The wellness and fitness industry has expanded anabolic steroid and other performance enhancing drug usage far beyond the bodybuilding world. Steroids are no longer just for bodybuilders. Walk into any gym and someone will appear who is using anabolic steroids to enhance their physique.
Once upon a time, a teenage boy would open muscle magazines and see muscular bodybuilders promoting supplements such as Cell Tech and Nitro Tech as the gateway to their physique. Like many teenage boys in the late 90s and early 2000s, I spent a lot of money at GNC on such supplements, hoping to develop the same muscles. Eventually, I crossed into learning about the reality of anabolic steroids and other performance enhancing drugs that bodybuilders and world class strength athletes used to develop muscle and strength. I had to learn from others who had been there before and find a close group community to learn these secrets. Today, teenagers are flooded with perceived expert content from professional bodybuilders, contest prep coaches, and general fitness and wellness influencers explaining how to use these drugs. I am no longer surprised when an 18 year old male already knows most of the anabolic steroids in existence, whereas in my teenage years I only knew about creatine.
As anabolic steroid use has moved from bodybuilding into the mainstream recreational gym population, what concerns lie ahead? What are we not seeing above the neck when the focus primarily stays below the neck when using these compounds?
For starters, anabolic steroids cross the blood brain barrier. Sex steroid receptors are found in the hippocampus, amygdala, prefrontal cortex, hypothalamus, and brainstem. When anabolic steroids are used in doses five to one hundred times greater than what the body naturally produces, the neurological consequences are structural, functional, and lasting (Chisari et al., 2025). A study looking at 130 male weightlifters with prolonged anabolic steroid use and 99 non-using controls found that the brain age gap, which is the difference between chronological brain age and predicted brain age based on imaging scans, was significantly worse in the anabolic steroid group (Bjornebekk et al., 2021). The anabolic steroid group showed accelerated brain aging that was unrelated to depression, IQ, or other substance use patterns. The longer the use, the greater the acceleration in aging.
Long term anabolic steroid use shows measurable volume reductions and cortical thinning in the prefrontal cortex and hippocampus. The prefrontal cortex is responsible for executive functioning, impulse control, and emotional regulation. The hippocampus is responsible for memory consolidation and spatial learning, and shrinkage in this area is linked to suppression of neurogenesis, which is the brain’s ability to generate new neurons leading to reduction of cognitive flexibility and memory function (Chisari et al., 2025). What is important for anabolic users to understand is that losses in these areas earlier in life impact the cognitive reserve that protects the brain from aging later in life.
The amygdala, known for initiating the fight or flight response, shows a hypertrophy effect. Just as anabolic steroids enlarge muscle tissue, the amygdala can also enlarge. This is associated with dysregulation of the prefrontal cortex, impairing executive functioning, impulse control, and emotional regulation. Kaufmann et al. (2015) found that anabolic steroid users had significantly larger right amygdala volumes than non-users and also showed reduced connectivity between the amygdala and frontal, striatal, limbic, and hippocampal regions. While many anabolic steroid users may feel euphoria from physical muscle gains, structural neurological changes are occurring with longer use and increased lifetime exposure.
The orbital frontal cortex became an area that stood out to me when I began studying neuroscience after bodybuilding and steroid use. This area is associated with evaluating reward versus consequence, emotional decision making, impulse control, inhibition, cognitive flexibility, and social judgment. It is essentially the rational mind. A study by Bjornebekk et al. (2019) showed that the greatest amount of cortical thinning in anabolic steroid users occurs in the orbital frontal cortex. When combined with an enlarged amygdala and thinning of the hippocampus and prefrontal cortex, particularly the orbital frontal cortex, accelerated cognitive decline becomes likely in anabolic steroid users.
Structural Damage to Cognitive Decline
What is the likely trajectory of cognitive health in long term anabolic steroid users? Bjornebekk et al. (2021) stated that an older looking brain in a younger body reflects reduced neurological resilience, earlier onset of cognitive impairment, and a diminished buffer against normal aging. A major concern is the potential increased risk of Alzheimer’s disease, as the hippocampus is one of the first areas affected in Alzheimer’s progression. When long term anabolic steroid use suppresses hippocampal neurogenesis and induces atrophy in the user’s 30s and 40s, the loss of cognitive reserve increases the risk of Alzheimer’s and other cognitive decline pathways (Chisari et al., 2025). Bjornebekk et al. (2021) associated larger brain age gaps with longer histories of anabolic steroid use, suggesting that a 10-year use history by age 35 may result in cognitive function similar to someone aged 70 or 80 later in life projecting at minimum, a 10-year acceleration in cognitive aging.
