Acne:
High levels of androgens stimulate the sebaceous glands in the skin to secrete an oily substance called sebum. When the secretion of sebum becomes excessive, the hair follicles may clog, resulting in acne. For mild cases of acne, there are numerous over-the-counter topical medications to help clean the skin from excess oil. More severe acne breakouts may require stronger medications like isotretinoin (Accutane). Acne typically resolves with the cessation of steroids.

Aggression:
While on a steroid cycle, a common side effect that users experience is increased aggression, resulting in mood swings, irritability, and a short temper. Some users have even reported rare cases of verbal and physical violence. These extremely rare cases may be more due to the general behavior of the individual rather than the drug itself.

We cannot dispute that aggression exists among steroid users, or terms like ‘roid rage’ wouldn’t exist. However, this behavior might also be psychologically induced by the belief that taking steroids will cause aggression. In animals, there is documented evidence linking natural testosterone and aggression, but these tests have not been conclusive in humans.

Increased aggression is largely dependent upon the dose and stacking different highly androgenic compounds. Many athletes in explosive strength sports like cage fighting, bodybuilding, powerlifting, and sprinting favor highly androgenic steroids due to their alleged abilities to support aggression and mental and physical drive. However, the only way to achieve factual evidence that steroids increase aggression would be to conduct a clinical trial with two groups of patients, one group being administered high doses of anabolic steroids and the other a placebo. This is unlikely to happen soon.

Blood Pressure:
Anabolic steroids may increase blood pressure when used in dosages above therapeutic levels. In most cases, elevations in blood pressure are relatively modest, but it’s advisable to monitor levels closely. Action should be taken if blood pressure exceeds 140/90. Common causes of increased blood pressure include water retention, increased vascular stiffness, and increased red blood cell volume. Aromatizing or highly estrogenic steroids tend to cause the greatest influences on blood pressure, although any steroid may cause elevated blood pressure. Blood pressure tends to normalize with the cessation of steroids.

Cholesterol & Lipids:
Some steroids may cause a harmful increase in LDL (bad) cholesterol and a decrease in HDL (good) cholesterol. Esterified injectable steroids are generally less stressful to the cardiovascular system than oral agents. Estrogens can have a favorable impact on cholesterol profiles. The aromatization of testosterone to estradiol may, therefore, prevent a more dramatic change in serum cholesterol. The drug tamoxifen citrate (Nolvadex) has shown positive effects on HDL values, whereas other anti-estrogens like aromatase inhibitors show the opposite.

Depression:
During steroid administration, natural hormone production is diminished because the body recognizes the excess hormone levels. When the steroid drugs are abruptly discontinued, the body can enter a state of temporary hypogonadism (low androgen levels). This may be associated with psychological symptoms including depression, insomnia, and loss of interest. This condition is referred to as anabolic steroid withdrawal depression and can persist for weeks or even months as the body slowly resumes normal hormone production. The best way to combat this is by following a proper PCT cycle. The other reason could be due to the toxins that have built up in your body following a steroid cycle, so it is advisable to detoxify your body after each cycle.

Gynecomastia:
Anabolic steroids with significant estrogenic or progestational activity may cause gynecomastia (female breast development in males). This disorder is characterized by the growth of excess glandular tissue in men, due to an imbalance of male and female sex hormones in the breast. The first sign is typically pain in the nipple area, quickly coinciding with minor swelling. This is sometimes referred to as pseudo-gynecomastia, as it primarily involves fat and not glandular tissue. At this stage, it may be possible to address mild nipple swelling by reducing or eliminating the offending steroidal compounds and administering an appropriate anti-estrogenic medication for several weeks. If left untreated, this may progress to clear gynecomastia, which involves significant fat, fibrous, and glandular tissue growth. Noticeable gynecomastia is likely to require corrective cosmetic surgery.

Careful steroid selection and reasonable dosing are usually regarded as the most basic and reliable methods for preventing its onset. Many steroid users also frequently take some form of estrogen maintenance medication, which may effectively counter the effects of elevated estrogenicity. Common options include aromatase inhibitors such as anastrozole. The use of a PCT program at the conclusion of steroid administration (which usually includes several weeks of anti-estrogen use) is also commonly advised, as gynecomastia is sometimes reported in the post-cycle hormone imbalance phase when steroids are not being taken.

