Androgenic anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone. AAS are used by athletes and recreational users of all ages to enhance their athletic performance and/or physical appearance. While several adverse effects of AAS abuse have been described, their effect on the immune system has not been clearly elucidated. The literature generally indicates that supraphysiologic doses of AAS with an intact steroid nucleus are immunosuppressive, that is they reduce immune cell number and function. While those with alterations to the steroid nucleus are immunostimulatory as they induce the proliferation of T cells and other immune cells. Specifically, several common AAS have been shown to adversely influence lymphocyte differentiation and proliferation, antibody production, Natural Killer Cytotoxic activity and the production of certain cytokines, thereby altering the immune reaction. These effects may be profound and long lasting depending on the dosing regime, types or combinations of AAS used and the extent and duration of AAS abuse. Nevertheless, the effects of long term use of supraphysiologic doses of AAS on the immune system remain uncertain.