Do Steroids Make You Tired? The Surprising Link Between Medication and Fatigue

October 6, 2025 •

4 min read

While the direct effect of some steroids is often a feeling of increased energy or alertness, up to half of patients on long-term, medium-to-high doses of corticosteroids experience adrenal insufficiency upon withdrawal, a condition with severe fatigue as a primary symptom. However, exhaustion can occur even during treatment due to indirect effects like sleep disruption. Understanding this seemingly paradoxical relationship is key to managing your energy levels while on medication.

Quick Summary

Steroids can cause fatigue both during and after treatment. Direct side effects like insomnia disrupt sleep, leading to daytime tiredness. Long-term use can suppress the adrenal glands, causing extreme fatigue upon abrupt withdrawal. Other factors, including dosage and duration, influence the severity of tiredness.

Key Points

Steroids Cause Indirect Fatigue: Medications like prednisone do not cause direct sleepiness but lead to fatigue through side effects like insomnia and altered cortisol levels.
Insomnia is a Key Factor: By mimicking the stress hormone cortisol, corticosteroids can cause heightened alertness and agitation, leading to sleep disruption and subsequent daytime fatigue.
Adrenal Suppression is a Major Risk: Long-term steroid use can cause adrenal gland suppression, and abrupt cessation can trigger a withdrawal syndrome marked by extreme fatigue and weakness.
Fatigue Can Occur During Treatment and Withdrawal: Patients can feel tired while on steroids due to poor sleep and muscle effects, and also experience severe exhaustion during the tapering process.
Management is Possible: Strategies like taking medication in the morning, improving sleep hygiene, and gradual tapering under a doctor's supervision can help manage steroid-related fatigue.
Anabolic vs. Corticosteroids: The fatigue side effects differ between anti-inflammatory corticosteroids and anabolic steroids, with the latter often associated with fatigue during withdrawal.

The Paradox of Steroid-Induced Fatigue

For many patients, especially those on corticosteroids like prednisone, the initial experience is not one of tiredness, but of an unsettling burst of energy, agitation, and sleeplessness. This is because corticosteroids mimic the effects of cortisol, the body's natural 'stress' hormone, which promotes wakefulness and alertness. This initial effect is what makes the subsequent onset of fatigue so confusing for many patients. The exhaustion that occurs is almost always an indirect consequence of the medication's effects on the body's natural systems, rather than a direct sedative effect.

Indirect Causes of Fatigue While on Steroids

Insomnia and Sleep Disruption

One of the most common reasons steroids make you tired is ironically because they keep you awake at night. Corticosteroids disrupt the body's natural sleep-wake cycle (circadian rhythm). Normally, cortisol levels are high in the morning and decrease at night to promote sleep. By introducing synthetic cortisol, particularly with evening doses, steroids artificially elevate nighttime levels, causing restlessness and insomnia. The subsequent sleep deprivation leads to daytime fatigue and low energy.

Adrenal Suppression and Withdrawal

Long-term steroid use is a common cause of adrenal suppression, a condition where the body's adrenal glands stop producing sufficient amounts of natural cortisol. The synthetic steroid replaces the body's natural hormone, effectively causing the adrenal glands to go into a 'sleep-like' state. This is not a problem as long as the medication is being taken consistently. However, if the medication is stopped too quickly, the dormant adrenal glands cannot immediately resume adequate natural cortisol production, leading to a hormonal crash. Severe fatigue is a hallmark symptom of this withdrawal syndrome. This is why doctors emphasize the importance of gradually tapering off corticosteroids.

Muscle Weakness and Myopathy

Chronic, high-dose steroid therapy can lead to muscle weakness, a condition known as steroid-induced myopathy. The breakdown of muscle tissue reduces physical strength and endurance, contributing significantly to a feeling of overall fatigue and low energy. This effect can make even simple daily activities feel exhausting.

Blood Sugar Fluctuations

Steroids are known to increase blood sugar levels, a side effect that can worsen or trigger diabetes. For individuals with diabetes, or even those without, these fluctuations in blood glucose can lead to episodes of fatigue. Poorly controlled blood sugar can cause an energy crash, mimicking the feeling of being tired.

Comparison: Corticosteroids vs. Anabolic Steroids

It is important to differentiate between corticosteroids and anabolic steroids, as they have different effects and risks.


