Every bodybuilder, powerlifter, athlete and gym rat who has ever taken anabolic steroids (AAS) worries at one point or another about the risks involved. Even though there are not designated parking spots at gyms for ambulances to make it easier for EMTs to push oversized gurneys to the squat racks, every public statement made by politicians, health agencies and celebrity athletes emphasizes the potential damage to a person’s health in addition to tagging AAS users as cheaters. 

Certainly, AAS use carries risks, as does the use of any drug. Unfortunately, the true scope and degree of that risk is unknown, as AAS research has been stunted due to biases in funding and ethical concerns from traditionally ultra-conservative Institutional Review Boards (IRBs). Clinical research involving humans and animals is approved by an IRB prior to recruiting volunteers to ensure that the subjects will not be exposed to significant or unnecessary risks. At this time, the risk profile for testosterone use appears to be dose-related, with doses that result in plasma (blood) concentrations well outside the normal range (both above and below), leading to side effects that range from temporary and trivial to serious and permanent…potentially fatal in rare cases. Not only do the risks depend upon the concentration achieved; age, gender (sex), AAS used and underlying health conditions (sometimes undiagnosed) in the user need to be considered as well. Extremely young (adolescents or children) and elderly people may not be able to tolerate the sudden or extreme swing in androgen concentrations; women are much more sensitive to changes in androgen levels and may develop features that would go unnoticed or be of little consequence in men; while testosterone is generally well-tolerated, other AAS may affect certain tissues or behaviors negatively; and lastly, the existence of psychiatric or health conditions that may be stimulated or accelerated by fluctuations in androgens are relevant concerns (certain cancers, mania, depression, etc).