T Nation

Anabolic-Androgenic Steroids and the Heart

We all know the health risks of anabolic-androgenic steroid use when used in sane, performance enhancing doses are overexaggerated. Liver damage is primarily a side effect of C17 Alpha Alkylated androgens and when liver damage occurs it is usually in the occurrence of acute cholestasis that reverses once androgens are discontinued. Roid-rage is a myth, and there is no good data to back up the claims that supraphysiologic doses of anabolic steroids increase aggression in humans, as a matter of fact, there is evidence towards the contrary, showing that a dose of 600mg testosterone enanthate weekly does not increase the occurrence of aggressive behaviour (halotestin, tren and cheque drops are another story). Other side effects that people sling around as being associated with anabolic steroids are paranoia, hallucinations, delusional behavior etc, most of which have NO scientific backing. What isn’t said is that most of these side effects that do exist are preventable or temporary. Based on research, the one serious (possible) side effect of anabolic steroid use that I find worrying is the potential for left ventricular hypertrophy, hypertrophic cardiomyopathy, reduced endothelial, diastolic and systolic heart function etc. There have been 0 large-scale studies on anabolic androgenic steroid users (in bodybuilding doses), and the effect on the heart, however a few small-scale studies have looked at bodybuilders who have chronically used anabolic steroids (sometimes in conjunction with HGH and recreational drugs such as cocaine). The results have been divided, a few studies found an increased level of atherosclerosis in bodybuilders compared to normal controls, however that is to be expected, especially as oral steroids such as stanozolol absolutely (but only temporarily) wreck the individuals lipid profile (very low HDL and elevated LDL cholesterol), two small studies have shown a daily dose of stanozolol at a mere 5-6mg reduces HDL cholesterol by 30-40 percent (reduces HDL-2 by 80-90 percent) and increases LDL cholesterol by 30-40 percent. When we consider the bodybuilding/ athletic performance enhancing doses of stanozolol (winstrol) for men is 25-50mgs per day or even more one can only imagine the wreckage of lipids that would occur. This wreckage of lipids will likely cause an increase in the process of atherosclerosis, which is when plaque builds up in the arteries in the heart, kidneys and various other organs. If an artery becomes sufficiently blocked (especially if one has thick blood that clots easily, and anabolic steroids are known to increase RBC count), a heart attack will occur as blood will be unable to reach the heart and cardiac tissue death will occur. The issue of atherosclerosis is not quite as important as the issue of hypertrophic cardiomyopathy as many bodybuilders will eat a very healthy diet, use on cycle support and the lifestyle of strenuous exercise will lessen the negative impact of trashed lipids. One can also avoid orals completely; however, Tren is also very harsh on the lipid profile. The issue with anabolic steroids and heart enlargement is to figure out whether the enlargement is benign or dangerous, if it is dose dependant or reversible, how long it takes to cause such structural changes in the heart and left ventricular remodelling etc. A study frequently referanced to express concern with the heart effects of anabolic steroids was by the American heart association. The study took 12 people using anabolic steroids and 7 nonusers with the average use being a weekly dose of 675mg of hormones (not specified exact cycle details) for the equivalent of roughly 468 lifetime weeks. The average LV ejection fraction in anabolic steroid users was 50.6 percent. The average left ventricular ejection fraction is between 55 percent and 70 percent, however LV ejection fraction is not considered reduced until it is below 50 percent and to have a high risk of developing a dangerous arrhythmia and going into heart failure LV ejection fraction is usually below 35 percent. Other parameters of heart function such as Longitudinal strain, radial strain e/a ratio were impaired when compared to non-users, however if we look at studies that determine the reference ranges for various heart functions such as longitudinal strain etc we see that most steroid users are within the normal reference ranges, albeit on the very low side of normal and if one were to draw a box plot, the lowest quartile of heart function for anabolic steroid users in this study is actually below normal, however the majority still fall within “normal” realms, therefore the verdict that anabolic steroid induced heart dysfunction being “more severe than previously thought” is exaggerated, the study is also extremely small, the fact that the steroid users have an increased incidence of heart impairment could legitimately be purely coincidental. A small (older) study by the American College of Cardiology took twelve anabolic steroid users and 11 non-users. The users had done at least three cycles over the past year. The verdict was that anabolic steroid use was NOT associated with LVH or clinically detectable systolic and diastolic dysfunction. ANOTHER study examined arterial and cardiac structure/function in bodybuilders using steroids and no steroids. The conclusion came in stating “although high level bodybuilding (natural or not) is associated with impaired vascular reactivity and increased arterial thickening, the use of AAS per se is not associated with significant abnormalities of arterial structure or function” however the use of anabolic steroids was associated with significantly larger left ventricular mass. Weightlifting, with or without steroids will lead to a concentric left ventricular hypertrophy, however I believe steroids tend to exaggerate the existing LVH caused by weightlifting, whether the enlargement is benign or not is unknown, however when we look at the weight of pro bodybuilders, considering they weigh about as much as a morbidly obese person, it must cause heart strain to maintain such a heavy weight, plus the inclusion of GH, insulin and diuretics (diuretics can cause electrolyte imbalance and lead to fatal arrhythmias, GH, slin and IGF-1 will cause organ hypertrophy over time at high doses). There have been a multitude of studies on athletes with enlarged hearts and the studies usually come to conclusions that athletes heart does not increase the chance of cardiovascular disease or sudden cardiac death. Many studies of anabolic steroid usage on Rats, rabbits etc have shown