Testosterone and all anabolic steroids when used at high doses and when not monitored by a qualified physician can increase blood production and blood thickness to a point that raises blood pressure and cause clots; a clot in the brain causes a stroke, whereas a clot in the heart causes a heart attack. When you hear about younger (under 50 years old) muscle men who use anabolic steroids dying from massive heart attacks, that’s the usual mechanism. 

Some bodybuilders who don’t see a physician keep track of their blood thickness levels and get regular phlebotomies, or donate blood on a regular basis, and that’s certainly a good thing to do, as it prevents them from having a clot before they turn 50. 

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The consistent (non-cyclical) use of any anabolic steroid at high doses can also cause heart failure. 

But Nandrolone (AKA "Deca") has other effects on the heart that are completely separate from the effect on blood thickness or blood pressure. 

This effect is exerted directly on the heart muscle making it more excitable, in a way that makes it prone to developing an abnormal fatal electric rhythm that can occur without provocation. We call this abnormal fatal rhythm “V-Fib”, which stands for Ventricular Fibrillation. It also alters the lining of the heart vessels (Coronary arteries) making the heart more susceptible to vasospasms that can be fatal.

Trenbolone and Boldenone--although widely used among bodybuilders through the black market--are not bioidentical, and the lack of research on them makes their cardiac safety profile unknown.

You can reduce harm by consulting a qualified physician, avoiding consistent use of high doses, avoiding non bioidentical anabolics, and by obtaining a cardiac ultrasound every few years to assess the presence of adverse structural changes that might have occurred from long term anabolic steroids.

Another harm reduction method is the use of Rapamycin, a drug that can prevent and counterbalance many of the adverse effects of long term anabolic steroids. I prescribe Rapamycin to all the patients who are at risk. 

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If you are on non-bioidentical steroids, hopefully I can persuade you that we may get the same results with bioidentical ones and at lower doses. 

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Even if I cannot persuade you to join our vitality program, we can aim for maximal harm reduction; I know you’re getting your labs checked on your own, and I know you’re getting your blood dumped every few months, and your blood pressure is good. But as i explained above, there are other adverse effects to monitor and there are affordable harm reduction tools at our disposal such as a cardiac echocardiogram and Rapamycin.