Do Anabolic Steroids Cause Kidney Damage?

Question: Do anabolic steroids cause kidney damage? A few years ago, the New York Times had a story suggesting that steroids could have been responsible for focal segmental glomerulosclerosis in a few IFBB pro bodybuilders. Bodybuilder Flex Wheeler had a kidney transplant. Bodybuilder Luke Wood died of complications from a kidney transplant. What role, if any, did steroids play?

Answer: More than one factor is involved, but for reasons having — in my opinion — to do with the muscle-hating psychology of many individuals, these findings may be considered by them to be a useful weapon against anabolic steroids.

It is actually a reasonable argument that supraphysiological androgen levels may aggravate glomerulosclerosis where it is already developing, or perhaps be “the last straw” if other factors contribute. Or perhaps even with some forms of use being sufficient as a sole factor. There is considerable evidence that testosterone, even at physiological levels, can be an aggravating factor.

However, whether this is due to anything but hypertension, I don’t know.

Certainly hypertension is strongly linked to this disease state, and is prevalent among those with high BMI, whether from extreme muscle mass or from obesity. Androgens also can raise blood pressure, but of course the individual can monitor this and so by no means is this an inevitable side effect.

I have never had anyone I consulted with on steroid use — which is certainly more than a thousand individuals — come back and report to me that they suffered kidney problems from following my advice, whether at the time or years later. It certainly is not an inevitable outcome when reasonable care is taken.

As an example reference on the link between hypertension and glomerulosclerosis, which could well be the best explanation for the reported result or a possibly-necessary factor (first part of the abstract only):

Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches.
Med Clin North Am. 2009 May;93(3):733-51.
Reisin E, Jack AV.

The increasing prevalence of obesity in the industrialized world is causing an alarming epidemic. Almost 70% of American adults are overweight or obese. The link between increasing body weight and hypertension is well established. Obesity hypertension through metabolic, endocrinic, and systemic hemodynamic alteration causes structural vascular and cardiac adaptations that trigger concentric, eccentric left ventricular hypertrophy and electrophysiological changes, which may increase the risk for congestive heart failure and sudden cardiac death as a result of arrhythmias. The increased renal blood flow in conjunction with a decreased renal vascular resistance causes renal hyperperfusion and hyperfiltration. Such changes lead to glomerulomegaly, focal segmental glomerulosclerosis, tubulointerstitial inflammation, and fibrosis that characterize the renal damage in obese hypertensive subjects.