Feature	Corticosteroids (e.g., Prednisone)	Anabolic Steroids (e.g., Testosterone)
Primary Medical Use	Reduce inflammation, treat autoimmune diseases, suppress the immune system.	Treat certain hormone imbalances, sometimes misused for muscle gain and performance enhancement.
Mechanism of Action	Mimic natural cortisol, a stress hormone, to block inflammatory processes.	Act like testosterone, a male sex hormone, to increase muscle mass and strength.
Energy Levels	Can cause insomnia and agitation, which leads to fatigue during treatment. Severe fatigue is also a symptom of withdrawal.	Misuse can cause sleep disruption and mood changes. Withdrawal can lead to severe fatigue and depression.
Legality	Prescribed medication for various medical conditions.	Controlled substance with strict regulations and significant health risks when misused.

Managing Fatigue While Taking Steroids

Managing fatigue while on a steroid regimen involves addressing its root causes under a doctor's supervision. Some effective strategies include:

Optimizing medication timing: Taking the full daily dose of an oral corticosteroid like prednisone in the morning can help align with the body's natural cortisol rhythm, reducing the risk of insomnia at night.
Prioritizing sleep hygiene: Establishing a consistent sleep schedule, creating a restful bedroom environment, and avoiding stimulants like caffeine can improve sleep quality.
Engaging in light exercise: Regular, low-intensity exercise such as walking or yoga can boost energy levels and reduce feelings of fatigue.
Maintaining proper nutrition and hydration: Eating a balanced diet and staying hydrated can support overall energy levels and counteract some steroid side effects.
Working with a healthcare provider: If fatigue is severe or persistent, it is essential to discuss it with a doctor, who may adjust the dosage, taper the medication, or investigate underlying issues like adrenal insufficiency.
Never stop abruptly: To avoid withdrawal symptoms and a potentially life-threatening adrenal crisis, you should never stop taking steroids abruptly, especially after long-term use. A gradual taper under medical supervision is critical.

Conclusion

While the stereotype of a steroid user often includes hyperactive behavior, the reality is that fatigue is a significant and common side effect for those on corticosteroids. The exhaustion is typically not a direct sedative effect of the drug but an indirect result of sleep disturbances, adrenal suppression upon withdrawal, muscle weakness, and blood sugar imbalances. By understanding these mechanisms and working closely with a healthcare provider, it is possible to manage or mitigate the fatigue and other side effects associated with steroid use. Always follow a doctor's guidance regarding dosage and tapering to ensure safety and prevent serious complications.

Frequently Asked Questions

Steroids do not directly cause sleepiness but can cause indirect fatigue by disrupting your sleep-wake cycle. Corticosteroids can cause insomnia, which leads to sleep deprivation and daytime tiredness. Additionally, long-term use can suppress your body's natural cortisol production, and sudden cessation can cause a withdrawal effect characterized by severe fatigue.

Yes, it is possible to experience fatigue from a short course of prednisone. While longer courses carry a higher risk, a short-term prescription can still disrupt your sleep and cause daytime tiredness. Taking the medication in the morning can help minimize its impact on sleep.

Yes, fatigue is a very common and expected symptom during steroid withdrawal, especially after long-term use. This occurs because the adrenal glands, which have been suppressed by the medication, need time to recover and resume natural cortisol production. A doctor-supervised tapering schedule is essential to manage this transition safely.

Signs of steroid-induced adrenal insufficiency can include fatigue, muscle weakness, body aches, loss of appetite, and dizziness. In severe cases, an adrenal crisis can occur with dangerously low blood pressure, severe vomiting, and extreme fatigue. This is a medical emergency.

To reduce fatigue, you can take your medication in the morning, practice good sleep hygiene, get light to moderate exercise, stay hydrated, and eat a balanced diet. If fatigue persists, consult your doctor about potential dosage adjustments or other strategies.

Yes. Corticosteroids like prednisone cause fatigue indirectly by disrupting sleep and suppressing adrenal function, especially during withdrawal. Anabolic steroids, often misused for performance, can also cause sleep problems and severe fatigue during withdrawal as the body's natural hormone production is restored.

The duration of post-steroid fatigue varies. For individuals on short-term therapy, sleep disturbances may resolve within days or weeks. For long-term users, the body's hormonal balance may take weeks or months to recover fully, and fatigue can persist for some time after the medication is tapered off completely.