What Are Anabolic Steroids and Dietary Supplements Used for Bodybuilding, and Are They Harmful?
In this article
Substances used in bodybuilding fall into two separate categories that are often confused. Anabolic steroids are drugs — synthetic testosterone derivatives acting as hormones; nonprescription use is both illegal and doping in sport. Protein powder and creatine are nutritional supplements — they contain no hormones. This article clarifies the difference, but more importantly distinguishes, on both sides, source-verified risks from exaggerated risks.
There is a specific reason we publish this on an oncology website. The least-discussed consequence of anabolic steroids is liver tumors: following certain oral steroids used for 5–15 years, liver adenoma and hepatocellular carcinoma have been reported. Supplements also offer a stark cancer lesson: high-dose vitamins have been shown not to prevent cancer, but to increase it in large randomized studies. We discuss both below with figures.
What is an anabolic steroid?
Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone. "Anabolic" means building: they increase protein synthesis and stimulate muscle growth; "androgenic" describes development of male characteristics. Under medical supervision, they treat particular conditions such as hypogonadism, severe muscle wasting and delayed puberty. For proper medical management of deficiency, see our low-testosterone article — its treatment and the use discussed here are not the same: medical treatment replacesphysiological levels, while sports use raises them many times above normal .
A figure in the source text needs correction. Dependence symptoms in steroid users are often quoted as "25%." The literature-supported value is approximately 30% (Pope et al. 2014). This figure's nature matters: rather than a single prospective study, it is a best estimate from combining existing epidemiological research. Saying "one in three users develops dependence" is therefore incorrect; the correct point is that dependence is not a rare exception.
Mechanism: why does the body stop its own production?
This is the most predictable and misunderstood consequence. External testosterone is detected by the body, which shuts down its own production. This is not a side effect but normal system function.
Figure 1 · Why do external steroids stop the body's own production?
This is normal feedback-system function, not a side effect. The red bar shows suppression.
Cycles, stacking, PCT: what do they do, and what do they not solve?
Understanding the terms is necessary to evaluate claims. A cyclemeans using steroids for a defined period and then taking a break. Stackingmeans using multiple substances together. PCT (post-cycle therapy) is the medicated period after stopping, intended to restart the axis suppressed in Figure 1.
We do not publish a sample cycle schedule here — for a reason. Even labeled "for information only," a week-by-week drug and dose table functions as an actionable recipe . A health website's role is not to explain how to use nonprescription steroids, but what they do . The following sections discuss what happens in the body during the schedule, rather than the schedule itself.
| Practice | Claimed purpose | What actually happens? |
|---|---|---|
| Cycling (use–break) | Reduce side effects through "breaks" | Suppression does not end immediately during breaks; the axis may remain suppressed for months. Breaks do not reverse damage — they divide exposure. |
| Stacking (combination) | Complement effects and reduce side effects by dividing doses | Total exposure increases. Especially when oral agents are added, liver burden accumulates. |
| PCT (post-cycle therapy) | Restore natural production | It aims to speed up the axis, but recovery time varies greatly between individuals, and some consequences, such as arterial plaque, are outside PCT's scope entirely. |
The fundamental reasoning error is this: cycling, stacking and PCT attempt to manage steroids' hormonal effects. Yet some lasting harms are not hormonal — plaque accumulating in coronary arteries and a liver tumor developing over yearsremain even if the hormonal axis recovers. The concept of a "correct cycle" accounts for the wrong organ.
The liver: the oncology-related part of this article
Steroids' liver effects depend on which steroid is taken by which route , a distinction often overlooked.
Chemical structure is decisive. To prevent oral steroids from breaking down after passing through the stomach, a methyl group at the 17-alpha position is added. This makes them orally effective but also toxic to the liver. This class includes methandrostenolone (Dianabol), oxymetholone (Anadrol), stanozolol (Winstrol), oxandrolone (Anavar), methyltestosterone, danazol and fluoxymesterone . In contrast, esterified testosterone (injection) and transdermal testosterone have no reported cholestasis.
