A Comprehensive Guide to the Potential Side-Effects Associated with Steroid Use

The following information was taken from the Underground Steroid Handbook Volume II


Acne can occur in both men and women on steroids. It is a very common side effect, although some steroid users are never bothered by it, no matter what kind of steroid is used. Steroids which are known riot to be androgenic, such as Anavar, Winstrol, and the Primobolans, usually won’t generate acne. But take them in large enough dosages and they will. All other steroids can cause acne in women, and if taken in greater than moderate dosages will cause the problem in men. Acne is not to be taken lightly. It is not a problem, but a symptom of a bigger problem.

The skin is the largest organ of the body and does more than just hold your guts and musdes in. Androgens will bind at the receptors of the sebaceous glands, causing excess oil production. Coupled with bacteria in the oil, the result is not just oily skin, but clogged pores, whiteheads, blackheads, and even cystic acne. Athletes seem to get it mostly on the back, shoulders and chest. One can either avoid the androgenic steroids commonly known to cause acne (the testosterones, Finajet, Halotestin, Anadrol), or lower the dosage of the so called ‘anabolics’ (Dianabol, Deca) so that the acne is minimized. Light acne can be eliminated with nightly application of Retin-A cream, .1% for the body and .050% for the face.

Severe acne should be controlled with Accutane, either 10mg or 20mg once a day, depending on how bad the acne is. You may also need a mild antibiotic to kill off the bacteria that is feeding from the oil in the sebaceous glands and turning it into pus. Acne in the strength athlete usually brands him or her as a heavy steroid user, and that idea is socially repugnant. Not only is acne bad for your skin, and your whole recuperative process, it’s bad for your mind also. Yes, you could just live with it; the acne goes away when you stop using steroids, but the pockmarks and scarring (both dermal and emotional) stay.


In women aggression can be a positive aspect and in these modern times is grudgingly accepted. The worst case of aggression I’ve encountered in women was not much more than simple obnoxiousness, no ‘More unpleasant to bear than a Scientology accostall or an EST/Forum trade.

The obnoxiousness results from women straying into the realm of the minor or major androgenic steroids. Remember that just 2 Dianabol a day for a woman gives her the androgen equivalent of a normal male. If a woman insists on using androgens and her aggression negatively affects her job and relationships, well, she has wandered into the realm of irrationality and the options are to convince her to change her drugs, get counselling, slip her a Valium, or just ignore her.

Men, though, with increased aggressiveness can become outright frightening and dangerous, as well as being general dickheads. Try riding in a car with a 300 pound, acne ridden, hungry testosterone repository during rush hour traffic, Men have no excuse. Even the most bonehead of steroid users knows that all the really good, effective steroids: Testosterone, Anadrol, Dianabol, will make you more aggressive. Small or moderate amounts don’t usually make men too objectionable, but if you insist on megadosing these drugs for whatever reason, and your family and friends are valuable to you, then learn to control the aggression. It is simply a form of mental discipline. Learn to control the drug; don’t let the drug control you.


Some steroids can make your hair fall out. It is rarely an anabolic steroid that does this, but rather the androgens, notably the testosterones. Anadrol, which is a borderline androgen, seem to cause hair loss as well as a more potent androgen can. Scientists think that the hair loss is related to a high conversion rate of the steroid to DHT (dihydrotestosterone). Although there is some regrowth of hair after taking the drugs, this side effect should be considered a permanent one. It you are a man and the men in your family have a history of male pattern baldness, the androgens will accelerate the process on you.

Men get hair loss at the widow’s peak and the monk’s cap area. Women who got hair loss from steroids (few do, as few use such androgenic drugs) get the hair loss on the sides of the head at the temples and above the ears. So far there is no way to treat this side effect, only to avoid it. I personally have seen one male get astounding hair regrowth using a Minoxidil and Retin-A liquid preparation, so perhaps this will become a viable therapy.


