Anabolic steroids, oral ones especially, lower HDL (“good”) cholesterol and often raise LDL. Together with higher blood pressure and thicker blood, that is the main long-term risk of steroid use.
- Oral steroids like Winstrol and Anavar cause the biggest HDL drops.
- Test lipids, blood pressure and hematocrit before and during use.
- Cardio, diet, time off and medical follow-up all reduce risk.
Most people worry about liver damage or hair loss when they think about steroid side effects. Cardiologists worry about something else: the heart and blood vessels. Studies of long-term steroid users show more heart disease, at younger ages, than in the general population. The changes are silent for years, which is exactly why they need tracking.
What steroids do to your cholesterol
Androgens increase an enzyme in the liver called hepatic lipase, which breaks down HDL cholesterol. HDL is the particle that carries cholesterol away from your arteries, so less of it is bad news.
- HDL falls, sometimes by half or more with oral steroids.
- LDL often rises, especially with orals and higher doses.
- The ratio worsens, which matters more than any single number.
Injectable testosterone at replacement doses has a small effect on lipids. The effect grows with dose and is much stronger with oral, 17-alpha-alkylated compounds. Our explainer on methylated steroids covers why.
| Compound type | Typical effect on HDL |
|---|---|
| Testosterone (replacement dose) | Small drop |
| Testosterone (high dose) | Moderate drop |
| Nandrolone | Moderate drop |
| Oral steroids (Winstrol, Anavar, Dianabol, Anadrol) | Large drop, sometimes over 50% |
Beyond cholesterol
- Blood pressure rises in many users, partly from water retention.
- Hematocrit (the share of red cells in your blood) rises, making blood thicker and more prone to clotting.
- The heart muscle can thicken (left ventricular hypertrophy) with long-term, high-dose use, and imaging studies show weaker heart function in some long-term users.
How to monitor it
Ask your doctor for a lipid panel before you start and again part way through. Canadian guidelines from the Canadian Cardiovascular Society also support measuring apolipoprotein B (ApoB), which counts the particles that cause plaque and is often more useful than LDL alone. Add a complete blood count for hematocrit.
Check blood pressure weekly at home or at a pharmacy machine. Readings consistently above 130/80 deserve attention, and above 140/90 need a doctor. Our Canadian bloodwork guide explains how to order these tests.
Practical ways to protect your heart
Choose compounds and doses carefully
Dose drives risk. Staying close to medical doses, avoiding stacked orals and taking real breaks between uses all limit lipid damage. HDL usually recovers within weeks to months after stopping.
Train your heart, not just your muscles
Two to four sessions of moderate cardio a week, such as brisk walking, cycling or rowing, raise HDL, lower blood pressure and improve the heart’s efficiency. Canada’s physical activity guidelines recommend at least 150 minutes a week.
Eat for your arteries
- Soluble fibre: oats, barley, beans, lentils, psyllium.
- Oily fish twice a week: salmon, mackerel, sardines, trout.
- Nuts, olive oil and avocado in place of butter and fatty processed meat.
- Limit salt, especially from processed and restaurant food.
Other habits
Do not smoke or vape nicotine; it multiplies the risk. Limit alcohol. Sleep seven to nine hours. If you are eligible, donating blood with Canadian Blood Services lowers hematocrit, though they have their own eligibility rules.
A simple monitoring routine
Turning this into habit is what actually protects people. A routine many use:
- Before starting: lipid panel with ApoB, complete blood count, and three days of morning blood pressure readings to get a true baseline.
- Weekly while using: blood pressure on the same arm, sitting, after five minutes of rest. Write it down.
- Part way through: repeat lipids and blood count.
- Six to twelve weeks after stopping: repeat everything to confirm values are heading back to baseline.
If HDL has not recovered before you consider another run, that is your body asking for more time. Long-term users who skip this step are the ones who end up surprised by a cardiology referral in their forties.
When medication is needed
If lipids or blood pressure stay high, a doctor may prescribe a statin, blood pressure medication or other treatment. These are common, inexpensive and usually covered by provincial plans. Being honest with your doctor about steroid use lets them choose the right drug and interpret your results correctly.
For a complete approach to staying safer, read our harm reduction guide.
Frequently asked questions
Which steroids are worst for cholesterol?
Oral 17-alpha-alkylated steroids such as Winstrol, Anavar, Dianabol and Anadrol cause the largest drops in HDL. Injectable testosterone at moderate doses has the smallest effect.
Does cholesterol go back to normal after steroids?
In most people HDL and LDL return toward baseline within weeks to a few months after stopping, but long-term, repeated use may cause lasting changes.
What cholesterol tests should I ask for in Canada?
A standard lipid panel plus ApoB, along with blood pressure and a complete blood count for hematocrit.
Photo: kinkate, StockSnap (public domain).
General health information, not medical advice. See a doctor about cholesterol, blood pressure or heart symptoms.
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