Anabolic Steroids’ Impact on the Heart

Anabolic androgenic steroids (AAS), designed to mimic the male sex hormone testosterone, are often utilized to enhance muscle mass and athletic performance. However, their influence extends beyond muscle growth, significantly impacting the heart through a cascade of biological and structural changes, which can lead to serious health consequences.


The effects on the heart can be broken down into structural changes, effects on lipid profiles, and impacts on blood pressure and clotting factors, all of which compounds upon each other.

Cardiac Remodeling

Think of your heart as an essential pump that manages the flow of blood in your body. When you use anabolic steroids, it's like forcing an upgrade on this vital system that it didn't ask for. Steroids enhance the body’s ability to build proteins and muscle cells, which also causes the heart muscle to thicken and grow. Normally, intense exercise leads to healthy growth in heart muscle, helping it handle more work. But the kind of rapid and excessive growth that steroids cause throws off this balance. In the heart, having too much muscle can make it less efficient and flexible. This issue, known as left ventricular hypertrophy (LVH), is similar to the walls of the heart getting so thick that they can't stretch and squeeze properly. It's like trying to pump water with a balloon that's no longer stretchy. This reduces the heart's ability to do its job such as circulating oxygen-rich blood throughout the body, which can lead to heart failure or arrhythmias (irregular heartbeats).

Changes in Lipid Profile

Steroids can disrupt the balance between two types of cholesterol in our blood. They raise the levels of LDL cholesterol, often referred to as "bad" cholesterol, and lower the levels of HDL cholesterol, known as "good" cholesterol. This imbalance leads to the formation of plaque, a sticky substance that can accumulate inside the arteries. Over time, this buildup narrows the arteries, a condition called atherosclerosis, making it harder for blood to flow through. Atherosclerosis can increase the risk of heart disease by restricting blood flow to the heart.

Increased Blood Pressure & Water Retention

Steroids can affect the body's electrolyte and fluid balances which increases the volume of blood in the circulatory system. This extra volume stiffens and narrows blood vessels, increasing the pressure against the vessel walls and forcing the heart to work harder. Over time, this increased workload can cause the muscle wall of the heart's left ventricle — the chamber responsible for pumping oxygenated blood to the body — to thicken, further exacerbating LVH as described above.

Certain compounds can also cause endothelial dysfunction, impairing the blood vessels' inner lining from regulating blood flow smoothly, which adds more resistance and pressure. Together, these factors strain the heart, causing hypertension which is a major risk factor for heart disease, strokes, and heart failure.

Increased Risk of Blood Clots

Steroids also increases blood clot risk by boosting clotting factors. Combined with damaged artery walls, clots may form in crucial areas such as the heart and brain which can lead to heart attacks and strokes.

Notable Compounds

The following compounds have been particularly noted for their potential adverse effects on the heart:

  • Trenbolone
  • Anadrol (Oxymetholone)
  • Winstrol (Stanozolol)
  • Dianabol (Methandrostenolone)

Complications & Symptoms

As mentioned above, steroid use can lead to several serious heart-related complications.


This condition involves the weakening of the heart muscle, making it more difficult for the heart to pump blood to the rest of the body. An enlarged heart (cardiomegaly) is a common form of cardiomyopathy associated with steroid use.


  • Shortness of breath, especially during physical activity or when lying down
  • Fatigue and weakness
  • Swelling in the legs, ankles, and feet due to fluid buildup
  • Palpitations or fluttering in the chest due to irregular heartbeats

Coronary Artery Disease (CAD)

Plaque buildup reduces blood flow to the heart muscle, increasing the risk of a heart attack.


  • Chest pain or discomfort, often described as aching, pressure, or squeezing, that may worsen during physical activity and improve during rest
  • Shortness of breath


Irregular heartbeats or arrhythmias can range from harmless to potentially life-threatening, depending on the type of arrhythmia and how it affects heart function.


  • Palpitations, a sensation of a racing, uncomfortable, or irregular heartbeat
  • Light-headedness or dizziness
  • Fainting (syncope) or near fainting
  • Shortness of breath
  • Chest discomfort


High blood pressure can damage the heart as well as other organs like the kidneys and the brain.


  • Hypertension often presents with no symptoms, earning it the nickname "the silent killer."
  • In some cases, severe hypertension can cause headaches, shortness of breath, or nosebleeds, but these symptoms are not specific and usually don't occur until the condition has reached a severe or life-threatening stage.