The source statement "Anavar is considered relatively mild" needs correction. Oxandrolone is also a 17-alpha-alkylated steroid on the list of agents reported to cause liver injury. Fewer cases may have been reported than for oxymetholone or stanozolol, but that does not make it safe for the liver . The correct statement is: oxandrolone belongs to the same structural class; fewer reported cases do not mean safety.
Figure 2 · Liver conditions associated with oral 17-alpha-alkylated steroids
The vertical line on the left shows time . The four conditions below are notsuccessive stages; they are distinct clinical conditions appearing after different delays.
Blood tests may mislead. In steroid-related cholestasis, liver enzyme increases are moderate — ALT and ALP often remain within 2–3 times the upper limit. Thus, "my tests are near normal" does not mean the liver is unaffected. Intense weight training itself can also raise muscle-derived enzymes, confusing the picture. We discuss interpretation in our liver enzymes article .
Heart and blood vessels: reversible and irreversible
For years, cardiac effects were described as "possible." A 2017 study made them measurable. Men with an average of at least two years' use, 86 men , were compared with nonusers, 54 men :
| Measurement | Steroid users | Nonusers |
|---|---|---|
| Left ventricular ejection fraction (heart pumping strength) | 52% ± 11 | 63% ± 8 |
| Coronary plaque volume (median) | 3 mL³ | 0 mL³ |
The most important finding was that these rows behaved differently. Comparing current and former users, pumping strength was 49% versus 58% — cardiac muscle impairment partly improves after stopping. In contrast, coronary plaque volume increased with cumulative duration and did not recede after stopping. Every additional 10 years corresponded to a marked increase in plaque burden.
This yields the article's most important statement: some steroid effects reverse, while others do not. The hormonal axis and heart muscle may substantially recover. Arterial plaque and a liver tumor developing over years belong to the permanent account . "I will stop and recover" is true only for the first group.
How long does recovery take after stopping?
This is the question most men using or considering steroids ask. The answer has two parts: most people recover, but timing varies greatly and not everything recovers.
Figure 3 · Recovery after stopping
Bars show the cumulative percentage of men whose sperm concentration returned to normal. Rates come from published reviews, and bar lengths are proportional.
Withdrawal is not only hormonal. Among steroid users, approximately 30% have reported dependence symptoms . During withdrawal, depression and anxiety risk rises, the strongest factor driving reuse. During use, aggression and anger-control problems ("roid rage") have been reported. Contrary to belief, sexual problems also occur during use, not only withdrawal: a meta-analysis reported steroid users with erectile problems in up to 19% .
SARMs: unapproved drugs sold as "supplements"
Absent from the source text, this group is among the most widely sold online in Türkiye. SARM (selective androgen receptor modulator) substances — ostarine (MK-2866), ligandrol (LGD-4033), RAD-140, andarine (S-4) and similar agents — are marketed as "not steroids, a side-effect-free alternative." Both claims are wrong.
First: SARMs are not dietary supplements. None is approved for human use; they are investigational drugs. Legally, they cannot be in supplements. In sport they are always prohibited by WADA — in and out of competition, under "other anabolic agents."
Second: they are not side-effect-free. SARM-associated cholestatic liver injury has been described in more than twenty published case reports; it typically begins within 2–3 months and can be severe. The United States Food and Drug Administration warns of heart attack, stroke and serious liver injury with SARM products. Testosterone suppression, kidney and prostate effects, and tendon rupture cases have also been reported.
The central problem is labeling: "supplement" on a product does not mean it contains no unapproved drug. We return to this next.
Sports supplements: what has evidence?
Dietary supplements are concentrated oral nutritional products. They contain no hormones and are not anabolic steroids. But "nutrient" does not automatically mean "safe at every dose" — sourceable figures matter here too.
Protein: which figure is correct?
The source range "1,6–2,2 g/kg/day" is correct but attributed incorrectly. The International Society of Sports Nutrition (ISSN) position paper gives 1,4–2,0 g/kg/day: "daily 1,4–2,0 g/kg protein is sufficient for most exercising individuals to build and maintain muscle." "1,6–2,2" comes from another source: combining 49 studies and 1.863 participants, a 2018 meta-analysis found that total protein intake above 1,62 g/kg/daydid not increase resistance-training lean-mass gains (95% confidence interval 1,03–2,20). Thus 1,6–2,2 is not a "target range," but a saturation point and its uncertainty margin.