Steroids do allow cartilage growth and parts of the nose and ears are made of cartilage. You don’t seem to notice the ears growing, nor do you notice the nose growth on men very much. Women, however, seem to show marked nose growth from continual steroid use, when the use extends into years.


I first noticed that Deca Durabolin was doing something to my blood when all those little shaving nicks took a long time to clot up. Athletes complaining of nosebleeds usually get them as a result of too high blood pressure and a slower clotting time. It is standard practice to go off steroids before any surgery. So far, this side effect has been only a minor annoyance; I’ve never heard reports of a life-threatening situation developing.


Most steroids can prematurely close the ends of the long bones, resulting in a short stature. This theoretically would happen if steroids were used by children and teenagers. However, before the bone closure happens, most steroids will accelerate bone growth, resulting in an increase in height. So although most steroids will stunt growth, the majority of teenagers using steroids actually see a marked increase in height before they stop growing. Anavar does not cause bone closure and has been used by pediatricians to increase height in teenagers. Most steroids shouldn’t be used by children. They could stunt their growth even with the growth acceleration because children are not near their full adult height as teenagers are. These children could end up short; short people are unhappy people, and who needs a world with more unhappy people?


This side effect has only been documented in one athlete. He died of liver cancer and had been taking unspecified amounts of oral steroids continually for 4 years. We do know that his liver was healthy before steroid usage. We do not know of any other health problems he may have had, nor what other drugs he used along with the steroids.


This usually happens alternately with hot flashes to women who use Nolvadex. As Nolvadex is an estrogen antagonist, initial usage of the drug or a sudden increase in dosage could mimic menopause. This is an uncontrollable very temporary, and harmless side effect.


Although there is argument about whether steroids truly lower HDL levels, the research showing that serum cholesterol can increase while using steroids cannot be dismissed. Steroid use doesn’t always raise cholesterol in everyone. My cholesterol level stays under 200 whether I am on or off steroids. If you are going to stay on steroids for a long time, your cholesterol is naturally high and the steroids raise it higher, you are gambling with your health. It you only are using steroids for 2 or 3 months maximum out of the year, elevated cholesterol for this period of time is a more acceptable risk.

You can minimize cholesterol elevation while using steroids. Using steroids while on a calorie restricted diet will result in a lower serum cholesterol level than on a gain weight program. You can, of course, severely restrict dietary cholesterol and saturated fats and see if this lowers your cholesterol. Adding thyroid to speed up your metabolism seems to lower it, and for some unexplained reason, adding Nolvadex along with the steroid array lowers it also. If you intend to be using steroids for most of the year (as I and many others do) then you ideally want your cholesterol level to be under 200 all the time. It it is over, even after all efforts I just outlined to try to lower it, then just realize that you may be seriously compromising your health. Curiously, many, many steroid users have had elevated cholesterol levels for decades and show no signs of heart disease. So although I have cautioned you to play it safe, most have not and they are still healthy, alive, and vigorous as they advance into old age. Whether they die of heart disease in their 70’s or 80’s, well, only time will tell. Let us hope that if such an occurrence happens, that the steroid use enriched their vigorous life so much as to be justifiable compensation for a shortened one.


Women get quite confused about this occurrence. Before it happens they dread that it will. Once it happens (androgenic steroids are the cause) they realize that they have an easier time achieving an orgasm, and also find that multiple orgasms happen frequently. A little bit of clitoral enlargement seems to be acceptable among women, but gross clitoral enlargement, when the clitoris takes on the physical aspects of a small penis, usually causes severe psychological distress. Although in a physiological sense, a large clitoris is not harmful, many men and women feel it to be sexually repugnant. Clitoral size will reduce only slightly upon cessation of steroid use, but will never return to normal, pre-drug use size. Even low androgen steroids such as the nandrolones will, it used over a long period of time (months), or in a high enough dosage, enlarge the clitoris. Steroids generally known not to cause any clitoral enlargement are Anavar, Winstrol in moderate dosages, and the Primobolans.


As mentioned earlier, death from anabolic steroid use by healthy athletes appears rare, as we only have one documented case.


