Steroids and PEDs: Health Risks and Why Bloodwork Matters

Performance-enhancing drugs (PEDs) are part of bodybuilding, and pretending otherwise helps nobody. Plenty of people use them, many more think about it, and most of the information they find comes from forums and people selling something.

This article covers what the research says about the health risks of anabolic steroids, SARMs and related drugs, so that whatever you decide, you decide with your eyes open. It does not give doses, cycles or sources. The only option without these risks is not to use them.

The short answer

• Anabolic steroids do build muscle, which is why people use them. They also carry real and sometimes permanent risks, especially to the heart and hormones.
• SARMs are not a "safer steroid". They are unapproved drugs, and many products do not contain what the label says.
• In general, risks rise with higher doses, longer use and combining several drugs.
• If you use them, a doctor who knows what you take and regular bloodwork are the bare minimum.
• The enhanced physiques you see online are not a fair comparison for natural progress.

What counts as a PED

"PEDs" covers a wide range of drugs. The main ones in bodybuilding are:

• Anabolic-androgenic steroids (AAS): testosterone and drugs made from it, taken as injections or pills.
• SARMs (selective androgen receptor modulators): drugs developed as possible medicines that never got approval.
• Others: growth hormone, insulin, thyroid hormone, clenbuterol, diuretics and the peptides covered in peptides for bodybuilding. Each has its own serious risks.

This article focuses on steroids and SARMs.

The legal position

As of October 2026, in the US, anabolic steroids, testosterone included, are Schedule III controlled substances under the federal Controlled Substances Act. Under federal law, having them without a valid prescription is an offence (a misdemeanour for a first offence; state laws can add their own penalties), and giving them to someone else, even for free, counts as distribution, which carries a maximum of 10 years in prison.

In the UK they are Class C drugs under the Misuse of Drugs Act 1971. In England, Wales and Scotland, possessing them for your own use is not an offence, but possessing them with intent to supply, supplying them (even free, to a friend) and importing them by post or courier are offences, with a maximum of 14 years in prison and an unlimited fine.

SARMs are not approved medicines in either country. In the US they are unapproved drugs, and selling, shipping or marketing them for people to take is unlawful. In the UK they have no marketing authorisation: selling, supplying or advertising them for people to take is an offence (maximum 2 years in prison), while possessing them for your own use is not.

Laws differ between countries and change often: this is a summary, not legal advice, and may be out of date. Every major anti-doping body bans steroids and SARMs, in and out of competition.

What the research shows

Heart and blood vessels

This is the biggest concern.

• A 2017 study by Baggish and colleagues in Circulation compared long-term steroid users with lifters who did not use them. The users' hearts pumped less well, relaxed less well between beats, and they had more plaque in the arteries of the heart.
• Steroids typically lower HDL ("good") cholesterol and raise LDL ("bad") cholesterol, and can raise blood pressure.
• They raise the number of red blood cells, which thickens the blood and can increase the risk of clots.

The Endocrine Society's 2014 scientific statement on PEDs (Pope and colleagues, Endocrine Reviews) summarises these and the other risks below in detail.

Hormones and fertility

• While you take steroids, your body stops making its own testosterone. Sperm production can fall sharply, sometimes to zero, and the testicles shrink.
• After stopping, recovery can take months or years, and for some it is not complete. A 2016 study by Rasmussen and colleagues in PLoS One found that former users still had lower testosterone and symptoms of low testosterone years after they stopped.
• Breast tissue can grow in men (gynaecomastia), which may need surgery to remove.

Liver

Some steroid pills are hard on the liver and can cause liver damage and, rarely, tumours.

Mind and mood

Irritability, aggression and mood swings are commonly reported while using, and low mood and depression when stopping, as the body's own hormones are slow to recover. Some users become dependent on steroids.

Women

Steroids can cause a deeper voice, facial and body hair, an enlarged clitoris and changes to periods. Some of these, such as the voice changes, can be permanent.

Overall health

A Danish study (Horwitz and colleagues, Journal of Internal Medicine, 2019) followed men caught using steroids in fitness centres. Over the following years their death rate was about three times higher than that of similar men who were not caught. It was an observational study, so it cannot prove steroids alone caused the difference, but it is a sobering number.

SARMs

SARMs are often marketed as a milder alternative. They are not approved medicines anywhere.

• In October 2017 the US FDA warned that body-building products containing SARMs have not been approved by the FDA and are not dietary supplements but unapproved drugs. It said SARMs have been linked to serious problems, including liver damage, and may increase the risk of heart attack and stroke.
• A 2017 analysis in JAMA (Van Wagoner and colleagues) tested 44 products sold online as SARMs. Only about half contained a SARM at all, and many contained other unapproved drugs or different amounts from the label.
• Like steroids, SARMs can shut down your own testosterone.

If you use PEDs: honesty and bloodwork

If you have decided to use them, these steps reduce the risk. They do not remove it.

• Tell your doctor. A doctor cannot help with something you hide. Many will monitor you without judgement because they would rather know.
• Get regular blood tests and check-ups before, during and after use. A doctor will typically look at blood pressure, red blood cell levels (haematocrit), cholesterol, liver and kidney function, and hormone levels, and may check your heart.
• Never share needles or vials. Many areas have free needle and syringe services.
• Know the warning signs. Chest pain, shortness of breath, a severe headache, a painful swollen leg, or yellowing of the skin or eyes need urgent medical help.

Testosterone replacement therapy (TRT), prescribed by a doctor for diagnosed low testosterone and monitored with regular tests, is a medical treatment. It is a different thing from self-sourced steroids, even when the drug is the same.

Natural vs enhanced: set fair expectations

Many of the physiques on social media are enhanced, and not all of them say so. Comparing your natural progress to them leads people to think they are failing when they are not, and pushes some toward drugs they would not otherwise consider.

Natural progress is real but slower. With good training and nutrition, beginners can build muscle quickly, and the rate slows with experience. How much muscle can you build naturally? gives realistic numbers year by year, and lean bulk: how fast should you gain weight? turns them into a target for the scale.

Where coaching helps

If you use or are considering PEDs, being honest with your doctor is the single most useful thing you can do for your health. CoachAk never gives doses, cycles or sources, and never tells you to start, stop or change a medicine.

The things that drive most people's results are the basics: a program that progresses, the right food and protein, enough sleep, and someone reviewing your progress every week. With one-to-one coaching from CoachAk, that is what you get: a plan written for you, a weekly check-in your coach reads, and adjustments as your body responds.

If you want to see what your body can do with the basics done properly, apply for coaching.