This article reviews the current body of literature linking anabolic steroids to atherogenic alterations in serum lipid levels. Anabolic steroids cause marked high-density lipoprotein2 levels [corrected] depression (weighted average, 52%) and severe depression of high-density lipoprotein b levels (weighted average, 78%) while raising low-density lipoprotein levels an average of 36%. The mechanism of these lipid changes, their time course in relation to anabolic steroid use, and their dependency on route of anabolic steroid administration are discussed. Interpretation of the observed lipid level changes in light of the epidemiologic data linking lipids to coronary heart disease risk is used to estimate the lipid-based increase in coronary heart disease risk due to anabolic steroid use.