This happens to most women using steroids to some degree. How severe the drop is depends on the androgenicity of the steroid, duration of its use, and the metabolism of the woman. I’ve encountered women whose voices deepened while taking minimal amounts of Anavar; so you can’t predict the individual’s response. The deep voice brands the woman as a steroid user. The voice doesn’t go back to normal after the drug use. This side effect is physically harmless, but again may inflict permanent psychological damage, as many people, even other steroid using athletes, find a female with a deep voice socially and sexually undesirable.


This happens in the extreme to women, as they experience an estrogen rebound when terminating steroid and/or Nolvadex usage. The depression is a given: it cannot be avoided, but can be treated with anti-depressant drugs. Women coming off steroids are going from an enhanced metabolic state to one that is SUB-normal because of the rapid estrogen rise. Eventually they will return to a normal female metabolic state, but in the interim they will feel weak, depressed, lethargic, and apathetic. Women must understand that it is simply a hormonal imbalance controlling their emotions, and that they are not ‘going crazy’. Steroids do cause a feeling of euphoria in both men and women. When men go off steroids, if they have not worked to keep their testosterone levels elevated to compensate for the steroid withdrawal, then they will feel depressed too. And of course, both men and women will be disheartened to see their strength, energy, size, and leanness ebb away. Don’t despair: it doesn’t all go away, and it will probably come back to a greater degree it steroid therapy is used again.


Women using steroids that are moderately or highly androgenic usually have what’s known as ‘the drip’. The discharge is not a result of any infection, and is usually odorless. It is a physically harmless side effect, but bothersome to deal with. Steroids such as Anavar, Winstrol, and the Primobolans don’t appear to cause it. Dianabol does.


Some steroids such as Anadrol and Halotestin will make you feel strong, but at the same time you just don’t seem to feel healthy and vibrant. You will be perplexed at how strong you are in the gym and how terrible you feel the rest of the day. Though there’s no research to prove that this side effect is dangerous, I would assume it is. Face it: if you don’t feel healthy, then you probably are not healthy; so stay away from those steroids which cause this effect. Not many do, so your choices are not that limited.




Decreased frequency. I consider this a very serious side effect. Because most steroids cause the body to shut down testicular function, testosterone, sperm count, and libido all go down. Though these side effects are temporary, reversible, and avoidable, many men do not bother to deal with the problem and just accept their temporary impotency as a given when taking steroids. I have seen many, many marriages and relationships end because of sexual disinterest and inattention to one’s sexual partner. By simply taking HCG and maintaining a sexual schedule, decreased erections should not be a problem. Consider this a serious side effect because it psychologically and emotionally hurts other people, people very close, which ultimately will affect the emotional well being of the athlete. This is a steroid specific side effect. Testosterone users complain (?) about frequent erections. Frankly, no one has charted any of the individual steroids on the ‘peter meter’. Volunteers, anyone?


Increased frequency. This side effect is so rare, its actually thought of as a gift from God, and not a hindrance. In small amounts, steroids can cause this effect to a beginning user, but usually, just the opposite happens. Sustanon 250 in moderate amounts (250mg/wk) has the reputation of being the best steroid to generate this particular effect.


This is a temporary side effect mostly experienced by women using Nolvadex for the first time, and either men or women using Equipoise. Some very androgenic steroids will cause women to have a fever that will not go away. Finajet does this to some women (but, they shouldn’t be using Finajet anyway).


Although women do produce a form of nandrolone during pregnancy, pregnant women who still have steroids in their bloodstream will cause masculinization of the female fetus, and precocious puberty in the male. I think that this side effect is so self evident that most female athletes would never consider bearing a child until they are tested clean. An odd repeated occurrence I have observed worldwide is that when men are on steroids and impregnate their wives/girlfriends, mostly female babies are born. I couldn’t begin to tell you why, but I get phone calls piling up the statistics all the time.


