The link between steroids and blood pressure is one of the better-documented cardiovascular effects of anabolic-androgenic steroid (AAS) use. Prospective research has found that blood pressure tends to rise during AAS use, and cross-sectional studies have found higher rates of elevated blood pressure among users than among non-users.
These changes matter because high blood pressure usually causes no symptoms, yet over time it is a major risk factor for heart disease, stroke, and kidney damage. Understanding how AAS can affect blood pressure, and why the change often goes unnoticed, helps explain why blood pressure is an important part of evaluating health after AAS exposure.
This article focuses on anabolic-androgenic steroids. Corticosteroids, such as prednisone, can also raise blood pressure, but they are a different class of medication with different mechanisms and uses.
Do anabolic steroids raise blood pressure?
Evidence indicates that they can. The most informative data come from the HAARLEM study, a prospective study that followed 100 men who were performing an AAS cycle and measured their health before, during, and after use.
During AAS use, average systolic blood pressure increased by about 7 mmHg and diastolic blood pressure by about 3 mmHg compared with baseline (Smit et al., 2022). The researchers described these changes as small but clinically relevant.
Cross-sectional studies point in the same direction. One study found higher average 24-hour systolic blood pressure among AAS users than among non-users, along with a substantially higher prevalence of elevated systolic blood pressure (Rasmussen et al., 2018).
Why averages can hide individual differences
An average increase of a few mmHg does not mean that every user experiences a small change. Some people show little or no change, while others experience larger increases.
The size of the effect may depend on the compounds used, the doses, the duration of use, baseline blood pressure, body weight changes, and the use of other substances. For this reason, the average result from a study does not predict what will happen in any individual.
How do steroids raise blood pressure?
The exact mechanisms are not fully understood, and several processes probably contribute.
Fluid and sodium retention
Androgens can increase the retention of sodium and water by the kidneys. A larger volume of fluid in the circulation can raise blood pressure. Fluid retention was the most commonly reported negative effect among participants in the HAARLEM study (Smit et al., 2021a).
Changes in blood vessels
AAS use has been associated with increased arterial stiffness. Stiffer arteries are less able to absorb the pressure of each heartbeat, which can raise systolic blood pressure in particular (Rasmussen et al., 2018).
Increases in red blood cells
Androgens stimulate red blood cell production, and AAS use is commonly associated with a higher hematocrit, the proportion of the blood made up of red blood cells (Smit et al., 2022). Thicker blood is harder to pump, which may contribute to cardiovascular strain, although its direct role in raising blood pressure is less clear.
Other contributing factors
People who use AAS may also use other substances that can affect blood pressure, such as stimulants, and may experience rapid changes in body weight. These factors can make it difficult to attribute changes in blood pressure to AAS alone.
Does blood pressure return to normal after stopping steroids?
In the HAARLEM study, blood pressure returned toward baseline after AAS use ended, and the researchers described the changes as rapidly reversible after cessation (Smit et al., 2022).
However, that study followed participants through a single cycle. The effects of long-term or repeated AAS use are less clear. Cross-sectional research that included both current and former users has found evidence of vascular changes, such as arterial stiffness, that may not fully resolve in every individual (Rasmussen et al., 2018).
Reversibility after one cycle therefore should not be assumed to apply to every pattern of use.
Why blood pressure changes often go unnoticed
High blood pressure is often called a “silent” condition because it usually produces no symptoms until it has already caused damage. Feeling well, training hard, and looking fit do not indicate that blood pressure is normal.
This is the main reason measurement matters. The only reliable way to know whether blood pressure has changed is to measure it.
Measurement in muscular individuals
Accurate measurement requires a blood pressure cuff that fits the upper arm properly. A cuff that is too small for a large, muscular arm can produce falsely high readings. Readings are also affected by recent exercise, caffeine, stress, and body position.
For these reasons, a single high or normal reading taken under poor conditions may be misleading. Healthcare professionals typically base assessments on repeated measurements taken under standardized conditions.
Why blood pressure matters for heart health
Sustained high blood pressure forces the heart to work harder. Over time, this can contribute to thickening of the heart muscle, damage to blood vessels, and an increased risk of heart attack, stroke, and kidney disease.
In AAS users, blood pressure is rarely the only cardiovascular change. AAS use has also been associated with unfavorable lipid changes, which are covered in our article on how steroids affect cholesterol levels, and with changes in heart structure. In a subset of HAARLEM participants, echocardiography showed that AAS use was associated with thickening of the left ventricle and reduced cardiac function, which were largely reversible after use stopped (Smit et al., 2021b).
The combination of several risk factors can be more significant than any single change on its own.
Does medical testosterone also affect blood pressure?
Testosterone used for medical purposes can also raise blood pressure. In February 2025, the US Food and Drug Administration (FDA) required all testosterone products to carry a warning about increased blood pressure, after required monitoring studies confirmed blood pressure increases across the drug class (FDA, 2025).
Those studies involved testosterone replacement at doses intended to restore normal hormone levels. Non-medical AAS use often involves much higher doses and multiple compounds, so its effects cannot be inferred from medical studies. Our guide to the key facts about steroids explains the difference between medical and non-medical use in more detail.
When should blood pressure be evaluated?
Anyone who is using or has used AAS can benefit from having their blood pressure checked by a healthcare professional, particularly if readings have been elevated or if there are other cardiovascular risk factors such as a family history of heart disease.
A healthcare professional can confirm whether blood pressure is elevated, consider other causes, and assess related cardiovascular risk factors. Elevated blood pressure should not be self-treated or dismissed as a temporary effect of training.
Very high readings accompanied by symptoms such as chest pain, severe headache, shortness of breath, vision changes, weakness, or confusion require urgent medical attention.
The bottom line
The evidence on steroids and blood pressure indicates that AAS use can raise blood pressure. In a prospective study, average increases during a cycle were modest but clinically relevant, and some individuals may experience larger changes. In that study, blood pressure returned toward baseline after use stopped, although the effects of long-term or repeated use are less certain.
Because high blood pressure usually causes no symptoms, it can go unnoticed in people who otherwise feel healthy and fit. Accurate measurement and professional evaluation are the only reliable ways to know whether blood pressure has changed.
References
Rasmussen JJ, Schou M, Madsen PL, et al. Increased blood pressure and aortic stiffness among abusers of anabolic androgenic steroids: potential effect of suppressed natriuretic peptides in plasma? Journal of Hypertension. 2018;36(2):277–285.
Smit DL, Buijs MM, de Hon O, den Heijer M, de Ronde W. Positive and negative side effects of androgen abuse. The HAARLEM study: a one-year prospective cohort study in 100 men. Scandinavian Journal of Medicine & Science in Sports. 2021;31(2):427–438. [2021a]
Smit DL, Voogel AJ, den Heijer M, de Ronde W. Anabolic androgenic steroids induce reversible left ventricular hypertrophy and cardiac dysfunction. Echocardiography results of the HAARLEM study. Frontiers in Reproductive Health. 2021;3:732318. [2021b]
Smit DL, et al. Prospective study on blood pressure, lipid metabolism and erythrocytosis during and after androgen abuse. Andrologia. 2022;54(4):e14372. doi:10.1111/and.14372.
US Food and Drug Administration. FDA issues class-wide labeling changes for testosterone products. February 28, 2025.
