Dear Dr. Eva,

I’m hoping you’ll give a straight answer on this: Is it okay to take steroid shots to build up muscles?

Don’t steroids build up your immune system as well as your muscles?

I know you shouldn’t buy them on the street, but what if you get them from a doctor?

Gym Rat


Dear Gym Rat,

Yes, I can give you a straight answer. Anabolic-androgenic steroids, the medical name for muscle-building steroids, are bad for your health.

What are they? There are several types of anabolic steroids, but most are illegal in the US. The only one legally available here is testosterone. Testosterone is prescribed to men, usually older men, whose bodies don’t make normal amounts of testosterone, and to transmen. The medically correct, safe doses prescribed for these two groups are very small compared to the huge doses some bodybuilders take.

Why do people who have normal testosterone levels take extra testosterone? Because, when used together with many repetitions of muscle-building exercises, anabolic steroids increase muscle mass more than any other known method.

Why do people want such huge muscles? This is really the key question. Your guess is as good as mine. Because they want to compete in body-building contests? Because they think huge muscles will make them desirable? Because they just want to look a certain way? Whatever the reason, there are significant risks.

What are the risks? There are a few.

  • Testicle atrophy, which leads to sterility (inability to make sperm and father babies) and impotence (inability to get an erection).
  • Breast growth, because excess testosterone is changed in the body to estrogen, a female hormone
  • Mood swings and sudden uncontrollable anger, resulting in road rage and violence against domestic partners, other family members, friends, co-workers, or strangers
  • High blood pressure
  • Increased chance of high cholesterol and diabetes (metabolic syndrome)
  • Increased risk of heart attack
  • Overproduction of red blood cells, leading to increased risk of stroke
  • Skin problems: acne, oily skin, stretch marks
  • Kidney damage
  • Dangerous changes in the shape of the heart (because the heart is mostly muscle)
  • Testosterone does not improve immune function. In fact, in high doses decreases immune function, so risk of infection is greater, not less.
  • In genetic males: prostate enlargement and prostate cancer
  • In genetic females: loss of scalp hair, permanent hair growth on the face and body, deeper voice, increased cartilage growth causing a more masculine face, infertility, and clitoral enlargement

Some, but not all, of these problems can improve after a person stops using steroids. None of these problems occur with the low doses of testosterone recommended for transmen and for genetic men with low testosterone.

Testosterone is a controlled substance, restricted by law to be used only when prescribed and only to give normal testosterone levels to men whose bodies do not make enough of it. If a doctor prescribes it for any other use, they are breaking the law and could go to jail. If you know of someone claiming to be a doctor and prescribing testosterone for building muscles, it’s doubtful if that person has a valid license to see patients. If they did, they wouldn’t risk losing it. Anyone can check to see if a doctor is licensed by going to their state’s board of medical licensing website.

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Dr. Eva Hersh, MD
Dr. Eva Hersh, MD
Eva Hersh is a family physician. Send your comments and questions to her by email at