Does steroid use weaken tendons?

I came across an orthopedic sports surgeon on tiktok claiming that while steroid use increases the size of the muscle, it also weakens your tendons overtime. He also said that when he operates on steroid users he notices that “their tendon quality looks very poor”. Is there any truth to this? I am a little skeptical of his claims, as he did open up the video saying that max effort sets on exercises like deadlifts are dangerous due to the likelihood of them causing a disk herniation or other back injury which could cause problems for the rest of your life. The link if your are curious, points 1 and 5 TikTok - Make Your Day

There are two studies suggesting anabolic use may increase injury risk. In one case report, all 4 individuals who had ruptured their triceps brachii muscle had previously taken oral anabolic steroids prior to their injury. In the second case report, 96% of the 48 patients who suffered an injury due to bench press had also used anabolic steroids. Not terribly convincing or robust, but I do think that rapid increases in strength that outpace other musculoskeletal adaptations may increase catastrophic injury, e.g. tendon or muscle rupture, during RT. However, this is still exceedingly rare!

Additionally, the claim that anabolic use independent of loading- increase risk of tendon, ligament, or other soft tissue rupture is not supported by evidence. Existing evidence within controlled populations show similar adaptations in these tissues, albeit not necessarily in lock-step with strength performance. I am not aware of any evidence suggesting anabolics alter the integrity of ligaments or tendons in a negative or unique way either.

I ruptured my quad tendon while squatting. It was a PR, but only 5lbs more than the week before and not a huge weight. I’ve heard several stories of people having that injury walking down stairs. At the time, I was a week into a 10 day prednisone protocol. Some of my physical therapists and doctors have suggested a relationship. I may be wrong about this, but it seems like the reason tendons rupture is somewhat mysterious to the medical profession.

This is a very different situation, because “steroids” are not just one thing.

Prednisone is not an anabolic steroid (the kind used to build muscle), but is instead catabolic (it breaks down and weakens musculoskeletal tissues). These corticosteroid/glucocorticoid-type steroids like prednisone are primarily used for their potent anti-inflammatory effects, but these musculoskeletal side effects (and many other side effects) are well-known, and lead us to ideally use these medicines at as low a dose as necessary, for as short of a period of time as necessary. That you experienced a tendon complication while taking prednisone may be relatively uncommon, but is not a mystery.

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Actually, it is true. Some studies show that Anabolic steroids used while exercising may lead to dysplasia of collagen fibrils, which can decrease the tensile strength of the tendon.

I’ve heard mixed opinions on the effects of steroids on tendons. Some studies suggest that long-term steroid use may indeed weaken tendons, while others argue that proper training and dosage management can mitigate this risk.