How to Avoid Erectile Dysfunction on Steroids

According to locker room talk, using steroids can make testicles shrink and hair fall out, and for bodybuilders, it can also make their gains extreme. But do steroids cause erectile dysfunction (ED) as well?

Put simply, yes — ED can absolutely result from steroid use and abuse, since they can affect your hormone levels and well-being. When it comes to other questions, like “do steroids make you last longer in bed?,” “do steroids increase sex drive?” and “do steroids make you horny?,” things can get complicated. That’s especially true when you compare a proper steroid user against someone engaging in steroid abuse.

That said, the question we’re here to help you answer is how to avoid erectile dysfunction on steroids. Doing so requires proper care, responsible steroid use and knowledge about how erectile dysfunction and steroids intersect.

It’s possible for steroids to affect you sexually, and even cause erectile dysfunction.

A 2022 review, which looked at several meta-analyses of anabolic steroid use, found that almost 20 percent of anabolic-androgenic steroid-using males had erectile dysfunction issues. Further, over 30 percent reported a reduced libido due to steroid use (though the review pointed out that the data was limited).

First some clarification, steroids is a broad class of compounds, the above review examined anabolic steroids, which are structurally similar to testosterone and have similar physiologic effects. They are also referred to as anabolic-androgenic steroids because of the effect on muscle building (anabolic) and virilizing (androgenic) processes in the body.

Still, we can at least infer that sexual dysfunction may be caused by the steroid as it is more prevalent in men abusing anabolic steroids.

There are a wide variety of typical causes of ED. For instance, performance anxiety and other mental health issues can lead to decreased libido and difficulty achieving an erection. Medications like selective serotonin reuptake inhibitors (SSRIs) can induce ED in some,  as can cardiovascular diseases, obesity, diabetes and hypertension.

Additionally, even certain hormonal irregularities and disorders that affect your hormone production can cause ED, which is where steroids come in because they disrupt normal testosterone by suppressing testicular function. Using anabolic steroids like testosterone supplements can result in serious side effects, including decreased sperm count, shrunken testes — and erectile dysfunction.

There are two kinds of steroids that can contribute to sexual dysfunction: corticosteroids and anabolic steroids.

Corticosteroids like prednisone are a type of steroid commonly used to treat inflammation and allergies. But in doing so, they can temporarily lower testosterone levels, potentially causing prednisone erectile dysfunction.

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. However, they’re also used illicitly or illegally as performance enhancement medications for athletes hoping to gain muscle mass.

Side effects of anabolic steroid use are difficult to predict, according to the research we have. But basically, anabolic steroid users are messing with a sex hormone, which can have impacts on blood flow to the penis, sexual function and desire. Further, taking anabolic steroids can increase the risk of heart attacks and other serious cardiovascular issues, as well as cause testicular shrinkage and infertility.

Muscle growth and athletic performance enhancement may sound like great benefits to reap, but it’s somewhat difficult to reverse certain types of damage that are caused by anabolic steroid use, including many of the aforementioned side effects.

Risks with alternatives like pre-workout may be lower, though you’ll still want to understand how pre-workout and erections interact.

Treating steroid-induced erectile dysfunction generally involves stopping the usage of anabolic steroids, and then waiting for normal testosterone production to return.

Because it’s necessary to account for factors like dosage and other variables, it’s difficult to say for sure how long it will take for your normal levels of testosterone to return after you stop taking steroids. This uncertainty also applies to when symptoms of ED from steroid usage may disappear.

Some research shows that it’s likely that normal testosterone levels will return within 13 to 24 weeks from the start of withdrawal. However, it can take longer after anabolic steroid misuse. Even then, some of the adverse effects may be irreversible — mood swings may fade, but hair loss from steroids may stick around.

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. Further, there can be risks associated with taking Viagra on steroids (this goes for other PDE5 inhibitors as well).

But if your testosterone levels return to normal after stopping steroids and you’re still experiencing erectile dysfunction or other sexual function issues, talk to a healthcare provider. They may suggest any number of erectile dysfunction treatment options.

Use of anabolic-androgenic steroids, especially when they are not medically prescribed or are taken recreationally, can be a serious problem. As such, you should never take steroids without medical advice.

Even if you think you’re using them carefully and know what you’re doing, the long-term effects of steroid use can be serious and permanent, and even impact your sexual function:

• 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 ED, 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 abandon the use of anabolic steroids.

• The health professional you’re working with may also suggest other ED treatment options. If you’re using steroids as directed, they may offer slightly different instructions for the management of ED, based on your unique health circumstances. Either way, talking to a healthcare professional is your best bet if you want to make sure your erection will be safe.

If you’re not sure where to turn first, we can offer support through our erectile health resources. Our erectile and sexual health blog is a good place to start for more information. We also offer a range of ED treatments, from Stendra (Avanafil®) to chewable ED meds.