Another finding is more instructive: supplementation added average lean mass of 0,30 kgand maximum strength of 2,49 kg . Statistically significant, clinically modest. The United States National Institutes of Health states: "If you are an athlete, you can probably eat enough protein-containing food to meet your needs."
Protein powder needs a correct definition: it is a effect rather than an delivery format. If food does not meet your daily target, it is convenient; if it does, adding more offers no measurable benefit. For dietary sources, see our high-protein foods article .
Creatine: the most maligned supplement
| Common claim | Evidence-based position |
|---|---|
| "It damages kidneys" | ISSN position: users and controls show no clinically significant difference in kidney-function markers. Recommended doses have not demonstrated kidney injury in healthy people. |
| "It cannot be used long-term" | ISSN: up to 30 g daily for up to 5 years has been safe and well tolerated in healthy individuals. |
| "It causes hair loss" | One rugby study found DHT after loading increased by 56%. However, ISSN's 2021 review: overall evidence does not show creatine increases testosterone, free testosterone or DHT, or causes hair loss. |
| "It causes cramps and dehydration" | ISSN: experimental and clinical research does not confirm this. |
Dose: ISSN loading is 5–7 days, four daily doses of 5 g (approximately 0,3 g/kg); maintenance is daily 3–5 g(large athletes may use 5–10 g).
BCAA and branched-chain amino acids
The picture is less favorable. The National Institutes of Health is clear: "Studies have not consistently shown that BCAA supplements or individual components improve exercise or athletic performance, build muscle or help exercise recovery." The same source explains that eating complete-protein animal foods already automatically increases BCAA intake.
What labels do not say
The structural problem is: "dietary supplement" is a legal category, not a safety certificate. In the United States, where many brands originate, FDA states "FDA does not have authority to approve dietary supplements before marketing" and "FDA can regulate only after marketing." Manufacturers bear safety responsibility. FDA also warns that some exercise and performance products may contain unlisted stimulants, steroids, hormone-like substances, controlled substances or unapproved drugs . Note: this regulation is American; Türkiye has separate supplement legislation.
Heavy metals in protein powders: what do figures say?
This issue has been both exaggerated and dismissed. Two figures must be considered together.
| Products tested | 23 protein powders and ready-made drinks (independent consumer organization review) |
|---|---|
| Finding | Approximately 70%of products exceeded the organization's own daily 0,5 microgram lead threshold by over 120%. The highest measurement per serving was 7,7 micrograms. Plant-based products contained lead, compared with milk-based (whey) products, averaging nine times higher. |
| Comparison benchmark | FDA daily lead reference levels: children, 2,2; women of childbearing age, 8,8; other adults, 12,5 micrograms/day. |
No conclusion is possible without both rows — this assessment is our interpretation. The 0,5-microgram threshold is, compared with FDA's 12,5-microgram adult threshold, twenty-five times stricter. A pharmacologist reviewing the same 23 products notes four exceeded FDA's child threshold of 2,2 micrograms, but all remained well below FDA maximum daily exposure levels. An honest summary is: this is not an urgent health threat, but plant-based products show a systematic difference and no "safe level" of lead is defined. For multiple daily scoops over years, particularly pregnancy or children, brand selection matters.
Supplements and cancer: the hardest lesson
An oncology discussion cannot omit this history. Three large randomized studies disproved "vitamins are harmless; excess is excreted."
| Study | Who took what? | Result |
|---|---|---|
| SELECT | Over age 50, 35.533 healthy men; daily 400 IU vitamin E ± 200 mcg selenium | No prostate cancer prevention. After an additional 1,5 years, vitamin E users' risk was 17% higher — statistically significant. |
| ATBC | Ages 50–69, 29.133 male smokers; daily 20 mg beta-carotene + 50 mg alpha-tocopherol | Beta-carotene increased lung cancer risk by 18%; overall mortality was 8% higher. |
| CARET | 18.314 current/former smokers and asbestos-exposed people; 30 mg beta-carotene + retinyl palmitate | Lung cancer risk, 28%; lung cancer deaths, 46%; all-cause death, 17% increases. The trial was stopped early. |
The shared lesson is: a substance's presence in food does not mean high-dose supplements help. All three expected prevention and found the opposite. Selenium evidence is discussed in our separate article, and the same question for vitamin D in our vitamin D and cancer article . Our lung cancer and prostate cancer articles provide the clinical background.
