Steroid use is a risk factor for developing cardiovascular diseases. Steroid users are often in denial of this, but it doesn't change the facts.
First, a risk factor is something that increases the likelihood an event will happen. The more of these risk factors you have, the more likely you are to have an issue.
Obesity, smoking and having a family history of heart issues are all risk factors. So is steroid use. It can lead to a poor blood lipid profile, thick blood, elevated blood pressure, increased heart rate, left ventricular hypertrophy, and unnaturally high body weight.
Those in denial will point out that bodybuilders don't have more heart problems than the general population in the US. That's statistically true. But that's because the general population presents several risk factors of their own, risk factors that steroid users tend not to have: obesity, poor nutritional choices, and physical inactivity, among others.
Bodybuilders, generally speaking, are physically active, have low body fat, pay attention to their nutrition, and don't smoke. And yet, they die of heart-related issues at the same rate (or slightly higher) than the general, increasingly unhealthy population. That should tell you something. It should tell you that bodybuilders are doing something that negates everything else they're doing right.
Steroids (and adjacent drugs) are the main reason behind their increased incidence of heart problems. Period.
I'm not going to tell you to stop using steroids; that's a personal choice. But I will give you a few things to do to reduce the risk factors.
1 Bad Lipid Profile
Steroids negatively impact lipid profile. They increase LDL/bad cholesterol and decrease HDL/good cholesterol.
Cholesterol is like a taxi. Fatty acids are the passengers. Cholesterol can thus transport fatty acids to various parts of the body. Bad cholesterol brings fatty acids to the blood vessels; good cholesterol takes it out.
When you have too much bad and too little good cholesterol, you have what's called an "arteriosclerotic profile." This means you're more likely to create arteriosclerosis, which is the biggest risk factor for cardiovascular problems.
Arteriosclerosis is when you deposit fats and other substances in the walls of your arteries. This plaque will make the arteries harder and more rigid, and decrease the space available for the blood to travel. It's simply harder for the heart to push the blood through.
It also increases the risk of blood clots. Plaque is freed up and then blocks the artery, causing a stroke or heart attack. Steroid use increases the risk of arteriosclerosis.
2 Thicker Blood
Several steroids increase hematocrit levels (the biggest culprits being equipoise, Anadrol, and high-dose testosterone). This means increasing the proportion of red blood cells, the solid part of the blood. The result is thicker, more viscous blood.
This is harder to push through your blood vessels. Imagine pushing ketchup through a straw. The thicker the blood, the harder the heart must work. This also increases the risk of blood clots.
Having thicker blood and constricted arteries due to arteriosclerosis isn't a good combo.
3 Left Ventricular Hypertrophy
A side effect of the heart working harder is a thickening of the heart's left ventricle. This is sometimes called an enlarged heart.
To be fair, endurance athletes also have larger hearts, but this comes with improved function because of the type of exercise they do. An endurance athlete's heart gets bigger but maintains its extensibility because of the frequent endurance work.
In steroid users, the heart gets bigger but also more rigid and less extensible. If the heart can't expend as much, it means two things:
- Less blood can enter the heart at any time, decreasing the amount of blood that can be pushed out in each heartbeat.
- The heart becomes weaker at pushing the blood out. Why? Because the more you can stretch the heart, the stronger it can push (due to the stretch reflex). It's like a bow and arrow: the more you pull the string back, the more force is applied to the arrow. If your heart is too rigid, it can't expand as much, and there's less stretch reflex to push the blood out.
This both reduces the strength of each heartbeat (so the heart needs to beat more often for a certain level of effort) and makes the heart action less efficient.
Steroids will cause a thickening of the heart by two mechanisms. First, steroids make the heart work harder (it has to push thicker blood through narrower vessels). Second, steroids are anabolic to the heart muscle, too.
When you do cardiovascular work, especially at a high intensity, which requires a lot of oxygen to be sent to the muscles, the heart is forced to stretch more to send more blood volume and oxygen. The blood also "comes back faster" (veinous return), leading to an expansion or stretching of the heart.