This is enlargement of the male breast, and usually a tumor growth (non-cancerous) accompanies it. Many steroids aromatize to estrogen, and this excess estrogen in the male will cause the breast tissue to grow. Its most apparent because the tumor is usually located just under the nipple and in a lean condition can be discerned with even casual observation. Gynecomastia can be almost entirely avoided by not using steroids known to aromatize to a marked degree (the testosterones and Anadrol do), keeping the dosages of mildly aromatic steroids low to moderate, adding 20mg of Nolvadex per day to your steroid array, or just using the very few steroids that don’t aromatize. If the tumor is small, it may appear to go away after steroid use, but will probably flare up if you use steroids again. If the gynecomasta cannot be controlled with Nolvadex, and stays after the drug use, then the only way to get rid of it is surgery. This is a minor operation involving cutting at the edge of the nipple, removing some breast tissue, the tumor, and chasing down any offshoots the tumor may have sprouted and removing them. Even after the operation you may have a slight swelling of the breast tissue while on aromatizing steroids, you just won’t have the sore lumps under the nipples. This is because some breast tissue must be left to keep the nipple erect; total removal of all the breast tissue would result in a flaccid, soft looking nipple. The average cost of a well done gynecomastia operation is $2000. Health insurance companies usually will pay for it. If during puberty you experiencienced transient gynecomatia, then it is likely that offending steroids will cause it in adulthood.


Headaches usually are caused by highly androgenic steroids, such as Halotestin (the #1 steroid to cause headaches), Finajet, or Parabolan, or can be the result of high blood pressure caused by a particular steroid. Headaches are more serious than you think; they are not a problem but are a symptom of a (greater) problem. Avoid steroids that cause headaches; don’t just take aspirin.


This side effect has yet to show up in a statistical sense in healthy athletes using steroids. By all medical logic if an athlete on steroids has high blood pressure, high serum cholesterol, high serum triglycerides, and low HDL levels, he is a high probable for heart disease. The real world facts do not follow through on this one. Although the media would like you to think differently, heart disease has yet to be a significant problem in the healthy steroid taking athlete. That’s not to say that it is definitely nothing to worry about; I assume that it could be, so I do everything I can (thyroid, Nolvadex, keeping blood pressure, cholesterol, and saturated fat intake low) to avoid a future complication and I recommend any steroid-taking athlete to do so especially if he has a family history of heart disease.


High blood pressure is very common in men using steroids. Realistically, a male strength athlete can hope to attain a 120/90 reading as normal. I’ve seen lower readings, mostly with women, but men don’t often get below this figure while weight lifting unless they are on a strict diet. My blood pressure suddenly went to 160/120 recently and stayed there. It was not steroid related, and stopping the use of steroids did not significantly lower it. I felt terrible. I had shortness of breath, labored breathing, and fluid in the lungs. I could never get a good night’s sleep, got headaches; I just felt quite ill. I now use an anti-hypertension medicine daily (Diazide) and my blood pressure is now 112/80, even while on steroids. Always monitor and control your blood pressure: you’ll not only live longer, you’ll just feel healthier.


This is the medical term for hairriness in women and though treatable, is irreversible. Most of the very muscular women in bodybuilding and powerlifting have to shave every day. Not just the legs, but the arms, the chest (including around the nipples), the face, and the buttocks, especially the lower inner glutes around the rectum. Although such hairriness is physically harmless, it is considered socially and sexually repugnant and does cause severe emotional trauma for women. Hairriness can happen even on low androgen steroids such as the Decas. It usually does not happen with Anavar, the Prirnobolans, and moderate dosages of Winstrol. A woman using 50mg of injectable Winstrol every 2nd or 3rd day can get hair growth, but a daily dosage of 10-15mg would probably not cause the problem. Most of the hair can be shaved, waxed, or removed by electrolysis, but even with electrolysis women will experience hair regrowth, especially when using steroids again.