A separate important warning for patients receiving treatment. During chemotherapy and radiotherapy, oncologists generally recommend not using antioxidant supplements . The reason comes directly from mechanism: these treatments cause oxidative injury in cancer cells; antioxidants may reduce it and lower treatment effectiveness. The National Cancer Institute states: "Until more is known about antioxidant supplements' effects in cancer patients, they should be used cautiously." Some studies report worse outcomes in patients taking supplements during treatment. Nobody receiving treatment should continue supplements without telling their oncologist.
Creatine and cancer — unverified. Evidence that creatine increases or decreases risk could not be found; neither the National Cancer Institute nor Office of Dietary Supplements identifies it as a risk factor. An ongoing trial in metastatic prostate cancer, involving 200 men receiving androgen suppression, investigates whether creatine and resistance training preserve muscle mass — but this is ongoing research, not a result. Today's accurate statement is: there is no evidence in either direction about creatine's cancer relationship.
The difference between steroids and supplements
| Criterion | Anabolic steroid | Protein powder / creatine |
|---|---|---|
| What it is | Drug — synthetic testosterone derivative | Concentrated nutrient |
| Mechanism | Acts hormonally; shuts down natural production | No hormonal effect; complements diet |
| Hormonal axis | Suppressed (Figure 1) | Unaffected |
| Liver | Cholestasis, adenoma and carcinoma reported with oral alkylated agents | No injury reported at recommended doses |
| Cardiovascular | Coronary plaque accumulation; increases with duration and does not reverse | No known effect |
| Legal status | Prescription drug; doping in sport | Legal supplement (provided no banned substances) |
| Main risk | Systemic, partly permanent organ damage | Quality/purity problems; unlisted substances |
But this is not a "good–bad" table. The risks differ in kind: steroid risks arise from the substance itself, while supplement risks mainly arise from product quality and unnecessary high doses . The former do not disappear with correct use; the latter largely do. The question is not "which is harmful," but "on which side can I manage risk?".
Does testosterone therapy cause prostate cancer?
This is where medical therapy and bodybuilding steroids are most often confused; it needs separate discussion.
Completed in 2023, TRAVERSE followed men with low testosterone and high cardiovascular risk, 5.204 men , for approximately three years. Prostate cancer numbers were, with testosterone, 12 cases, versus placebo, 11 cases. High-grade prostate cancer also did not differ. Based on cardiovascular results, FDA, on 28 February 2025 , made class-wide label changes and removed the boxed cardiovascular risk warning, adding a blood pressure warning instead.
Do not overstate this in either direction. TRAVERSE, physiological replacement was studied in men with genuinely low testosterone. Bodybuilding doses are many times higher , and TRAVERSE says nothing about this use. Follow-up averaged 33 months , insufficient to exclude small long-term effects in slowly developing prostate cancer. The correct summary is: medically indicated testosterone at appropriate doses showed no prostate cancer signal over three years; this does not guarantee supraphysiological-dose safety.
A healthy approach: what works?
- Training: progressive loading, regular deload weeks and sleep. Muscle grows at rest, not during training.
- Protein: a source-supported target of 1,4–2,0 g/kg/day; saturation around 1,6 g/kg/day . Per meal, 20–40 g is sufficient.
- Timing: the "anabolic window" claim has softened — ISSN says exercise's anabolic effect lasts at least 24 hours . You need not rush to drink protein afterward.
- Creatine: daily 3–5 g monohydrate. It has the strongest evidence and lowest cost.
- Vitamins-minerals: only if deficiency is documented. The three trials above show the cost of "just in case."
