Anabolic steroids entered American gyms as a Cold War experiment and never left. Nearly 70 years later, cardiologists are still counting the damage.
Recent studies tie long-term use to scarred arteries, weakened hearts, and early death, even in men in their thirties.
The drugs work. That is the uncomfortable center of the problem.
Synthetic testosterone builds muscle faster than training alone ever could, and millions of people have decided that trade is worth making.
Where the drugs came from
Chemists isolated testosterone in 1935. Adolf Butenandt and Leopold Ruzicka shared the 1939 Nobel Prize in Chemistry for that work, along with related research on sex hormones.
Clinical trials with synthetic testosterone began within two years. Doctors prescribed it for hormone deficiency, wasting illness, and burn recovery. Nobody designed it as a sports drug.
Athletes found it anyway. Some West Coast weightlifters were injecting testosterone by the late 1940s, well before any organized program existed.
A Cold War arms race
The 1954 World Weightlifting Championships in Vienna were a pivotal event. John Ziegler, the U.S. team physician, learned from a Soviet counterpart that Soviet lifters were taking testosterone.
Ziegler went home and worked with Ciba Pharmaceuticals. In 1958, the company brought methandrostenolone to market as Dianabol. Ziegler began supplying it to lifters at the York Barbell Club in Pennsylvania.
Historians dispute how much of the chemistry Ziegler actually did. Several accounts credit Ciba’s Swiss chemists with the compound itself.
What nobody disputes is his role in spreading it through American weightlifting.
He came to regret it. Ziegler watched his test subjects escalate their doses and develop swollen prostates and shrunken testicles. He ultimately condemned the drugs before his death in 1983.
The 1980s boom
By the early 1960s, drug companies had roughly a dozen competing steroids on the market. The International Olympic Committee banned them in 1976. Use kept climbing.
Then came the fitness decade. Commercial gyms spread across American suburbs, bodybuilding went mainstream, and steroids moved from elite locker rooms into ordinary weight rooms.
The scale finally became visible in December 1988. William Buckley of Pennsylvania State University surveyed 3,403 male high school seniors across 46 schools.
He found that 6.6 percent used or had used anabolic steroids, which suggested roughly 500,000 American boys.
More than two-thirds of those users started at age 16 or younger. About 21 percent named a health professional as their main source. A third had no plans to play school sports at all.
“It’s much broader than we thought,” said Buckley, then an assistant professor of health education.
Three months earlier, sprinter Ben Johnson had lost his Olympic 100-meter gold medal in Seoul after testing positive for stanozolol. The two events together turned steroids into a national story.
Congress steps in
Lawmakers responded quickly. President George H. W. Bush signed the Anabolic Steroids Control Act in November 1990, placing the drugs in Schedule III of the Controlled Substances Act.
Two later laws widened the net. The 2004 act pulled prohormones under federal control.
The Designer Anabolic Steroid Control Act of 2014 added about two dozen more compounds and set penalties up to $500,000 for false labeling.
Enforcement never closed the market. Underground labs and online sellers simply replaced the pharmacies, and the drugs remained easy to find for anyone who looked.
What the heart shows
Cardiologists spent decades working from case reports. Then, a team led by Aaron Baggish at Massachusetts General Hospital ran a controlled comparison and published it in 2017.
The researchers scanned 140 experienced male weightlifters between 34 and 54 years old. Of those, 86 reported at least two years of lifetime steroid use and 54 reported none.
The gap was large. Users averaged a left ventricular ejection fraction of 52 percent against 63 percent in nonusers, meaning their hearts pumped noticeably less blood with each beat.
Users also carried more coronary artery plaque, and the burden rose with cumulative years of use.
“The magnitude of dysfunction was higher than expected, and thus a surprise,” Baggish told reporters when the study appeared in the journal Circulation.
Danish researchers later tracked outcomes rather than scans. They followed 1,189 men sanctioned for steroid use in fitness centers between 2006 and 2018, matched against 59,450 men from the general population.
Over an average of 11 years, the users had triple the rate of heart attack.
Their rate of cardiomyopathy ran nearly nine times higher. Heart failure, blood clots, and arrhythmias all climbed as well.
Those numbers put steroid use alongside the classic risk factors doctors already screen for.
The signals were “not only the associations but quite strong associations,” said Josefine Windfeld-Mathiasen, who led the 2025 analysis. The men averaged just 27 years of age at entry.
Damage beyond the heart
A 2025 study extended the picture to women. Researchers at Odense University Hospital scanned 164 recreational athletes recruited from Danish fitness centers, roughly a quarter of them female.
Active users showed more soft, rupture-prone plaque in their coronary arteries than nonusers. Longer lifetime exposure predicted worse calcification, and use beyond five years marked the sharpest turn.
Cumulative exposure also tracked with abnormal heart muscle mass in both sexes.
The rest of the body pays too. More than 10 percent of users in one Danish cohort reported acne, breast tissue growth, or erectile dysfunction.
Oral compounds strain the liver, and suppressed natural testosterone can persist for months after a user stops.
A new generation of users
The population has shifted. A meta-analysis of 187 studies put global lifetime use at 3.3 percent, rising to 6.4 percent among men and falling to 1.6 percent among women.
Most of today’s users never compete. They want to look a certain way, and researchers increasingly point to social media as the pressure source. Muscle dysmorphia, a distorted sense of being too small, shows up repeatedly in this group.
Prevention research now argues for education over prohibition, since decades of bans have not shrunk the market.
Meanwhile, the ordinary exercise targets that protect the heart remain available to anyone, at no cost and no risk.
Tools that predict heart risk may eventually help clinicians flag former users before symptoms start.
The full study on cardiovascular status in male and female users was published in the journal JAMA Network Open.
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