To reiterate, our current understanding of the adverse cardiovascular effects of anabolic steroids is based on rather limited information gathered from a small number of research studies. The available reports, though, certainly give a glimpse of unwanted cardiovascular effects that may occur, even if the causal mechanisms are not yet understood. Going forward, we are unlikely to have large-scale prospective studies to gather more information and additional retrospective studies are likely to have the methodologic pitfalls I mentioned above. Given our current understanding, athletes who choose to use anabolic steroids should be aware of the possibilities of high blood pressure, unfavorable lipid profile, structural changes in the heart, and even heart attack or SCD.
Many abusers who inject anabolic steroids may use nonsterile injection techniques or share contaminated needles with other abusers. In addition, some steroid preparations are manufactured illegally under nonsterile conditions. These factors put abusers at risk for acquiring lifethreatening viral infections, such as HIV and hepatitis B and C. Abusers also can develop endocarditis, a bacterial infection that causes a potentially fatal inflammation of the inner lining of the heart. Bacterial infections also can cause pain and abscess formation at injection sites.