- Product selection: third-party-tested products listing each ingredient's dose; "proprietary blend" commonly conceals contents.
- Blood monitoring: annual blood count, liver and kidney function, lipid profile and, if needed, hormones are reasonable for intense training and supplement use.
DROZDOGAN Academy Commentary
Discussion often uses moral language: "cheating" and "natural." The real issue, however, is accounting . Some steroid costs are paid upfront and reversed; others are paid years later, irreversibly . Helping a young person distinguish these is more useful than saying "don't."
⚡ Why it matters
The audience is young and informed by social media. Its model is "cycle, recover with PCT, no problem." This silently assumes all damage is hormonal . Coronary plaque and liver tumors are not; PCT does not address them. That is why we center this distinction.
✅ Strong evidence
Three points are clear. First, axis suppression is inevitable, determined by mechanism rather than dose. Second, oral 17-alpha-alkylated steroids are hepatotoxic; prolonged use has documented adenoma and carcinoma, not speculation. Third, broad, consistent safety data support creatine and protein. These form the firm ground.
⚠️ Exaggerations and omissions
Exaggerations: "creatine damages kidneys" (unsupported), "protein powder is steroid" (it is food), "powders are full of lead" (measurements well below FDA maximum daily exposure). Omissions: SARMs — unapproved hepatotoxic drugs sold as supplements; and permanent vascular damage — outside every protocol. These distinctions are our assessment.
🩺 Practical meaning
Three concrete steps for current or former users: (1) Tell a physician every substance used, especially whether any were oral ; embarrassment must not obstruct deciding about liver imaging. (2) Withdrawal depression and anxiety are expected; regard them as treatable, not weakness. (3) If planning children, sperm recovery takes months; plan accordingly. Adolescent use may also cause early growth-plate closure and cessation of height growth — irreversible.
❓ An open question
Almost all available data are cross-sectional: measurements comparing users and nonusers at one point. Substance, dose and duration are mostly self-reported. Thus for the key question of long-term mortality we cannot give a sourceable number. Illegality creates this gap, which may never close. Our best evidence is imaging and laboratory data demonstrating permanent organ damage.
Conclusion: Anabolic steroids work — that is the problem. Real muscle and strength gains enable narratives hiding the cost. Our sole claim is that some of the cost is irreversible and appears on no cycle schedule. Quality protein powder and creatine are not even in the same account.
Frequently asked questions
- Can anabolic steroid use be made safe?
- No. "Correct cycles," "clean stacks" and "aggressive PCT" only attempt to manage hormonal effects. Coronary plaque and liver tumors developing over years are outside these protocols and do not reverse after stopping.
- Why do testes shrink? Is it reversible?
- External androgen cuts LH and FSH signals from brain to testes; without signals, they shrink (Figure 1). This is normal, not malfunction. It generally reverses after stopping, but timing varies greatly.
- Can I have children after stopping steroids?
- Most men can, but patience is needed. Review data show sperm concentration returned to normal in 67% within 6 months, 90% within 12 months, and all within 24 months . Total count may take longer. Testosterone recovery may remain incomplete years later in some men.
- Are oral steroids more harmful than injections?
- For the liver, yes. To be taken orally, 17-alpha-modified steroids (dianabol, stanozolol, oxymetholone, oxandrolone) are associated with injury. Esterified injectable and transdermal testosterone have no reported cholestasis. This does not make injections safe: hormonal and cardiovascular effects remain.
- Is Anavar (oxandrolone) a mild steroid?
- No. Oxandrolone is also 17-alpha-alkylated and among agents causing liver injury. Fewer case reports do not alter its structural class.
- SARMs are not steroids, so are they safe?
- No. SARMs (ostarine, ligandrol, RAD-140, etc.) are drugs unapproved for human use, not supplements, and always prohibited in sport. More than twenty published cases report cholestatic liver injury ; FDA warns of heart attack, stroke and serious liver injury.
- Does creatine damage kidneys?
- Evidence does not support this. ISSN finds no clinically meaningful renal-marker differences between users and controls; up to 30 g daily for up to 5 years was safe in healthy people. A physician decides for kidney disease.