That's why endurance athletes maintain the extensibility of their heart even if it gets bigger. This is NOT the case when the thickening of the heart is due to steroids and thicker blood. That rock-hard heart is another huge risk factor for heart disease.
4 High Blood Pressure
It's called "the silent killer" because most people don't realize their blood pressure is high, leading to several serious health problems.
Higher blood pressure strains the blood vessels in the heart and brain, increasing the risk of stroke, heart attack, and kidney damage.
Many steroids can increase blood pressure, mostly by increasing sodium/water retention. The increase in blood pressure seems to be dose-dependent.
The type of steroids used also has an impact. "Dry" compounds (leading to less water retention) seem to increase blood pressure to a lesser extent. However, sodium/water retention isn't the only cause of increased blood pressure from steroids.
There's a second possible reason: increased sensitivity of the beta-adrenergic receptors. This means your body responds more strongly to your own adrenaline (or supplements/drugs that target the same receptors, like ephedrine and clenbuterol).
Blood pressure rises when you're in a high-adrenaline state. A steroid that makes your beta-adrenergic receptors more sensitive can thus increase blood pressure, even without water retention.
Compounds like trenbolone, halotestin, and methyltrienolone all dramatically increase beta-adrenergic sensitivity and lead to an increase in blood pressure, even without the water/sodium retention.
By the way, those are the same compounds that can cause increased aggressiveness and impatience (what some call "roid rage") because adrenaline puts you in a fight-or-flight state.
5 Higher Body Weight
The more muscle or fat you carry, the harder the heart needs to work. You need more blood flow to cover all the tissue. Gaining muscle, in a way, can be worse than adding fat because muscle increases the need for augmented blood flow more so than fat.
Simply put, the more muscle you have, the harder the cardiovascular system must work.
In a natural lifter, it's unlikely that added muscle mass will be a huge problem by itself. The amount of muscle you can build naturally won't be excessive compared to the capacity of your heart to support it.
But steroids allow you to build muscle faster than your cardiovascular system's capacity to adapt (by adding capillaries and improving heart function). Steroids also allow you to build an amount of muscle that exceeds your genetic limit – an amount that can exceed what the rest of your body can safely support.
Modern bodybuilders are more at risk than old-school bodybuilders. The higher doses used and higher reliance on underground steroids instead of pharmaceutical products certainly plays a role. But the main reason modern bodybuilders are more at risk is their use of other substances: high doses of growth hormone, clenbuterol, and insulin.
High doses of growth hormone can dramatically increase water/sodium retention, which is why some bodybuilders think that GH rapidly blows them up. As noted earlier, that's going to increase blood pressure.
High doses of GH significantly increase heart rate, which puts more strain on the heart and can lead to heart thickening. GH can also lead to high blood sugar and insulin resistance when used in high (or frequent) doses.
Some peptides, most significantly MK-677, can be even worse in that regard. MK-677 leads to a constant elevation in GH levels, which means that blood sugar will constantly be elevated, making the user more likely to become insulin resistant. Not to mention, high blood sugar itself is a risk factor for arteriosclerosis.
Clenbuterol, by activating the beta-adrenergic receptors, produces an adrenaline-like effect and thus increases blood pressure. And don't forget that some steroids make the beta-adrenergic receptors more sensitive. This means they'll make clenbuterol a lot stronger, leading to an even more significant increase in blood pressure.
Clenbuterol can lead to cardiac hypertrophy and can even cause necrosis of heart tissue. I believe that clenbuterol is likely even more dangerous than steroids.
In addition, thyroid hormones also increase heart rate and blood pressure, and injectable L-carnitine can lead to increased fat deposits in the arteries.
The best protection against the potential risks of steroids and other drugs (besides, you know, not taking them) is non-idiotic usage:
- Keep doses small.
- Avoid compounds that promote beta-adrenergic sensitivity (trenbolone, halotestin, and methyltrienolone, for example).
- Use shorter cycles and include off periods.
