© 2026 Vannoni
Some of the most consistent gym-goers I see are men in their 30s and 40s who train hard, eat carefully, and look healthier than most of my patients. A subset of them are using anabolic-androgenic steroids. Most have never raised it with a physician, and most physicians never ask.
That silence has a cost. New research in European Heart Journal Cardiovascular Imaging gives the clearest picture yet of what long-term use does to the heart, plus something more useful: evidence about what happens when men stop.
What Did the Study Do?
Researchers at Oslo University Hospital in Norway took a group of male recreational strength athletes first examined between 2017 and 2019 and brought them back nearly a decade later for repeat heart imaging.
Of the original group, 70 steroid users and 35 non-using controls returned. Among the users, 35 were still using, 15 had quit after the first study, 14 had already been off and stayed off, and 6 had relapsed. Almost all were recreational lifters, not competitive athletes, and those still using had been using for a cumulative average of 17 years.
Comparing the same men to themselves over ten years is what makes this worth your attention.
At Madison Avenue Concierge Medicine, Dr. Meyer keeps himself and his patients on the cutting edge of every new medical development and study.
That’s the Madison Avenue Concierge Medicine advantage.
Be in the know regarding your health.
No excuses.
Join Madison Avenue Concierge Medicine
What Does Continued Use Look Like?
In the men who kept using, the echocardiograms showed a consistent pattern:
A thicker, heavier heart muscle. Left ventricular mass index stayed high, averaging 119 g/m², and the posterior wall continued to thicken over the decade.
A weaker squeeze. Ejection fraction, the percentage of blood the main pumping chamber ejects with each beat, averaged 48%. Normal is generally above 55%, and the non-using controls averaged 60%.
Severely reduced function in a meaningful minority. As many as 17% of continuing users had severely reduced heart function.
A stiffer heart. Measures of diastolic function, meaning how well the heart relaxes and fills between beats, got worse over the follow-up period.
That combination, a thick muscle that both squeezes poorly and fills poorly, is the picture of a heart heading toward heart failure. These were men in their 30s, 40s, and 50s.
Does Lowering the Dose Help?
Here is the finding I expect to surprise people most.
Many continuing users had cut their weekly dose between the two visits, roughly halving it. Possibly they had been shown their own imaging results at the first study and responded. Either way, their hearts did not improve. The thickening persisted and the pump function did not recover.
The lead author, Dr. Vibeke Almaas, put it directly: use even at lower doses was associated with persistent thickening of the heart muscle. You cannot coast on a lower dose and assume you are safe.
Join Our Concierge Membership Program
After the first meeting, you can apply to become a member in our premium concierge program and access our elite services, including our executive annual physical. The program consists in an annual membership fee giving access to our premium services.
BOOK AN APPOINTMENT
What Happened to the Men Who Stopped?
This is the encouraging half, and it is real. Among the 15 men who stopped after the first study and had been off for a median of six years:
Left ventricular mass index dropped from 112 to 91 g/m², a 19% reduction that brought them in line with the non-using controls.
Ejection fraction rose from 48% to 54%, an improvement of roughly 13%.
Men who had been off for a median of 11 years looked essentially like men who had never used, with no clinically significant differences in structure or function.
Two caveats keep this honest. The recently quit group improved but did not fully catch up to controls, who averaged 60%. And the men who relapsed showed no improvement at all. The heart responds to sustained cessation, not to intermittent breaks.
Can Treating Blood Pressure Make a Measurable Difference?
Among men who continued using, those not on blood pressure medication saw ejection fraction worsen by about 8% from baseline. Those on blood pressure treatment saw it improve by about 11%, though wall thickness did not improve.
I read that as an argument against the all-or-nothing approach. Stopping entirely is the goal. For a man not ready to stop, treating his blood pressure and cholesterol and getting aerobic exercise into his week is not a consolation prize. It changes his trajectory.
Our Concierge Medicine Services
At Madison Avenue Cardiovascular & Concierge Medicine, Dr. Mark Meyer offers the most exclusive medical care through premier membership to our concierge medicine services.
Is It More Than Just the Heart Muscle?
Earlier work points at the arteries too. A study of 140 experienced weightlifters published in Circulation found steroid users had lower ejection fraction than non-users, 52% versus 63%, along with worse diastolic function. Users also had significantly more coronary artery plaque, and plaque burden rose with each additional decade of use.
So two problems run in parallel: a weakening pump and accelerating atherosclerosis.