- Does creatine cause hair loss?
- One small study reported higher DHT after loading. However, overall evidence that creatine increases testosterone, free testosterone or DHT, or causes hair loss, does not demonstrate such effects.
- How much protein should I take?
- The source-supported range is 1,4–2,0 g/kg/day. A meta-analysis of 49 studies found no extra gain above 1,62 g/kg/day. Per meal, 20–40 g is sufficient.
- Can I take supplements during cancer treatment?
- Do not do so without consulting your oncologist. Antioxidant supplements are generally discouraged during chemotherapy and radiotherapy because they may weaken treatment mechanisms. Large trials show high-dose vitamins do not prevent cancer and increase risk in some groups.
Glossary
- Anabolic-androgenic steroid (AAS)
- Synthetic testosterone drugs. "Anabolic" means tissue-building; "androgenic" means developing male characteristics.
- 17-alpha-alkylated steroid
- Structurally modified for oral use. The modification makes it stomach-resistant but hepatotoxic.
- HPT axis
- Hypothalamic–pituitary–testicular axis, the feedback system regulating testosterone.
- LH and FSH
- Pituitary hormones signaling testosterone and sperm production. Steroids suppress them.
- Cycle / stacking / PCT
- Respectively: timed use with breaks; combining substances; medicated axis recovery after stopping.
- Cholestasis
- Impaired bile flow. Steroid-related cases may have only moderate enzyme increases.
- Peliosis hepatis
- Blood-filled liver cavities, partly reversible after stopping.
- Liver adenoma
- Benign tumor associated with long-term androgens; carries bleeding and rupture risk.
- Hepatocellular carcinoma
- The commonest malignant liver tumor, reported with long-term androgens even without cirrhosis.
- Coronary plaque
- Deposits in heart-supplying artery walls, increasing with duration and not reversing after stopping.
- SARM
- Selective androgen receptor modulator. Unapproved drugs sold as supplements; always banned in sport.
- DHT
- Dihydrotestosterone. Testosterone-derived androgen affecting hair follicles and prostate.
- Gynecomastia
- Male breast tissue enlargement, possibly from conversion of some steroids to estrogen.
- Dietary supplement
- A legal category, not approved like drugs before marketing; manufacturers bear safety responsibility.
Transparency note.
Verified: Hepatotoxic steroids are oral 17-alpha-alkylated agents including methandrostenolone, oxymetholone, stanozolol, oxandrolone, methyltestosterone, danazol and fluoxymesterone; no cholestasis reported with unmodified/esterified testosterone (injection/transdermal); cholestasis in methyltestosterone, danazol, stanozolol and oxymetholone users occurs in ~1% with moderate enzymes (ALT/ALP <2–3× upper limit); peliosis partly reverses after stopping; liver adenoma after 5–15 years of use and hepatocellular carcinoma after long-term androgens, even without cirrhosis — all from the National Library of Medicine's LiverTox. Cardiovascular data: 86 users and 54 nonusers, ejection fractions 52%±11 versus 63%±8; median plaque volume 3 mL³ versus 0 mL³; current versus former users' ejection fractions 49% versus 58%; plaque burden proportional to cumulative duration. Recovery: gonadotropins generally recover in 3–6 months; sperm concentration normal in 67% within 6 months, 90% within 12 months, all within 24 months; total count can take longer; recovery extremely variable and sometimes incomplete. Dependence prevalence, approximately 30% (Pope et al. 2014 via a secondary source), a pooled epidemiological estimate; erectile problems in up to 19%. No SARM approved for humans; always WADA-prohibited under "other anabolic agents"; cholestatic injury in more than twenty cases, typical delay 2–3 months; FDA warning of heart attack, stroke and serious liver injury. ISSN protein range, 1,4–2,0 g/kg/day , per-meal 0,25 g/kg or 20–40 g and anabolic effect lasting at least 24 hours; Morton et al. 2018 meta-analysis, 49 studies, 1.863 participants, 1,62 g/kg/day saturation (95% CI 1,03–2,20), +0,30 kg lean mass and +2,49 kg maximal strength. Creatine ISSN renal statement, 5–7-day loading (four daily 5 g doses), 3–5 g/day maintenance, up to 30 g daily for 5 years safety; 2021 ISSN DHT/hair review and rugby study's 56% DHT