Alcohol and Anabolic Steroids

The use of anabolic steroids is often associated with the pursuit of physical performance and aesthetic changes, while alcohol consumption is frequently seen as routine and socially acceptable. However, combining the two raises a warning sign. More recent studies show that, although there are still gaps in understanding the exact mechanisms of this interaction, the concurrent use of alcohol and anabolic steroids may increase the burden on the liver and be part of a broader context of risk behaviors, with consequences that go beyond liver health and include cardiovascular, hormonal, and psychiatric effects.

The non-medical use of anabolic androgenic steroids has grown in various contexts, far beyond professional sports. Today, this use is seen among gym-goers, amateur bodybuilders, and individuals motivated by aesthetic changes or improved physical performance. At the same time, alcohol remains one of the most widely consumed psychoactive substances in the world. When these two exposures overlap, an important public health concern arises: the potential combined effect on the body, especially on the liver¹.

Anabolic steroids alone are already associated with a range of adverse effects. Among the most well-known are hormonal changes, infertility, acne, gynecomastia, increased blood pressure, and mood changes. The liver is also a major concern. Recent reviews show that prolonged use at supraphysiological doses can lead to elevated liver enzymes, cholestasis, hepatic vascular alterations, and even benign or malignant liver tumors in some cases².

Alcohol, in turn, also has toxic effects on the liver and is associated with a broad spectrum of damage, ranging from steatosis to more severe forms of liver disease³. When a potentially hepatotoxic substance such as anabolic steroids is used in an organism already exposed to harmful alcohol consumption, clinical concern becomes even greater.

One of the most well-known studies on the topic analyzed data from the Drug-Induced Liver Injury Network (DILIN) in the United States, focusing on patients with drug-induced liver injury. The authors observed that among individuals with heavy alcohol consumption, anabolic steroids were prominent among the identified causes of drug-induced liver injury. This finding is relevant because it suggests that heavy alcohol use may be more common in groups where anabolic steroids already represent a risk factor for liver damage.

At the same time, the study raised an important point: the authors did not find clear evidence that heavy drinkers necessarily had worse final outcomes—such as liver-related death or the need for transplantation—compared to non-drinkers in that cohort. This does not mean the combination is safe. In practice, the findings suggest that the relationship between alcohol and anabolic steroid–related liver injury is complex and likely involves both biological and behavioral factors.

This point deserves attention. Part of the association between alcohol and anabolic steroids may reflect a broader context of risk behaviors, such as using substances without prescription, high-dose cycles, combining different compounds, and limited medical supervision²⁴. In other words, it is often not just the sum of two potentially harmful agents, but a pattern of use that already increases vulnerability to multiple health problems.

Recent literature also reinforces that the adverse effects of anabolic steroids extend far beyond the liver. A meta-analysis published in 2025 showed that abuse of these substances among athletes and physically active individuals is associated with significant increases in blood pressure and LDL cholesterol, highlighting their cardiovascular impact⁴. This broadens the discussion: individuals who use anabolic steroids and consume excessive alcohol may be exposing themselves to a combination of hepatic, metabolic, and cardiovascular risks simultaneously.

Another recent review highlighted that androgen abuse is associated with increased mortality and multisystem adverse effects, including cardiovascular toxicity, infertility, hypogonadism, hepatotoxicity, and mental health disorders³. This helps dispel the idea that anabolic steroids produce only “aesthetic” or “hormonal” effects. In reality, these substances can have wide-ranging impacts on the body, especially when used outside a medical context.

It is also important to distinguish between supervised therapeutic use and non-prescribed use. Recent studies show that individuals who use anabolic steroids without medical indication experience more adverse events than those undergoing clinically supervised testosterone therapy. This reinforces that risk is particularly concentrated in recreational, aesthetic, or performance-oriented use—often done without clinical monitoring, regular testing, or appropriate dosing, and sometimes involving unsafe combinations.

From a mental health and behavioral perspective, this combination also warrants caution. Recent reviews describe associations between anabolic steroid abuse and mood changes, aggression, impulsivity, and other psychiatric effects. Since alcohol is also linked to reduced self-control and increased exposure to accidents, violence, and risky decisions, the combination of these substances should not be viewed solely as a liver issue, but as a broader health concern.

From a prevention standpoint, the main message is clear: although more studies are needed to precisely define the biological interaction between alcohol and anabolic steroids, the existing body of evidence is sufficient to treat this combination with seriousness. It is not a trivial combination, especially when it involves heavy alcohol consumption, prolonged steroid use, oral compounds, and lack of medical supervision.

In summary, current evidence indicates that:

• Non-medical use of anabolic steroids is associated with risk of liver injury and other significant systemic adverse effects;
• Heavy alcohol consumption remains an important factor in liver damage;
• The combination of alcohol and anabolic steroids deserves special attention, both because of potential biological overload and the broader context of risk behaviors in which it often occurs.

Informing the public about these risks is essential to counter the normalization of anabolic steroid use and excessive alcohol consumption. In public health, waiting for absolute certainty about every mechanism before issuing warnings is often a mistake. When signals of harm are already consistent, prevention remains the best course of action.

References:

• 1. Dakhoul, L., Ghabril, M., Gu, J., Navarro, V., Chalasani, N., & Serrano, J. (2018) Heavy Consumption of Alcohol is Not Associated With Worse Outcomes in Patients With Idiosyncratic Drug-induced Liver Injury Compared to Non-Drinkers.
  2. Petrovic A, Vukadin S, Sikora R, Bojanic K, Smolic R, Plavec D, et al. Anabolic androgenic steroid-induced liver injury: An update. World J Gastroenterol. 2022;28(26):3071-3080.
  3. Grant B, Hyams E, Jenkins N, Jayasena CN. Androgen abuse: Risks and adverse effects in men. Ann N Y Acad Sci. 2024;1538(1):56-70.
  4. Liu M, Yu Y. Adverse effects of anabolic androgenic steroid abuse in athletes and physically active individuals: A systematic review and meta-analysis. Subst Use Misuse. 2025;60(6):873-887.
• Journal Impact Factor: 7,683
• D.O.I.: https://doi.org/10.1016/j.cgh.2017.12.036