It is important to note that progesterone can also augment the stimulatory effect of estrogen on mammary tissue growth. As such, progestational drugs may trigger gynecomastia in sensitive individuals, even without elevating estrogen levels. Many anabolic steroids, particularly those derived from nandrolone, are known to exhibit strong progestational activity. While gynecomastia is not a common complaint with these drugs, they are occasionally linked to this side effect in anecdotal reports. The anti-prolactin cabergoline (Cabaser) is usually taken in such instances.

Hair Loss:
Although dihydrotestosterone (DHT) is identified as the primary hormone involved in the progress of androgenetic alopecia, it does not possess a unique ability to influence this condition. All anabolic/androgenic steroids stimulate the same cellular receptor and are capable of providing the necessary androgenic stimulation. Baldness can result from steroid use, even in the absence of steroids that convert to, or are derived from, DHT. Treatment for androgenetic alopecia in men usually involves topical minoxidil and oral finasteride, a 5-alpha reductase enzyme inhibitor.

Insomnia:
Anabolic steroid use may be associated with insomnia. This adverse reaction appears to be related to an imbalance of hormone levels and has been noticed during both excess and insufficient hormonal states. While insomnia may be frequently reported among steroid users, this side effect rarely reaches a clinically significant level.

Kidney Stress:
Direct damage to the kidneys from anabolic steroid usage is very rare. However, high blood pressure resulting from steroid usage is usually to blame. In healthy individuals, clinical renal toxicity caused by the short-term administration of anabolic steroids is unlikely. Cranberry extract is sometimes used in an attempt to prevent kidney damage.

Liver Stress:
Many steroids are toxic to the liver (hepatotoxic). These compounds can cause serious and sometimes life-threatening damage when abused, and occasionally even under therapeutic conditions. Those agents commonly associated with clinical hepatotoxicity include (but are not limited to) fluoxymesterone, methandrostenolone, methylandrostenediol, methyltestosterone, norethandrolone, oxymetholone, and stanozolol. Liver strain, as assessed by elevated liver enzymes, has also been reported with non-alkylated esterified injectable steroids, including nandrolone decanoate and testosterone enanthate in extremely rare instances. These steroids have never been associated with severe liver damage, however. If liver enzymes are elevated beyond normal levels (especially above 100), steroid use should be terminated and the situation monitored. It is also recommended to use liver detox supplements on and off cycle.

Stunted Growth:
High doses of anabolic steroids in prepubescent patients may accelerate bone maturation, thus reducing the total length of the bones. This is due to the prematurely initiated and hastened closure of the epiphysial growth plates in the long bones.

Testicular Atrophy:
One of the most commonly reported side effects of anabolic steroid use is testicular atrophy. When anabolic steroids are taken, the body is prompted to reduce its own production of testosterone. The reduced activity of the testes leads to some shrinkage (atrophy). At the same time, the testicles are less active in producing sperm, so sperm count and fertility tend to decrease as well. With the cessation of steroid use, the body will resume normal testosterone production and sperm count. The testicles should return to their normal size within a couple of months. While using anabolic steroids, most men experience some degree of testicular atrophy, the level of which depends on the dose and duration of intake.

Water & Salt Retention:
Some anabolic steroids convert to estrogen via the aromatase enzyme. An excess of estrogen may lead to water and sodium retention. When using such agents, users may notice an increase in subcutaneous water retention, which typically results in a smooth, bloated appearance. This type of weight gain can negatively affect definition, causing the physique to look softer, and may also place increased stress on the cardiovascular system. Blood pressure is often elevated when using these agents, mainly due to water retention. Although steroids that do not aromatize may also have a negative impact on water balance, the primary offenders are estrogenic steroids. Increasing the intake of potassium, reducing sodium, and drinking more water may help alleviate the condition. The use of aromatase inhibitors like anastrozole or anti-estrogens like tamoxifen may also help reduce estrogenic side effects. However, these medications are often reserved for when symptoms are more problematic, as lowering estrogen levels too much can have a negative impact on cholesterol balance and may reduce anabolic effectiveness. Additionally, keeping excess water retention in check may help reduce the risk of developing high blood pressure and minimize water gain in the first place.