increase. BCAA assessment by Office of Dietary Supplements. Heavy metal review: 23 products, 0,5 µg/day threshold, ~70% exceeding 120% of it, maximum 7,7 µg/serving, plant lead averaging nine times milk-based; FDA daily levels (children 2,2; childbearing-age women 8,8; other adults 12,5 µg/day), and four of 23 exceeding 2,2 µg but all below maximum levels. FDA does not approve supplements before marketing, regulates afterward, and warns of unlisted stimulants, steroids and unapproved drugs. SELECT (35.533 men, 17% prostate cancer increase), ATBC (29.133 male smokers, 18% lung cancer increase, 8% mortality increase), CARET (18.314 people, 28% lung cancer, 46% lung cancer mortality, 17% all-cause mortality increases, stopped early). Statements against antioxidants during chemotherapy/radiotherapy. TRAVERSE: 5.204 men, prostate cancer 12 versus 11, mean ~33 months; FDA class-wide label change on 28 February 2025 removing cardiovascular boxed warning.
Unverified: The source's "25% dependence" was not verified; literature gives approximately 30%, used here. Pope et al. 2014 was not accessed directly, but cited through a current publication. For anabolic steroid users, long-term mortality had no sourceable hazard ratio, so none is given. In FDA's adulterated supplement database, the product count could not be verified. No proportion of positive doping tests attributable to supplements was found. For peliosis, adenoma and carcinoma, case-series counts were unavailable; only qualitative statements and 5–15-year delay were used. For creatine and cancer, no evidence in either direction was found. Turkish steroid/SARM sales regulations, TİTCK scope and supplement legislation details could not be verified during preparation; regulatory information concerns the United States , explicitly noted.
Ownership of criticisms: The judgment against sample cycle schedules; recognizing cycling–stacking–PCT addresses hormones, not permanent harm; reading metals alongside FDA levels; not extrapolating TRAVERSE to supraphysiological doses; and assessing the categories' risks as different in kind are assessments of ours. All figures, doses and mechanism explanations belong to cited sources.
Diagrams derive from verified text, adding no new data. Figure 2's vertical line shows time, not progression, as stated below it.
References
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury — "Anabolic Steroids" and "Selective Androgen Receptor Modulators" sections. NCBI Bookshelf, National Library of Medicine.
- Baggish AL et al. "Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use." Circulation. 2017 (via American College of Cardiology summary).
- Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. "Adverse health consequences of performance-enhancing drugs: An Endocrine Society scientific statement." Endocr Rev. 2014;35(3):341–375.
- Shankara-Narayana N et al. — reproductive axis recovery after androgen use. J Clin Endocrinol Metab. 2020;105(6):1827. And: scoping review of recovery after androgen cessation, Endocrine Connections. 2023;12(12).
- United States Anti-Doping Agency (USADA) — information page on SARMs and prohibited anabolic agents.
- Jäger R et al. "International Society of Sports Nutrition position stand: protein and exercise." J Int Soc Sports Nutr. 2017;14:20.
- Kreider RB et al. "International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation." J Int Soc Sports Nutr. 2017;14:18. And Antonio J et al. J Int Soc Sports Nutr. 2021;18:13.
- Morton RW et al. — protein supplementation meta-analysis. British Journal of Sports Medicine. 2018;52(6):376.
- National Institutes of Health, Office of Dietary Supplements — "Dietary Supplements for Exercise and Athletic Performance" (professional and consumer versions); "Vitamin E" and "Vitamin A" fact sheets.
- U.S. Food and Drug Administration — "Questions and Answers on Dietary Supplements"; "Lead in Food and Foodwares"; class-wide testosterone label change announcement, 28 February 2025.
- National Cancer Institute — "Antioxidants and Cancer Prevention" fact sheet.
- Independent consumer organization protein powder heavy-metal review (2025) and pharmacological commentary evaluating it (University of Connecticut).
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