What a Cycle Does to Your Cholesterol

A lean, hard-training bodybuilder doesn't look like someone with metabolic syndrome. Metabolic syndrome is the cluster of low HDL, high triglycerides, insulin resistance, high blood pressure and visceral fat that usually shows up in sedentary, overweight people. A 2021 review in Reviews in Endocrine and Metabolic Disorders by McCullough and colleagues asked whether anabolic-androgenic steroids (AAS) can produce that same picture in people who look nothing like it. The review covers how AAS build muscle and then works through each part of metabolic health in turn: lipids, glucose and visceral fat, and blood pressure. Lipids are where the evidence is strongest and most consistent. The other markers are less settled.

---

1. HDL falls, and it falls hard

HDL is the lipoprotein that carries cholesterol away from the artery walls and back to the liver. It also has anti-inflammatory effects on blood vessels. Low HDL is one of the defining parts of metabolic syndrome, and it is the lipid change AAS produce most reliably.

• In early studies of men self-administering AAS, HDL fell by 49% and LDL rose by 31% after 8 weeks.
• The drop in HDL, especially the HDL2 subfraction, was still there after 14 weeks of use.
• A more recent cross-sectional study found current users had 45% lower HDL, 26% higher LDL and 35% higher triglycerides than men who didn't use AAS.
• Other work cited in the review reports HDL reductions of 70% or more, with LDL increases above 20%.
• A case report followed one 35-year-old man through 5 years of cycling. His HDL fell almost 100% and his LDL roughly doubled.
• Women who use AAS chronically also show significantly lower HDL than healthy controls.