Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 12/12/2022
We’ve all heard the jokes around gym culture and professional athletics. Steroids, according to the locker room talk, can make your balls shrink, your hair fall out, your penis soft and your gains extreme. While that last one sounds good (and some men genuinely look great with a bald head), chances are that if you’re a steroid user, you’re probably wondering how to avoid erectile dysfunction and other negative sexual effects.
After all, it’s not just gym rats with their intolerable selfies and their sad chicken breast dinners that use steroids. Steroids can be used to treat illnesses, speed recovery after illness, give much-needed testosterone replacement therapies to people with hormonal deficiencies and for plenty of other life-changing therapies.
The point is that no matter why you’re using steroids, you want to avoid having the benefits outweighed by a massive, libido-killing side effect.
Can you avoid erectile dysfunction from steroid use? Yes, though it requires proper care, responsible steroid use and knowledge about how erectile dysfunction and steroids intersect.
Let’s start with the easier topic to get a grip: on your penis.
Erectile dysfunction is a worldwide phenomenon affecting all types of men. While it typically affects men over 40, men of all ages can feel the adverse effects of erectile dysfunction. And that’s unfortunate, because in addition to affecting a diverse range of men, ED can have a diverse range of causes.
You probably know a few of the typical causes of ED already. Performance anxiety and other mental health issues can reduce your sex drive and ability to achieve erection. Medications like selective serotonin reuptake inhibitors can induce ED in some people. ED can also be caused by cardiovascular diseases, obesity, diabetes, hypertension and even certain hormonal irregularities and disorders that affect your hormone production. And this last potential cause is where steroids come in.
Steroids — particularly anabolic steroids — are synthetic derivatives of the hormone testosterone. They can be used legally in the treatment of medical conditions like hypogonadism, testicular failure and others, as well as used illicitly or illegally as performance enhancement medications for athletes.
As you might already suspect or know, using testosterone supplements can cause serious side effects, particularly if they’re used by someone with otherwise healthy testosterone function.
Steroids can cause testicular issues, infertility problems and, yes, erectile dysfunction.
A 2022 review looked at several meta-analyses of anabolic steroid use, and found that almost 20 percent of anabolic-androgenic steroid-using males had erectile dysfunction issues, and more than 30 percent had a reduced libido due to steroid use (though they pointed out that the data was limited).
So, we can at least say that testosterone therapy didn’t improve erectile function generally in men with healthy testosterone function, and that sexual dysfunction may be more prevalent in men abusing aromatizable steroids.
Side effects of anabolic steroid use are difficult to predict, according to the research we have. Because dosage and other variables have to be taken into account, it’s difficult to say how long it will take for your normal levels of testosterone to return — and when the symptoms of ED might then disappear — after you stop taking steroids.
Some research shows that normal testosterone levels returning between 13 and 24 weeks from the start of withdrawal is likely, but if your anabolic steroid misuse (or even just use) has gone on for an extended period — longer than one year — it can take your body a longer period of time to adjust and return to your normal testosterone production.
Keep in mind, most of this data reflects illicit use. In people who are prescribed anabolic-androgenic steroids, normal function may be the result of steroid use. But if you’ve been using steroids as illicit drugs, it can signal a long road ahead.
Anabolic steroid users are basically messing with a sex hormone that can have impacts on blood flow to the penis, sexual function/sexual desire and blood pressure, and can increase the risk of heart attacks and other serious cardiovascular issues, as well as cause testicular shrinkage. Just for some additional muscle mass and athletic performance.
Muscle growth may sound great, but unlike increases in muscle mass, it can be somewhat hard to reverse certain types of damage — like many of these side effects — once it’s done.
Using steroids you weren’t prescribed can cause an imbalance, so fixing steroid-induced erectile dysfunction generally means correcting that imbalance. So, for the most part the “fix” is waiting for your normal testosterone levels to return.
Even then, some of the adverse effects might be irreversible — hair loss and other conditions aren’t always something you can rewind the clock on after the damage is done.
And while we’re all for recommending erectile dysfunction medications like sildenafil and tadalafil (the generics of Viagra and Cialis, respectively) for the treatment of vascular erectile dysfunction, any ED related to steroid use is something you may just have to wait out.
If, however, your levels of testosterone return to normal and you are still experiencing erectile dysfunction or other sexual function issues, that’s something to talk to a healthcare provider about. They may suggest any number of common treatments for erectile dysfunction — which you can read about in our erectile dysfunction treatment guide.
Use of steroids, especially when they are not medically prescribed or treated like recreational drugs, can be a serious problem. You may think you’re using them carefully, but the long-term effects of steroid use can be serious and permanent, even if you think you know what you’re doing.
But even if you’re using steroids as prescribed, those effects can be serious, and can mess with your erectile health. If you’re wondering how to prevent this, or at least deal with it when it becomes an issue, talk to your healthcare provider.
If you’re using steroids illicitly, they’ll tell you to stop. They may also suggest some of the above treatment options. If you’re using steroids as directed, they may have slightly different instructions for the management of ED, based on your unique health circumstances.
Either way, a healthcare professional is your best friend if you want to make sure your erection will be safe. If you’re not sure where to start, we can offer support through our erectile health resources. It’s a good place to start (as is our erectile and sexual health blog) and you’ve got to start somewhere.