Is This the Same as Prescribed Testosterone?
I want to be precise here, because the two get conflated constantly.
The men in these studies were using supraphysiologic doses, meaning far more than a body produces, often obtained outside the medical system. That is a different exposure from testosterone replacement prescribed and monitored for diagnosed low testosterone.
For that second group, the TRAVERSE trial randomized 5,204 men aged 45 to 80 with confirmed low testosterone and either cardiovascular disease or high risk for it. The primary endpoint of cardiovascular death, heart attack, or stroke occurred in 7.0% of men on testosterone and 7.3% on placebo. Testosterone was noninferior to placebo. The trial did find more atrial fibrillation, acute kidney injury, and pulmonary embolism in the testosterone group, and the investigators were clear that the results should not justify prescribing testosterone broadly to aging men.
Prescribed replacement at physiologic doses with monitoring is a different question from steroid cycles. Neither is risk-free, and the difference matters.
Madison Avenue Concierge Medicine relies on a wide range of diagnostic technologies to assess cardiovascular health.
These tools allow Dr. Meyer to make accurate diagnoses and inform evidence-based treatment plans.
What Do I Suggest?
If you are using, tell your physician. You will not be lectured in my office. What you will get is a baseline: an echocardiogram, blood pressure, a lipid panel, and a hematocrit. If your heart function is already reduced, that is worth knowing at 40 rather than at 60.
If you are considering starting, the honest summary is that these drugs damage the heart muscle and the arteries, cutting the dose does not appear to protect you, and reversal depends on stopping completely and staying stopped.
If you have stopped, get imaged anyway. Recovery is substantial but was not always complete here.
Long-term anabolic steroid use is associated with a thicker, weaker, stiffer heart and more coronary plaque, and roughly one in six long-term users here had severely reduced heart function. Lowering the dose did not help. Stopping did, with left ventricular mass returning to normal, pump function partly recovering, and men abstinent for a decade looking much like men who never used. This was a small observational study with self-reported use, so it describes a pattern rather than proving cause and effect. The pattern is consistent enough to act on.
Sources
Abdullah R, Almaas VM, et al. Cardiovascular Effects of Continued vs. Discontinued Anabolic-Androgenic Steroid Use: A Longitudinal Follow-Up Study. European Heart Journal Cardiovascular Imaging. 2026. https://doi.org/10.1093/ehjci/jeag238
Anabolic Steroids Linked to Serious Heart Damage in Weightlifters; Stopping Them May Aid Recovery. European Society of Cardiology press release. October 2026. https://www.escardio.org/news/press/press-releases/anabolic-steroids-linked-to-serious-heart-damage-in-weightlifters-stopping-them-may-aid-recovery/
Quitting Anabolic-Androgenic Steroids Can Reverse Some Adverse Cardiac Effects. TCTMD. October 2026. https://www.tctmd.com/news/quitting-anabolic-androgenic-steroids-can-reverse-some-adverse-cardiac-effects
Walter M. Weightlifters Do Significant Heart Damage When Taking Anabolic Steroids, but There Is Hope. Cardiovascular Business. October 2026. https://cardiovascularbusiness.com/topics/clinical/heart-health/weightlifters-do-significant-heart-damage-when-taking-anabolic-steroids-there-hope
Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use. Circulation. 2017;135:1991-2002. https://www.ahajournals.org/doi/abs/10.1161/circulationaha.116.026945
Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use (journal scan). American College of Cardiology. https://www.acc.org/latest-in-cardiology/journal-scans/2017/05/24/10/59/cardiovascular-toxicity-of-illicit-anabolic-androgenic-steroid
Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE). New England Journal of Medicine. 2023. https://pubmed.ncbi.nlm.nih.gov/37326322/
TRAVERSE Study Supports Cardiovascular Safety of Testosterone Therapy When Used as Indicated. Cleveland Clinic Consult QD. https://consultqd.clevelandclinic.org/traverse-study-supports-cardiovascular-safety-of-testosterone-therapy-when-used-as-indicated
Long-Term Anabolic Steroid Use Linked to Lasting Heart Damage. News-Medical. October 2026. https://www.news-medical.net/news/20261012/Long-term-anabolic-steroid-use-linked-to-lasting-heart-damage.aspx
Cardiac Structure and Function in Anabolic-Androgenic Steroid Users: A 16-Year Follow-Up Study. PubMed. https://pubmed.ncbi.nlm.nih.gov/40759534/
