic glucocorticoid use and basal cell skin cancer, with an adjusted rate roughly 15% higher among users in one case-control study, and between heavy use and non-Hodgkin lymphoma (British Journal of Cancer, 2009; JNCI, 2004). Observational studies like these cannot prove cause, and the underlying inflammatory disease or other immune-suppressing drugs can also play a role. Case reports link steroids to Kaposi sarcoma. The practical takeaways are sun protection, regular skin checks if you are on steroids long-term, and reporting any new or changing skin lesion.
Stopping safely
Do not stop a prescribed steroid on your own, especially after more than a couple of weeks. Many clinicians taper longer courses (often those beyond roughly two to three weeks), while short courses are frequently stopped without a taper. Your prescriber makes that call based on dose, duration, and your condition. If symptoms such as severe fatigue, vomiting, or dizziness appear during or after a taper, call promptly.
Tell any surgeon, dentist, or emergency clinician that you are taking, or recently took, long-term steroids. The body's stress response can be blunted, and extra cover may sometimes be needed.
When to get medical help
Seek urgent care for:
- Swelling of the lips, tongue, or face, or trouble breathing (possible allergic reaction)
- Chest pain, severe abdominal pain, black tarry stools, or vomiting blood
- Fainting, severe weakness, or persistent vomiting, especially after stopping a steroid
- Thoughts of self-harm or severe agitation
Contact your prescriber soon for: fever or other signs of infection (a cough producing mucus, painful urination, skin boils), vision changes, rapidly increasing swelling, extreme thirst and urination, or mood and sleep changes that interfere with daily life. If you use an inhaled steroid and notice white patches in your mouth, mention it; rinsing your mouth after each dose helps prevent this.
Anabolic steroid side effects
These drugs carry a different risk profile. The National Institute on Drug Abuse lists effects such as liver tumors, cardiovascular problems including heart attack and stroke, and psychiatric effects including aggression, mood swings, and depression. Men can experience testicular shrinkage, reduced sperm production, and infertility. Women can develop irreversible masculine traits. Withdrawal after stopping can include depressed mood, fatigue, insomnia, and reduced sex drive (NIDA). Products sold illicitly may also be contaminated or counterfeit, and injecting carries infection risks from shared equipment.
Non-medical use is illegal in many countries, including the United States, and rules differ elsewhere, so check local law. If you have used anabolic steroids, tell a clinician; blood work, blood pressure, and cholesterol checks can catch problems early.
FAQ
Can a low prednisone dose cause weight gain?
Yes. Hunger and water retention can occur even at lower doses, though risk generally rises with larger doses and longer treatment.
How long does moon face last?
It typically improves gradually once the dose is reduced or stopped, but the time varies from person to person. Ask your prescriber what to expect for your dose and duration.
Should I stop prednisone once I feel better?
Not without medical advice. After longer treatment the body may need time to resume making its own cortisol, and a prescriber can set a safe schedule.
Are prednisone and anabolic steroids the same?
No. Prednisone is a cortisol-like anti-inflammatory drug. Anabolic-androgenic steroids are testosterone-like drugs. They have different uses, risks, and legal status.
Can steroids raise blood sugar or blood pressure?
Yes, in some people. Clinicians may monitor both during treatment, especially in people with diabetes or hypertension.
Do corticosteroids cause cancer?
They are not established as a general cause of cancer, but observational studies have found associations with certain skin cancers and lymphoma that cannot confirm cause. Use sun protection and report new skin changes.
This article is general education, not medical advice. Talk to your prescriber about your own dose and symptoms.
