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Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle, so that it does not pump blood effectively. Steroid use disrupts the normal production of hormones in the body. Changes that can be reversed include decreased sperm production, 56’59 decreased function of the testes (hypogonadism) that leads to low testosterone levels, 60 and shrinking of the testicles (testicular atrophy). In females, anabolic steroids cause masculinization. Specifically, breast size and body fat decrease, the skin becomes coarse, and the voice deepens. It is commonly believed that anabolic steroids will produce irreversible enlargement of the clitoris in females, although there are no studies on this. Many people who inject anabolic steroids may use nonsterile injection techniques or share contaminated needles with other users. 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