The terms steroids generically refers to a large group of hormones the body produces naturally as well as similar man-made drugs.
When most people talk about steroids, they are referring to either corticosteroids (also known as glucocorticoids) or anabolic steroids (also known as androgenic steroids). These drugs have different side effects in women, which are most likely to develop with long-term oral, intravenous, or injected use.
Corticosteroids vs. Anabolic Steroids
Understanding the differences between corticosteroids and anabolic steroids makes it easier to appreciate their distinct side effects.
Medicinal corticosteroids — such as hydrocortisone (Cortef), dexamethasone (Decadron) and prednisolone (Orapred) — mimic the actions of steroids produced by your adrenal glands.
Doctors prescribe corticosteroids primarily to reduce harmful inflammation in the body due to a wide range of conditions, such as Crohn disease, ulcerative colitis, multiple sclerosis, lupus and rheumatoid arthritis.
Anabolic steroids include pharmaceutical testosterone (Androgel, Depo-Testosteron, Testim) and man-made hormones that exert similar effects in the body, such as oxymetholone (Anadrol) and oxandrolone (Oxandrin).
The U.S. Food and Drug Administration (FDA) has approved these drugs for use in pubertal-age boys and men with conditions that cause a testosterone deficiency.
Anabolic steroids are not FDA approved for use in women. Like their male counterparts, however, some women use these drugs illicitly to increase muscle mass, reduce body fat, and enhance their athletic performance.
Corticosteroid Side Effects
Overall, corticosteroids cause similar side effects in men and women. Common side effects with short-term use (4 weeks or less) of oral or injected forms of these medicines include increased appetite, insomnia, and mood changes such as irritability or agitation. Elevated blood sugar levels can occur, especially among people with preexisting diabetes or prediabetes.
A study reported in the April 2017 issue of the journal BMJ also found a short course of corticosteroids slightly increases the risk for experiencing a broken bone and development of a bloodstream infection or blood clot.
Taking corticosteroids for longer than 4 weeks can potentially cause a wide range of side effects. Women of childbearing age sometimes develop menstrual irregularity, although this is relatively uncommon. Examples of other possible side effects include:
- High blood pressure and water retention
- Weight gain with development of a rounded face and increased fat in the trunk of the body
- Wasting of large muscles of the arms and legs with possible weakness
- Poor wound healing and easy bruising
- Increased body hair
- Increased risk for certain conditions including infections, osteoporosis, kidney stones, glaucoma and cataracts
Anabolic Steroid Side Effects
Testosterone occurs naturally in women and men of all ages, although the levels in women are normally much lower. The abnormally high levels of testosterone and similar hormones that occur in people using anabolic steroids can lead to a variety of side effects, particularly among those using the drugs illicitly.
The risk for and severity of these side effects increases in parallel with the duration of use and dosage. Some side effects occur in both men and women while others are sex specific.
Anabolic steroids can cause virilization in women, meaning they trigger physical and biologic changes that mimic the effects of testosterone in boys going through puberty. These include:
- Increased facial and body hair, such as on the chin, above the lip, and on the chest
- Deepening of the voice
- Enlargement of the clitoris
- Decreased body fat in the breasts and hips leading to a more masculine body shape
- Increased muscle mass
- Loss of scalp hair leading to male-pattern thinning or baldness
Anabolic steroids also commonly cause menstrual irregularity. In some women, periods stop altogether leading to infertility. This effect is usually reversible if a woman stops taking the drugs.
Notably, taking testosterone or other anabolic steroids during pregnancy can lead to abnormal fetal development of the reproductive system, particularly among female babies. Further, it remains unknown how these hormones might affect babies of nursing mothers using these drugs.
Mental and Emotional Effects
Anabolic steroid use can cause mild to dramatic mental and emotional effects in both women and men. You've probably heard of "roid rage," which refers to a hair-trigger temper, aggression and hostility that commonly leads to verbal or physical arguments. Other possible mental and emotional side effects include:
- Persistent irritability, agitation and/or anxiousness
- Frequent mood swings
- Mania (a euphoric, hyperactive mental state)
- Paranoia (irrational feelings of people being out to get you)
- Hallucinations (seeing or hearing things do not physically exist)
- Psychosis (inability to distinguish what's real versus imagined)
Although anabolic steroids do not cause a high like many other drugs, long-term use can lead to addiction complete with distressing withdrawal symptoms such as moodiness, depression, fatigue, poor appetite and abnormal sleep patterns.
Effects on Body Organs
Long-term anabolic steroid use can cause harmful biologic changes and damage body organs. These side effects are sometimes permanent and include:
- Kidney damage
- Liver damage
- Insulin resistance, potentially leading to prediabetes or diabetes
- High blood pressure
- Abnormal blood fat levels
- Impaired heart function
The combination of insulin resistance, high blood pressure, and abnormal blood fat levels constitutes a perfect storm of increased risk for cardiovascular disease, including heart attack and stroke. A study report published in the May 2017 issue of the journal Circulation confirmed that long-term anabolic steroid use accelerates the development of coronary artery disease, which translates to increased heart attack risk among relatively young adults.
Other Considerations and Next Steps
If you are on corticosteroid or anabolic steroid therapy, talk with your doctor about the risks versus benefits. Healthcare professionals are well aware of the potential side effects of these medications and generally prescribe them only if the benefits outweigh the risks. That said, you know your body better than anyone. Contact your doctor if you experience any signs or symptoms that might signal a side effect.
If you are using anabolic steroids illicitly, talk with your doctor. It's a hard conversation to initiate but your doctor can help you find the necessary resources to address both the physical and mental/emotional challenges posed by this dependency. Remember, addiction is not a personal failure but rather a medical problem, no different from any other health challenge.
- Rheumatic Diseases Clinics of North America: Corticosteroids -- Mechanisms of Action in Health and Disease
- Stat Pearls: Anabolic Steroids
- American College of Obstetrics and Gynecology: Performance Enhancing Anabolic Steroid Abuse in Women
- BMJ: Short Term Use of Oral Corticosteroids and Related Harms Among Adults in the United States: Population Based Cohort Study
- University of Iowa Health Care: Steroids Side Effects Systemic Corticosteroid Therapy Adverse Effects
- Circulation: Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use
- Drug and Alcohol Dependence: Treatment of Anabolic-Androgenic Steroid Dependence: Emerging Evidence and Its Implications