As discussed before, many (too many) male athletes get reduced libido as a result of the whole male reproductive system shutting down in response to steroids in the body. The impotence is temporary, can be avoided with the use of HCG, and can be brought back once off the drugs. In the curious case of female impotence from steroid use, I truly am at a loss for a solution because the effects vary so widely from individual to individual. Some women get extremely aroused while using steroids; others using exactly the same steroid and dosage have no sex drive whatsoever. The impotence problem is compounded in both sexes while on a calorie restricted diet. Not only are both men and women usually impotent then; they’re usually defensive and mean-spirited about it.


Steroids do have mood elevating properties, and they can act like a mild central nervous system stimulant. This effect is most apparent if you take the steroids at night before you (try to) go to sleep. To avoid the steroid insomnia problem, steroids, both oral and injectable, should be taken just after awakening.


This is a very serious side effect, but is rarely encountered in healthy athletes. Jaundice indicates that you have some serious liver problems, possibly hepatitis. Before your skin turns yellow, the corners of the whites of the eye will, so you do have a preindication that something very bad is about to happen. This side effect warrants a quick cessation of steroid use and a visit to a doctor for some blood tests. A healthy athlete would have to be using a very large amount of oral steroids to reach this state.

LARYNX/Adam’s apple growth :

This is a very rare side effect that happens to women who use steroids which are moderate to highly androgenic and use them over a long period of time (years). First the voice gets low, then the cartilage on the outer larynx thickens and begins to take on the characteristics of the male’s Adam’s apple. Again, this is a side effect that is physically harmless, but socially repugnant.


Most reported cases of liver disease have developed in hospitalized non-athletes. Documentation of liver disease in healthy athletes is, as discussed before, so rare as to be statistically insignificant. This does not mean that the steroid taking athlete is home free. With the lowered quality of steroids on the black market, along with the increasing appearance of bizarre designer steroids, it is now irresponsible not to monitor organ functions while taking steroids.


Many women using steroids stop getting their periods, especially if they have a low bodyfat percentage. But then women athletes who don’t take steroids can have the same irregularities if they become lean enough. Most women I’ve polled don’t mind not getting their period. All that I have interviewed also got their periods back once they went off the drugs and allowed their bodyweight to rise.


A very few steroids, only Anadrol and Halotestin that I know of, may cause nausea. Anavar can give the impression of stomach fullness, but has never been associated with a queasy feeling. This effect of nausea seems to mainly happen to older (middle-aged) men.


Powerlifters get nosebleeds more than other strength athletes. It seems to result from a combination of high blood pressure caused by the steroids, sudden elevation of blood pressure from the explosive nature of the lifts, along with the steroid’s other side effect of reduced clotting ability. Although the nosebleed Itself is not a serious problem, it may, as I keep saying, be a symptom of a more serious problem: high blood pressure. Remember, hypertension not only leads to heart problems, it also can damage the kidneys.


Oily skin occur in both men and women even on low androgen steroids such as the nandralones. It the oily skin does not develop into acne, then it can be controlled by simply bathing more frequently throughout the day. If the oiliness really becomes bothersome, then 10 mg of Accutane every second or third day will control it, although I think that this would be a frivolous use of a powerful medication.


Of course, this problem does not apply to women. Usually prostate enlargement happens when men use very androgenic steroids, and not necessarily high dosages of such steroids. The trenbolones can enlarge the prostate, and some of the old, no longer available DDR compounds (I believe the Nor-Diethylin 1 was extremely androgenic) caused a noticeable enlargement. Usually, a man can tell if his prostate is enlarged simply by tensing his sphincter muscle while in a sitting position. If the prostate is enlarged, then he should ‘feel’ that something is there. This is no guaranteed way of testing your prostate size, but it works for many men. Your doctor can, of course, tell you during a physical exam. Men should not put up with an enlarged prostate; they should back off the offending steroid(s), as an enlarged prostate can lead to a host of other health problems, mostly urinary, bladder, and kidney problems.


