CHOLESTEROL &
ANABOLIC STEROID USE

Cholesterol is a waxy substance that the body needs. It is used in cell membranes and is involved in the production of steroid hormones, bile acids and vitamin D. The body produces cholesterol itself, while additional cholesterol can come from dietary sources.

Cholesterol does not simply travel through the bloodstream on its own. It is transported within particles called lipoproteins. This is why a cholesterol result is better understood by looking at the different components of a lipid profile rather than focusing only on a single total-cholesterol number.

In practical terms, the commonly discussed measurements include HDL cholesterol, LDL cholesterol and triglycerides. These markers provide different information and can change independently.

When people talk about cholesterol being “good” or “bad”, they are usually referring to different lipoproteins rather than cholesterol itself.

Research into anabolic-androgenic steroids has repeatedly identified changes in lipid metabolism. One of the most consistent findings is a reduction in HDL cholesterol, while some studies also report increases in LDL cholesterol.

The effect is not necessarily identical for every person or every anabolic-androgenic steroid. Differences in compound, dose, duration, route of administration, genetics, diet, training, body composition and other health factors can all influence the resulting lipid profile.

Older research has documented substantial changes in HDL and LDL during anabolic steroid exposure, while more recent reviews continue to identify dyslipidaemia as an important cardiovascular concern associated with supraphysiological AAS use.

HDL is often referred to as “good cholesterol”, but that simplified description can hide the underlying biology. HDL particles are involved in the movement of cholesterol away from peripheral tissues and back toward the liver for processing.

Research involving anabolic-androgenic steroid users has found substantial reductions in HDL cholesterol. Studies have also investigated changes in HDL functionality, including cholesterol efflux capacity.

This is relevant because cardiovascular risk is not determined by one blood result in isolation. Blood pressure, smoking, family history, glucose metabolism, body composition, physical activity, kidney health and other factors can also influence overall cardiovascular risk.

LDL cholesterol is one of the most important lipid markers used when assessing atherosclerotic cardiovascular disease risk. Persistently elevated LDL-C can contribute to cholesterol accumulation within arterial walls.

Anabolic-androgenic steroid research has identified increases in LDL cholesterol in a number of populations. A 2025 systematic review and meta-analysis also reported a statistically significant increase in LDL-C among AAS users, although individual responses can vary.

This is one reason why cholesterol monitoring can be particularly relevant for people exposed to supraphysiological androgen levels. The objective is not to focus on one isolated laboratory result, but to understand the direction and magnitude of changes over time.

A lipid panel can contain several measurements. The exact tests ordered depend on the clinician and the individual's circumstances, but common lipid measurements include total cholesterol, HDL-C, LDL-C and triglycerides.

Cholesterol is only one part of cardiovascular health. For enhanced athletes and people using anabolic-androgenic steroids, a broader health-monitoring approach can provide more useful information than focusing on body weight, gym performance or one laboratory value.

Blood pressure, lipid markers, glucose-related measurements, liver markers, kidney-related measurements and other clinically appropriate tests may all be considered by a healthcare professional depending on the person's circumstances.

Baseline measurements can also be useful because they provide a reference point. Follow-up testing can then show whether specific markers have changed over time.

Although anabolic-androgenic steroids can materially influence lipid metabolism, cholesterol results are affected by multiple factors.

The cardiovascular effects associated with anabolic-androgenic steroid exposure extend beyond cholesterol alone. Research has investigated changes involving blood pressure, vascular function, cardiac structure, coagulation and other cardiovascular pathways.

This means a lipid panel should not be viewed as a complete assessment of cardiovascular health. It is one useful component within a wider picture.

For this reason, education around anabolic steroid use should include both supplementation and monitoring. No supplement can replace appropriate medical assessment, blood testing or treatment when a clinically significant abnormality is present.