Why Users Often Feel They Are in Control of Their Risk
For years, many bodybuilders, myself included, focused on mitigating physical risks through structured protocols and regular lab work, without considering risks to the brain, where no standard blood test indicates structural damage. A 2025 study examining experienced anabolic steroid users found common themes of feeling calculated, controlled, and educated in their use, rather than impulsive or reckless contributing to a minimized belief risk (Amarel et al., 2025). Participants also emphasized social environments such as online forums, coaches, and TRT clinics as ways to reduce perceived risk. In these communities, elevated hormone levels are normalized. Social reinforcement minimizes long term health concerns and amplifies the experience of physical superiority over subtle neurological changes. I know I lived in this state for many years.
Many outside these communities may label this as denial. However, individuals who actively research and study the compounds they use truly believe they are doing everything correctly and maintaining their health. Many perform due diligence with regular lab work and monitoring other measures such as blood pressure. When it comes to the brain, however, negative health markers remain hidden. When the prefrontal cortex, responsible for self monitoring, behavioral reflection, and decision making, becomes impaired, the ability to accurately assess one’s own impairment also declines. It becomes a situation where the more an individual uses anabolic steroids, the more their decision making ability is compromised. This makes it easier to justify longer use, higher doses, and riskier compounds or stacking of compounds without awareness of long term cognitive consequences.
I have an extensive history of anabolic steroid use throughout my 20s and 30s, and I can relate to the research discussed in this paper. I do not write this to condemn those who use steroids and other performance enhancing drugs, as everyone has the right to make their own choices with their body. However, we are living in an era where social media experts and easily accessible information lack accuracy control. Many individuals do not fully understand the risks they are taking because only the positive aspects are consistently promoted by their favorite influencers. There needs to be a counterbalance to the information available. We need to slow down and critically evaluate what we see in short videos or quick online content rather than accepting it as fact. The reality is that anabolic steroid use carries a strong likelihood of accelerating brain aging regardless of how favorable physical health markers may appear.
Are there ways to combat this? I believe there may be. I will discuss my hypotheses and potential strategies to address and possibly reverse some of these cognitive issues in another article. I am in the same position as many others, doing my best after the fact to support healthy brain function and aging after years of anabolic steroid use.
Reference
Amaral, J. M. X., Strang, J., & Gioacchini, N. (2025). Managing risks and harms associated with the use of anabolic steroids: A qualitative study. Harm Reduction Journal, 22, 129. https://doi.org/10.1186/s12954-025-01269-x
Bjørnebekk, A., Hauger, L. E., Walhovd, K. B., Jørstad, M. L., Sundseth, O. O., & Fjell, A. M. (2019). Structural brain characteristics of anabolic–androgenic steroid dependence in men. European Addiction Research, 25(6), 276–290. https://doi.org/10.1159/000501361
Bjørnebekk, A., Kaufmann, T., Hauger, L. E., Klonteig, S., Hullstein, I. R., & Westlye, L. T. (2021). Long-term anabolic–androgenic steroid use is associated with deviant brain aging. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 6(5), 579–589. https://doi.org/10.1016/j.bpsc.2021.01.001
Chisari, M., Esposito, M., Alloca, S., Franco, S., Francaviglia, M., Volonnino, G., Rinaldi, R., Fazio, N. D., & Mauro, L. D. (2025). Anabolic–androgenic steroids and brain damage: A review of evidence and medico-legal implications. Forensic Sciences, 5(3), Article 31. https://doi.org/10.3390/forensicsci5030031
Kaufmann, M. J., Kanayama, G., Hudson, J. I., & Pope, H. G. (2015). Brain and cognition abnormalities in long-term anabolic-androgenic steroid users. Drug and Alcohol Dependence, 152, 47–56. https://doi.org/10.1016/j.drugalcdep.2015.04.023
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