But there are other things you should do to maximize your chances of staying alive and relatively healthy.
Cardiovascular training is important for everyone. (See Metcon is Mandatory.) But it's even more important for steroid users.
Most of the steroid-caused risk factors are somewhat improved by cardiovascular training. Cardio or conditioning work improves:
- Blood pressure (decreases it)
- Blood viscosity (decreases it)
- LDL/bad cholesterol (decreases it)
- HDL/good cholesterol (increases it)
- Blood triglycerides (decreases it)
It also makes the heart stronger, which decreases the need for a high heart rate. Cardiovascular exercise might not be enough to nullify those risk factors (especially when using high doses of steroids), but it can vastly improve them.
Most bodybuilders do some cardio when they're in a cutting phase. But normally, the intensity of work isn't sufficient to significantly improve risk factors. To improve cardiovascular function, you must challenge the heart. Just walking on a treadmill at "conversation intensity" (where you can still hold a conversation) won't be enough to counterbalance the effects of steroids.
Most bodybuilders also avoid cardio during muscle-gain phases because they wrongfully believe that it will limit their gains. Sorry, but the most important time to do cardio is when bulking, especially if you do an all-out bulk to put on as much weight as possible.
During a bulking phase, there's a huge swing in body weight. An unnatural level of body mass itself shortens the lifespan. (See The Reason So Many Bodybuilders Die Early.)
During a bulk, you also retain more water (increasing blood pressure) and typically consume foods that lead to a poor lipid profile. Basically, bulking itself leads to increases in cardiovascular risk factors. These are added to the effects of steroids to make the situation even worse. That's why you need to do conditioning work when bulking.
Let's look at a few supplements that can make a significant difference, especially on the cardiovascular side of things:
Omega-3 Fatty Acids: Fish oil can increase HDL/good cholesterol, possibly decrease LDL/bad cholesterol, reduce the risk of blood clots, decrease blood pressure, and improve blood flow. Take your Flameout® daily.
Serrapeptase and Nattokinase: These enzymes might help dissolve blood clots/plaque by breaking down the fibrin component.
Resveratrol: It can increase HDL/good cholesterol and prevent damage to the blood vessels. Take two capsules of high-dose resveratrol daily. Rez-V™ is the top choice.
Vitamin D3: It may be able to help repair damaged blood vessels. Ideally, use the microencapsulated form, as found in Biotest's I-Well™ formula.
Carditone: This herb is one of the best natural supplements for decreasing blood pressure. I've seen as much as a 10 points drop in blood pressure from using it.
Citrulline and Beet Root Juice: These "open up" blood vessels (vasodilatation), making it easier for blood to go through the circulatory system. This reduces the stress on both the heart and blood vessels.
There are other good supplements for heart health, but these are sure to make a positive difference.
While it can have a negative impact on the digestive system, daily aspirin can make a big difference in heart health. By preventing blood clots and improving blood flow, it will also decrease blood pressure and reduce the stress on the heart and vessels.
Low-dose Cialis is being studied as a way to improve heart and kidney health by reducing blood pressure. It basically does what citrulline does, but much better: it creates vasodilatation, promotes easier blood flow, and decreases blood pressure.
Lastly, donate blood to reduce blood thickness. When you give blood, you decrease the number of red blood cells. The body will increase the "liquid" part of the blood faster than red blood cells, leading to less viscous blood.
The use of anabolic steroids doesn't automatically lead to health issues, but believing there's no risk is simply stupid. Steroids have an impact on too many risk factors. They are not "safe."
It might take years for these risk factors to cause noticeable problems, but the damage is building. Most steroid users don't get frequent blood work done, either because they don't see a need for it or because they subconsciously don't want to face the truth.
The thing is, the health risk factors that steroids can cause are not "felt." If you don't get blood work, you can easily believe nothing is wrong.
I believe adults have the right to live their lives however they want, as long as it doesn't hurt others. But it's important to present the true risks and maybe help minimize the likelihood of something bad happening.