Has gained a lot of attention in the media lately; mostly, I believe, because of a novel line of defense in a minor criminal case. Also, since the media and the medical community have not been able to establish a pattern of concrete, serious health problems occurring in athletes taking steroids, then the other recourse in order to keep fueling the fire is to explore the psychological damage that steroids could cause. We do have research documenting that cortical steroids have been known to make people psychotic permanently. But steroid psychosis is not permanent, not common, and its relationship between cause and effect has not been explored in enough detail. Most steroids won’t make you psychotic. Androgens taken in high enough dosages will induce aberrant behavior. If you wish to call this behavior induced by psychosis, well, I’m not a psychiatrist, so I will not argue the point. I think that I elaborated enough on this topic when discussing Testosterone Cypionate. Steroids do induce psychological changes and in women the changes linger long after steroid use.


Women have nice, soft, beautiful skin because skin has estrogen receptor sites to make it that way. Female athletes using steroids and/or Nolvadex for a long duration (months, years) can develop non-feminine looking skin, especially if steroids are used in conjunction with a lot of UV exposure (the sun, tanning beds; they both will do damage). Some women on heavy steroid arrays never lose their beautiful skin texture; most do. After stopping the drugs, the skin will reacquire its feminine properties, but may take a year to do so. There is no remedy (other than, perhaps, Retin-A) for UV damage.


This side effect seems unique to the use of Anavar, both with the oral and also with the new injectable form. Perhaps this is one reason why so many athletes use Anavar while dieting. This side effect is so apparent that I, along with many of the other ‘lab rats’ have been able to tell if a counterfeit Anavar really has oxandrolone in it, just from the stomach fullness side effect it generates.


Most steroids will cause premature bone closure in children and teenagers, limiting their stature. Anavar does not. Jeff Feliciano once stated that Halotestin does not, but as androgens stop bone growth faster than anabolics, I would not gamble with my child’s height on this speculation.


Most strength athletes don’t encounter this, but other athletes, primarily runners, who use steroids do. This effect mostly has to do with which steroid the athlete is using. For example, Anavar, Winstrol (if it is indeed effective), and Primobolan Acetate will impart strength to the muscles, but not load any significant extra fluid into either the muscle or connective tissue. Since the non-strength athletes mosty limit their use to these three steroids, tendon/ligament inflammation seems to happen because the muscle has become stronger, puts more stress on connective tissue which did not become spongier and more elastic, as the strength athletes’ connective tissues do because of their use of steroids that will act to increase fluid retention in the tendons and ligaments.


Anavar won’t cause this problem, nor will Teslosterone Undecanoate. Most other steroids will (well, unless you’re a girl). You can avoid this shrinkage by using HCG along with steroids, or you can get them to grow back by using HCG after going off steroids. For what it’s worth, they never seem to get back to their full, original, pre-steroid size. But this may be because many men go back on steroids sooner, perhaps, than the fully required ‘gonad grow back time’. I have no idea how long it takes.


This side effect concerns men, and is really an offshoot of an enlarged prostate. Usually the problem is a minor nuisance, in the guise of a post urination dribble after everything has been put away and zipped up, resulting in the ‘Look, he pissed himself!’ wet spot in the crotch of the pants. However, if you have a hard time to urinate, painful urination, or blood in the urine, these do not fall under the heading of ‘minor nuisances’; see a doctor. Note though that men and women who have extremely low bodyfat levels may have blood in the urine temporarily, usually after a bicycle ride over very rough road, or if the athlete has a heel pounding running style. Fat coats the organs (here we’re concerned with the kidneys) and acts as a cushion. It does happen that extremely rough jouncing of the pelvic area while low in bodyfat will result in a few pink urinations.


You also can call this side effect ‘edema’, as most doctors would. In its mildest form, water retention is considered socially unacceptable, resulting in the moon-faced, overfed look. Women find it more uncomfortable than men. But water retention is usually a good indication that something else is amiss, usually blood pressure, which can be controlled, or kidney damage, which is not easy to rectify. Many effective steroids increase fluid retention in all the tissues: muscle, tendon, ligament, skin, and blood. Muscle and connective tissue water retention is athletically beneficial. Puffy skin and high blood pressure are liabilities, not assets.

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