Heart Attack and Stroke:

The combination of changes caused by AAS, including cardiomyopathy, coronary artery disease, and hypertension, significantly raises the risk of heart attack and stroke. These conditions occur when the blood supply to the heart or brain is blocked, often by a blood clot or by the buildup of plaque in the arteries.


  • Heart Attack: Chest pain or discomfort, pain in shoulders, arms, neck, jaw, or back; shortness of breath; cold sweat; nausea; lightheadedness.
  • Stroke: Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion; trouble speaking or understanding speech; vision problems; trouble walking; dizziness; loss of balance or coordination; severe headache with no known cause.


To stay ahead of heart-related complications from the use of AAS, regular monitoring and early diagnosis through various tests and evaluations are crucial.

Blood Pressure Monitoring: As hypertension is a major risk factor to more serious complications, its essential to monitor your blood pressure regularly. Both in-office measurements and at-home monitoring can provide comprehensive insights into blood pressure trends over time. Prehypertension is defined as a systolic pressure from 120–139 mm Hg or a diastolic pressure from 80–89 mm Hg.

Blood Tests: Blood tests can measure levels of certain enzymes and proteins that indicate heart muscle stress or damage. Lipid profiles, which include cholesterol levels, are also important as AAS can negatively affect cholesterol, increasing the risk of coronary artery disease.

Electrocardiogram (ECG or EKG): An ECG records the electrical activity of the heart. It can identify arrhythmias, signs of heart attack, or other heart conditions. An ECG is useful for monitoring changes in heart rhythm and electrical activity that could be induced by AAS use.

Echocardiogram: An echocardiogram uses ultrasound waves to create images of the heart. It can show the heart's size, structure, and motion, providing details on heart muscle and valve function. This test is crucial for diagnosing cardiomyopathy and detecting an enlarged heart.

Cardiac MRI: A Cardiac MRI provides detailed images of the heart and is more precise than other imaging tests for evaluating heart structure and function. It's particularly useful for assessing the extent of heart muscle damage.

Coronary Angiography: For individuals with symptoms or tests suggesting coronary artery disease, coronary angiography can visualize blockages in the coronary arteries. This test involves injecting a dye into the coronary arteries to make them visible on X-rays.

Holter Monitoring: A Holter monitor is a portable device that records continuous ECG data for 24 to 48 hours. It's used to detect intermittent arrhythmias that may not be captured during a standard ECG.

Stress Test: Also known as an exercise test, this assesses how the heart performs under physical stress. It can indicate the presence of coronary artery disease and assess the risk of future heart complications.

Counteracting the Damage

While the most effective measure to counteract damage to the heart is simply to stop using steroids, adopting a comprehensive approach that includes lifestyle modifications, appropriate exercise, medical interventions, and supplements can mitigate some of the negative effects.


  • Cardiovascular Exercise: Regular aerobic exercise such as walking, jogging, swimming, or cycling improves heart health by increasing heart efficiency, reducing blood pressure, and improving cholesterol levels.

Lifestyle Changes

  • Avoiding Stimulants, Tobacco and Alcohol: Stimulants such as nicotine or caffeine can exacerbate heart problems. Quitting smoking, vaping, and limiting alcohol intake are vital.
  • Healthy Diet: Focus on a heart-healthy diet and reduce intake of salt, sugar, and unhealthy fats to help manage blood pressure and cholesterol levels.


  • Blood Pressure Medications: While not a substitute for regular cardiovascular exercise, medications such as ACE inhibitors, beta-blockers, or diuretics may be prescribed to manage hypertension caused by AAS use. (Some have utilized PDE5 inhibitors commonly found in erectile dysfunction medication such as Cialis and Viagra for this purpose.)
  • Cholesterol-lowering Drugs: Statins or other lipid-lowering drugs can help manage cholesterol levels, reducing the risk of coronary artery disease.
  • Heart Rhythm Medications: For those experiencing arrhythmias, medications to stabilize heart rhythm might be necessary.


  • Omega-3 Fatty Acids: Found in fish oil supplements, omega-3s can help lower triglyceride levels and slightly improve heart health.
  • Coenzyme Q10 (CoQ10): Some evidence suggests CoQ10 can help improve heart function and symptoms of certain heart conditions.
  • Fiber Supplements: Can help in managing cholesterol levels.

Ultimately, a combination of proactive health monitoring and committed lifestyle adjustments offers the best strategy for minimizing the cardiovascular risks associated with AAS use, underscoring the importance of personal health responsibility and the benefits of maintaining a balanced and active lifestyle for long-term heart health.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns