What Happens When You Take Steroids?
If you hang around a gym long enough, then chances are, some dude is gonna mention steroids. It’s probably just a joke or a passing reference, nothing to take seriously. And for the most part, nobody worries about it. Nothing to see here. Right? Right.
The reality, though, is a little more grim: Ever since famed slugger Mark McGwire was infamously accused of using performance-enhancing drugs back in 1998, steroid use has not only become a part of the pro game, but also infiltrated average Joe gyms across America. Even though anabolic steroids are technically illegal—the Drug Enforcement Agency busted 16 labs in September, netting tons of tablets and injectable liquid—that’s not stopping everyday dudes from trying to get their hands on them.
That’s right: Everyday dudes. “The main customers for what’s being churned out of the illegal labs the DEA took down are gym-goers who want to get stronger and look different,” ace reporter David Epstein wrote in “Everyone’s Juicing,” a September 2015 exposé for ProPublica.
But while guys are plenty familiar with the supposed “benefits” of steroids, they’re typically in the dark—or, worse yet, downright misinformed—about all the nasty side effects they have on your body and possibly even your mind. (And they are nasty.)
To clear up some locker-room rumors you may have heard, we talked to two experts: Dr. Ed Sebanegh, M.D., the department chair of urology at the Cleveland Clinic in Ohio, and Dr. Stuart Weinerman, M.D., an endocrinologist at North Shore–LIJ Health System in New York. We asked them the awkward questions about some persistent steroid myths, so you don’t have to find out the hard way from some jerk at the gym complaining about the sudden emergence of his man-boobs.
RUMOR: Steroids shrink a guy’s testicles.
TRUE. When a guy takes steroids to increase his testosterone levels, it throws his body’s natural hormone balance out of whack, and that manifests itself by shutting down his body’s native testosterone production. End result: Smaller testicles.
“Our body has feedback mechanisms, so it senses a guy’s levels of male hormones and uses that to decide whether it needs to ‘turn down the thermostat,’ so to speak, or if it has enough on its own,” Sebanegh explains. “When a guy uses these drugs, his body ‘turns down the thermostat,’ and it turns off the androgen production in the testicles.’”
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RUMOR: A guy’s testicles will go back to normal as soon as he stops taking steroids.
FALSE. Even after a guy stops taking anabolic steroids, his body will need time to ramp back up to its normal production of its own testosterone. “It’s a general rule of thumb that the higher the dose, and the longer the use of medication, the longer you can have suppression of the gonads,” Weinerman says. “It’s not fully clear if, or how often, it’s permanent in men. But I have seen patients with seriously or severely low testosterone for two years after stopping anabolic steroids.”
In some cases, Weinerman says, guys “can have long-lasting fertility and sexual dysfunction problems” as a result of steroid use.
RUMOR: Past steroid users can have difficulty getting it up during sex.
TRUE. A guy’s sexual prowess is probably unchanged on steroids (assuming his partner isn’t turned off by his small testicles.) But when he turns off the firehose of artificial testosterone in his system, it can result in the classic symptoms of “low T”—and that includes erectile dysfunction.
“Most patients don’t have a problem with erectile dysfunction while they’re on steroids,” Weinerman says. “But when they stop, or when they try to stop, then all of a sudden they have very low testosterone, and they can have a major problem with erectile dysfunction.”
RUMOR: Steroids can make guys grow breasts.
TRUE. Every guy’s body naturally converts some percentage of testosterone into estrogen. But when a guy takes huge quantities of testosterone, his body converts some percentage of that into estrogen to get back to what it thinks is a “normal” ratio of testosterone to estrogen. That spike in estrogen can have some results that are anything but manly.
“Some guys experience a growth in breasts,” Sebanegh says.
Weinerman elaborates: “With all these uncontrolled doses, you don’t know what you’re getting, and it’s pretty common to get either enlargement of the breasts—gynocomastia—or tenderness of the tissue—mastodynia. Most of the androgenic drugs that people use result in this.”
RUMOR: Steroids can hurt a guy’s fertility
TRUE. Just as steroids can shrink a guy’s testicles and drop his natural testosterone production, they can also damage his sperm count.
“Men naturally have super-high levels of androgens in their testicles, and that’s what turns on sperm production and keeps us at a normal level,” Sebanegh says. “If a guy is using drugs, however, his body will turn down those levels, and his sperm production will drop.”
That’s why “guys who are trying to improve fertility should be proactive regarding their health and ask a lot of questions when they’re going on drugs” like testosterone supplements, Sebanegh says. “For instance, the World Health Organization has been looking at testosterone-based therapies as a male contraceptive. If they’re looking at that as the ‘men’s pill,’ so to speak, then you definitely want to be careful about taking it with regards to your fertility.”
RUMOR: A guy can prevent production of excess estrogen.
NOT NECESSARILY TRUE. Faced with an unnatural rise in estrogen, some steroid users will then take a class of drugs called aromatase inhibitors, which are designed to block the production of estrogen in women with breast cancer, Weinerman says. That’s right: It’s a breast cancer drug. And aside from the obvious danger in further messing with hormones, guys who turn to aromatase inhibitors can have side effects like joint and muscle pain, the loss of sex drive, and the loss of bone density, which can then result in osteoporosis, according to a Susan Komen.