significant heart hypertrophy and increased amounts of atherosclerosis. One must take these studies with a grain of salt as drug metabolism is different in mice then it is in humans. A prime example of this would be a trial that for a cancer drug that passed with flying colors in rabbits, mice, monkeys etc but when given to humans at 1/500th of the dose (or something like that don’t remember the full specifics) the humans went into catastrophic multiple organ failure. One must also realize a mice’s lifespan is 1 year old on average, if a mouse is given anabolic steroids at a high dosage for a mere four weeks that is 1/12th of the mouses life, if a man lives until 75, 1/12th of his life is 6.5 years meaning every 4 weeks of a mouse/rat on steroids should theoretically be equivalent to a human blasting for 6-7 years. Another thing to look at is the (very few) cases of people aged 18-30 who have died suddenly and for seemingly no reason while on anabolic steroids. Most of these cases involve undiagnosed congenital heart defects #Zyzz, if one is to use TRT or anabolic steroids I would strongly suggest getting your heart checked for abnormalities (I had mine checked when I was born, no abnormalities). It seems as if using anabolic steroids combined with stimulants such as amphetamines or cocaine strongly increases the risk of SCD. what are you people’s opinions of the effects of anabolic steroids on the heart? Has anyone who is a long-term user here gotten an ECG to check for heart complications and for all you users that have run 5+ cycles, what issues have you run into? I would add stuff on potential kidney strain of AAS however I have already made this post super long. There is a study showing nandrolone is 11x more damaging to endothelial blood vessels than testosterone or some shit and I saw a post about a bunch of ppl freaking out about it however I would like to say, the post shows that nandrolone causes significant damage at a concentration of 9 UM, 1UM is the equivalent of 1000NMOL, when one injects 500mg of testosterone, their blood testosterone concentration will go up to about 100nmol, so imagine how much nandrolone one would have to use to get up to a concentration 9000nmol. I saw a post earlier suggesting that minors be flagged so members of this community can be aware of whether they are talking to a minor, I am 17 years old, I have never used anabolic steroids however I am on TRT (prescribed by doctor) for around five months (not sure if that counts), Will I use anabolic steroids in the near future? Probably, however that is not a topic I want to discuss. The reason for me going on TRT was because my TT levels dropped from the low 1000’s down to mid-200’s for unknown reasons and I was extremely symptomatic for about half a year, seems as if the problem may be related to testicular function but this is irrelevant to the point of this post. (never used anabolic steroids, although my post from ages ago asks about nandrolone) TRT protocols in Australia are terrible (250mg test E every 3 weeks, test undecanoate e14w, gel etc). If anyone who saw my last post on the pharma section from like a year ago is interested. I was taken off the arimidex (to stop premature ephysial plate closure), my joint pain decreased significantly, however I still have joint and bone pain, my e2 never really bounced back, stayed right at the bottom of the reference range, I lift weights again and I see a really good physio, however I experienced EXTENSIVE muscle wasting during my period of chronic pain and hypogonadism (6-10kg lost) and the TRT I’m currently on has been unable to get me past 300-400ng/dl which still keeps me with nonexistant libido, ED and so on. ANYHOW the point of this post is. How detrimental are the effects of long term anabolic steroids to the heart (in your opinions), I am undecided on whether the effect on the heart is benign or not or whether there is really an effect on the heart when used in moderation as there is not enough data. This possible side effect of AAS that is rarely talked about and should be talked about more commonly. Reasons for AAS possibly causing LVH include, blood pressure increase, the fact that the heart also has androgen receptors therefore direct growth is a possibility especially considering the heart is a muscle, complicated shit with cytokines that I don’t want to explain because it would make this post even bigger and it’s already huge however the exact cause effect relationship is unknown (if it does cause LVH). I hope not to get a lecture due to my age, however I will respond to any criticism with maturity unless someone speaks to me in a derogatory fashion in which if that is the case I simply will not reply. I posted this up so I could have a debate/intelligent convo about whether it causes these problems
http://circ.ahajournals.org/content/114/15/1633 (The heart of Trained Athletes)
http://www.onlinejacc.org/content/37/1/224 (Journal of the American College of Cardiology)
http://www.onlinejacc.org/content/19/2/278 (Left ventricular function is not impaired in weight lifters who use anabolic steroids
https://www.ncbi.nlm.nih.gov/pubmed/23218891 (Normal ranges of left ventricular strain: a meta analysis)
http://circheartfailure.ahajournals.org/content/early/2010/04/27/CIRCHEARTFAILURE.109.931063 (Long Term Anabolic Androgenic Steroid use is associated with Left Ventricular Dysfunction)
http://www.ergo-log.com/nandrotest.html (nandrolone 11x more damaging study)
https://www.ncbi.nlm.nih.gov/pubmed/2915439 (stanozolol cholesterol)
https://www.ncbi.nlm.nih.gov/pubmed/6813637 (stanozolol cholesterol)
https://www.sciencedaily.com/releases/2017/11/171104134433.htm (steroids atherosclerosis)
https://www.ncbi.nlm.nih.gov/pubmed/17085981 (steroids left ventricular ejection fraction in pro bodybuilders and calcification of arteries)
Cases of Sudden Cardiac Death
http://www.ergogenics.org/sudden-cardiac-death-during-anabolic-steroid-abuse-fatal-cases-of-bodybuilders.html (normal sized hearts, but tissue necrosis/death)
https://www.ncbi.nlm.nih.gov/pubmed/7728810 (20 year old who died suddenly, found to have an enlarged heart)
http://newsroom.unsw.edu.au/sites/default/files/documents/Paper%20published%20online%2019%20Feb.pdf (most of these cases were related to homicide, suicide or steroids combined with other drugs)
https://www.omicsonline.org/open-access/androgenicanabolic-steroid-boldenone-abuse-as-a-cause-of-dilated-cardiomyopathy-2329-9126.1000153.php?aid=25678 (this guy didn’t die but had a LV ejection fraction below 20% and haematocrit of above 60 percent apparently caused by boldenone (EQ)

