Steroid side effects: Short-term and long-term - Insider

• Side effects of steroids are common, affecting up to 90% of people who take them.
• Short-term side effects can include acne, headaches, dizziness, and heartburn.
• Long-term side effects include weight gain, mood changes, and reduced libido.
• Visit Insider's Health Reference library for more advice.

Steroids, aka corticosteroids or glucocorticoids, are powerful medications used to treat a plethora of conditions, from asthma to skin conditions and even cancer. 

However, they can come with short- and long-term side effects. In fact, up to 90% of patients will experience side effects while taking steroids. 

That's why, "the benefits versus the risk should always be considered carefully," says Adam Rivadeneyra, MD, a sports medicine specialist with Hoag Orthopedic Institute. 

Note: This article focuses on medically-prescribed corticosteroids, not anabolic steroids that mimic male sex hormones, or steroidal supplements that might be illicitly used to enhance athletic ability. 

Steroid side effects

When you take corticosteroids, they mimic cortisol, a hormone that your body naturally releases in response to stress like injury or illness. 

Steroids enter the nucleus of cells and stop the production of proteins and other chemicals that cause both inflammation and immune activity, says Erin McNeely, MD, an internal medicine physician at Spectrum Health. 

This impacts your hormonal system and can cause side-effects of short-term steroid use, including:

• Increased appetite
• Moodiness or increased happiness
• Sleep changes
• Acne
• Headache
• Dizziness
• Heartburn
• Weakness
• Easy bruising and slow healing

Long-term steroid use can cause more severe side-effects. 

"Steroid medications at high doses or long term treatment more than one to two weeks can be very harmful with some permanent complications or side effects," says Rivadeneyra.

Long-term side effects of steroid use include:

• Weight gain and swelling
• Loss of bone density and thinning of the skin
• Diabetes
• Mood changes and psychiatric effects
• Changes to the hormonal system
• Increased risk for serious infection
• New or changed hair growth patterns
• Changes to fat distribution
• Decreased sexual functioning
• Changes to menstruation

After using steroids you'll have a suppressed immune system for about the same length of time that you were on the steroids, leaving you at increased risk for infections, McNeely says. 

So, it's important to take measures to avoid illness like washing your hands frequently with soap and water.

Who is most at risk?

Older people and those with the following underlying health conditions have an increased risk for side effects from steroids:

• Diabetes
• Crohn's disease and other auto-immune conditions
• A suppressed immune system
• Depression and other behavior health conditions
• Cardiovascular disease

The longer you are on steroids and the higher the dose, the more likely you are to have side effects. However, side effects are extremely common even on short doses and for otherwise healthy people. 

Mitigating side effects

To reduce the risk of side effects, take steroids for the shortest possible time and lowest effective dose to address a condition, says McNeely. 

"It is important to limit the amount of steroids to prevent these side effects and especially infections that can happen when you are immunosuppressed," she says. 

The way that you take steroids also matters. Steroids can be inhaled, injected, applied as a cream, or ingested orally. 

In general, localized steroids — those that are inhaled, injected into a joint or tendon sheath, or applied as cream — have fewer side effects because they remain in one area of the body. 

On the other hand, injected steroids along with "oral steroids tend to have the most significant and potentially harmful side effects," says McNeely.

It's also possible to experience withdrawal symptoms — like fatigue, weakness, and nausea — if you reduce your steroid dose too quickly. For that reason, in many cases your doctor will taper your dose. This gives your body a chance to adjust to the lower dose and resume its own normal production of cortisol and adrenal gland function. 

When to see a doctor

"Not all side effects are truly harmful, but they should all be discussed with your doctor," says Rivadeneyra. 

However, if you experience any of the following side effects, seek medical care immediately:

• Vision changes or changes to the eyes, including teariness or redness
• Sore throat, fever or signs of infection
• Confusion or changed perception or reality
• Tingling in the limbs
• Upset stomach or vomiting
• Swelling
• Hives, rash, or itching

It's important that if you begin experiencing side effects while taking a steroid, call your doctor or seek medical attention, but do not suddenly stop the steroids unless a doctor has told you to do so. 

"It can be very dangerous for your health if you stop your steroid medication without your doctor's supervision," says Rivadeneyra. 

Note: Over-the-counter steroids like the anti-itch cream hydrocortisone can also cause side effects if used long term. If you need to use anti-itch cream for more than a few days, talk to your doctor, says Rivadeneyra.

Insider's takeaway

Steroids suppress the immune system and reduce inflammation. That makes them very powerful at treating conditions ranging from asthma to cancer. 

However, side effects from steroids are extremely common. It's important to discuss benefits and drawbacks with your doctor, and seek medical help immediately if you experience concerning symptoms like vision changes. 

"Steroid side effects can be severe and life altering," says McNeely. "Still, steroids can be appropriate in many settings. Make sure you understand what your particular risks and benefits are in any situation where you will be starting these medications."

Kelly Burch