RUMOR: Steroids can ruin a guy’s hips.
TRUE. Ever hear of a guy at the gym suddenly suffering a catastrophic hip injury, even though he didn’t injure himself in a way that could have caused it? Blame the steroids—and a nasty condition called aseptic necrosis of the femoral head.
“We don’t know exactly why [aseptic necrosis] results, but it is related to very high levels of [testosterone],” says Sebanegh. “The blood supply to the femoral head—basically, the part of your leg that connects to your hipbone—is inadequate, and the bone is not well vascularized.… I’ve had weightlifters in my practice who have come to me after having unusual hip fractures that were unrelated to trauma. It is something we see.”
RUMOR: Steroids will change the size of a guy’s penis.
FALSE. This myth gets tossed around a lot, but if a guy says steroids made his penis bigger, then he’s bluffing.
“[Steroid use] does not change penis size for guys who have had normal levels of hormones throughout their lives,” Sebanegh says.
Weinerman agrees: “In general, it shouldn’t affect your penis.”
RUMOR: Steroids can make a guy go bald.
SOMETIMES TRUE. Male-pattern baldness can be accelerated by the increase of hormonal imbalance created by steroids, Weinerman says.
“Some people are more sensitive to testosterone than others, and for men who have a tendency toward male-pattern baldness, this is going to exaggerate it,” he says. “It’s almost like a kid going through puberty—your body is not used to it, and so you have side effects like hair changes and acne.”
Worse yet, he says, “the baldness may not be reversible.”
RUMOR: Steroids can reduce a guy’s “good” cholesterol.
TRUE. “With testosterone, you increase the risk of heart disease by decreasing HDL, the healthy cholesterol,” Weinerman says. As is often the case in people with cholesterol problems, a drop in HDL increases the risk for heart disease.
It’s not immediately clear why this happens, but Sebanegh suggests that it may result from the way steroids affect metabolism in the liver.
RUMOR: Steroids will work regardless of what kind a guy buys.
FALSE. Steroid use is a risky and dangerous proposition for your reproductive and hormonal health, even when you use medically approved doses and chemicals. But what’s even scarier, Weinerman says, is that because steroids are regulated only as food supplements, not drugs, there’s virtually no control over what chemicals go into them.
“When you buy this crap over the counter, you don’t know what you’re buying,” he says. “You really have no idea how potent a supplement you’re taking. Even if you buy it from a non-shady guy over-the-counter at the drug store, [you] still don’t know what they’re buying.”
The research backs that up. A major university study of over-the-counter steroid supplements found that “some brands of androstenedione are grossly mislabeled,” according to the paper published in 2000 in the Journal of the American Medical Association.
RUMOR: A guy can get past the side effects of steroids by taking HCG.
NOT NECESSARILY TRUE. Some guys try to avoid the major side effects of steroid use by taking doses of a naturally occurring pituitary hormone called HCG, or human chorionic gonadotropin. Rather than simply pour more testosterone into a guy’s system, HCG over-stimulates a guy’s gonads to produce a higher proportion of testosterone, and sperm along with it. The only problem: There’s very little known about elevated HCG levels, and experts worry that it could lead to dangerous health consequences after prolonged use.
“We don’t know exactly how this affects people in the long term, and that’s a real concern for us,” Sebanegh says. “There are a lot of potential other problems that might result.”
Weinerman agrees: “Those patients don’t get the small testes and the sperm abnormality, but we don’t know the long-term side effects. There is some concern that because your gonads are overly stimulated, then you could have long-term disease. I tell my patients: ‘You don’t want to be a study animal.’”
Sometimes HCG is even promoted as a diet plan, but that’s also probably not safe and there’s really no proof it even works, according to the Mayo Clinic.
RUMOR: Steroids cause mood swings often nicknamed “roid rage.”
UNCLEAR, BUT POSSIBLE. The old saw about “roid rage” has long shadowed steroid use. While there is anecdotal evidence that steroid use causes emotional changes, there’s no hard proof of causation, and any studies that indicate it have often been based on unreliable sources of information like self-reporting.
“There’s not a lot of research around behavioral changes that result from the use of androgens,” Sebanegh says. “However, I’ll often see couples in my office who talk about behavioral changes—getting more easily angered, or reacting angrily to something—that did not occur before one of the partners started taking these kinds of supplements.”
One interesting note: “Research does suggest there is an increase in both homicide and suicide—either people killing themselves or being killed by others—that accompanies a use of steroids,” Weinerman says. “But it’s not clear why.”
RUMOR: Steroids make your forehead look big.
FALSE. Anabolic steroids can cause acne, but they’re not responsible for the “Cro-Magnon” look that is sometimes associated with steroid use. That pattern of facial growth—called acromegaly—is the product of taking too much human growth hormone (HGH), Weinerman says. “It leads to a thickening of the brow—a little Cro-Magnon-like—a thickening of the skin, and skin folds,” he says.
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