56,61 Irreversible changes include male-pattern baldness and breast development (gynecomastia) in men. Changes that can be reversed include decreased sperm production, 56–59 decreased function of the testes (hypogonadism) that leads to low testosterone levels, 60 and shrinking of the testicles (testicular atrophy). Steroid use disrupts the normal production of hormones in the body. Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle, so that it does not pump blood effectively. If blood is prevented from reaching the heart or brain, the result can be a heart attack or stroke, respectively.
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47,48 High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. Steroids contribute to the development of cardiovascular disease partly by increasing the level of low-density lipoprotein (LDL) 47 and decreasing the level of high-density lipoprotein (HDL). Steroid use has been associated with high blood pressure 41 decreased function of the heart’s ventricles 23,41,42 and cardiovascular diseases such as heart attacks, 43 artery damage, 44 and strokes, 45,46 even in athletes younger than 30.
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However, others may be permanent or semi-permanent. Most are reversible if the user stops taking the drugs.
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A variety of side effects can occur when anabolic steroids are misused, ranging from mild effects to ones that are harmful or even life-threatening.