Gym-Goers Who Quit Anabolic Steroids Saw Heart Walls Recover but Pumping Strength Stayed Lower in Norwegian Study

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ERIC LALMAND | BELGA MAG/AFP via Getty Images Share on Twitter Share on Facebook Share on Pocket Men who stopped using anabolic steroids saw their thickened heart muscle return to normal, but their hearts still pumped less strongly than those of men who never used the drugs, according to a small long-term study from Oslo University Hospital. The findings, published in the European Heart Journal: Cardiovascular Imaging, come from a follow-up of recreational strength athletes about seven years after they first enrolled. Men who kept using steroids, even at lower doses, showed ongoing heart strain.

For gym-goers who use or are considering anabolic steroids, the message is practical rather than judgmental. Heart damage may not cause obvious symptoms, and some of it may persist after stopping. The study also suggests that quitting completely, with medical support, is the step most likely to help the heart recover.

The original 2017 to 2019 study enrolled 101 men who used anabolic-androgenic steroids and 71 non-users, all recreational strength athletes. At follow-up, 70 users and 35 non-users returned for echocardiograms, heart ultrasounds that measure muscle thickness and pumping function. Of the returning users, 35 kept using, 15 stopped, 14 stayed abstinent after quitting earlier, and 6 relapsed.

In the 15 men who stopped, heart muscle mass adjusted for body size fell from 112 to 91 grams per square meter, a 19% drop that matched non-users. Their ejection fraction, the share of blood pumped out with each beat, rose from 48% to 54% but stayed below the 60% average among non-users. Senior author Vibeke M. Almaas, MD, a senior consultant at the hospital who led the study, said in a European Society of Cardiology release, “As many as 17% of those who continued using AAS had severely reduced heart function.”

Lowering the dose without stopping brought no measurable heart benefit. Among men who kept using, those not treated for high blood pressure saw their ejection fraction decline by 8%, while those receiving blood pressure treatment saw an 11% improvement, though their heart muscle did not thin. Only complete cessation and blood pressure treatment were linked to a measurable difference, the researchers reported.

The work builds on earlier findings from the same research group. In 2019, Oslo researchers reported that men with more than a year of steroid use had thicker heart walls and weaker contraction than non-users, though only a minority had experienced heart symptoms. “Continuous, long-term use of AAS might prove to be a ‘silent killer,’ but it is too early to tell,” said Rang Abdullah, then a medical student and now first author of the new paper.

MedicalDaily Evidence Check: This was an observational follow-up study with a small sample, especially the 15 men who stopped. Not everyone returned, steroid use was self-reported, and blood pressure treatment data were available only at follow-up. Other drugs, lifestyle habits, or health problems could have influenced the results, and the study included only men.

General warning signs that need prompt medical attention include chest pain, shortness of breath during light activity, swelling in the legs, a racing or irregular heartbeat, fainting, and unusually high blood pressure readings. Severe chest pain or fainting warrants a 911 call. Being honest with a primary care clinician about steroid use helps them choose the right tests, such as a blood pressure check or an echocardiogram.

Stopping can bring withdrawal symptoms, including fatigue, restlessness, insomnia, loss of appetite, and reduced sex drive, according to the National Institute on Drug Abuse. Depression is the most dangerous withdrawal symptom, which is one reason medical support matters. SAMHSA’s National Helpline, at 1-800-662-4357, offers free, confidential referrals to treatment around the clock.

Treatment for high blood pressure is widely available, and in this study it was linked to better pumping function among men who kept using steroids. “Our findings underline the importance of continuing both preventive work and harm reduction efforts,” said Astrid Bjørnebekk, PhD, who heads the anabolic steroid research group at Oslo University Hospital.

The heart may partly recover after steroids, but in this study it did not recover all the way, even years later. For anyone using them, stopping completely with medical guidance and keeping blood pressure under control appear to offer the best chance of protecting the heart.

What did the Norwegian study find? Men who stopped steroids saw heart muscle thickness return to normal levels. Their pumping function improved but stayed below that of non-users.

Does lowering the dose help the heart? Not in this study. Reducing the dose without stopping brought no measurable heart benefit.

What heart warning signs should steroid users watch for? Chest pain, shortness of breath with light activity, leg swelling, a racing heartbeat, and fainting need prompt medical attention. Severe chest pain or fainting warrants a 911 call.

Is it safe to stop steroids suddenly? Stopping can cause withdrawal symptoms such as fatigue, insomnia, and depression. A clinician can help monitor hormones and mood during the process.

Where can someone get help to stop? SAMHSA’s National Helpline at 1-800-662-4357 offers free treatment referrals at any hour. A primary care clinician is also a good starting point.

How strong is the evidence? The study was small, observational, and limited to men. Steroid use was self-reported, and not all participants returned for follow-up.