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That was a really good read. Thank you for posting that.

As an aside, I’ll throw this thought out there and see if anyone else feels the same. My whole life (35 years) all I’ve ever heard is that steroids are Very Bad Drugs taken by Bad Cheaters and that you’ll lose your mind and go pillage and plunder the neighboring towns because of your roid rage. None of it was true. Not then, not now. Meanwhile, doctors are handing out a fun class of drugs called ‘atypical antipsychotics’ to people with garden variety depression. Drugs made for people with serious mental illnesses have made their way into the normal prescribing habits of doctors all across America, and yet I hear not a peep about it in the zeitgeist. Go ask a 19 year old kid who’s never lifted a weight in his life what he thinks steroids do. After he washes down his Zyprexa with a Red Bull and finishes his bong rip, he’ll tell you that steroids give you roid rage and shrink your d*ck.

Sorry to go off on a rant, but your excellent piece of work got me angry at all the lies I was told my whole life. Anyway, seriously, thanks for posting that.

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I fully agree with you, I am 17 and the kids in my grade use MDMA, Meth, LSD, marijuana etc (I am drug free), yet when asked about anabolic steroids they say “nah mate, your dick will shrink, it’ll turn you into a woman etc.”, it infuriates me as well, the ignorance is unbelievable, hard drugs like meth and MDMA are far more destructive than even the harshest regiments of anabolic steroids.

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That was an interesting read. Where did you find it?

I wrote it @yubs

Nice work indeed; thank you for taking the time to site your references.

It’d be a great idea if a lot of AAS users on T Nation got the relevant heart tests done. You could then have a sample size of 100s of AAS users.

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In terms of how dangerous AAS are, the European consensus, when recreational drug harm experts get together, is AAS are low harm… 16th on a list of 20 recreational drugs.

Guess which drug is most harmful, taking into account harm to the user & to society?

Alcohol \m/

6th most harmful is tobacco.

AAS, MDMA & LSD are all rated low risk drugs.

Drug experimentation is a normal part of the human experience, and most people can use drugs quite responsibly. I believe in being educated about what you’re getting yourself in for, and the risks and rewards of various drugs.

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