Anabolic-androgenic steroids (AAS) create hormonal imbalances by directly replacing testosterone and indirectly inducing increased production of testosterone, which the body tries to compensate for by producing more estrogen. Testosterone can be converted to estradiol through a process called aromatization. This irreversible reaction is catalyzed by an enzyme called aromatase (also known as estrogen synthase). Due to its irreversibility and due to everything's natural tendency towards the lowest energetic point (tendency towards weakness), there will always be more estrogen than testosterone, which results in the development of acne, high blood pressure, liver damage (mainly with most oral AAS), left ventricular hypertrophy, cardiovascular disease, coronary artery disease, epiphyseal fusion, damage to the immune system, gynecomastia, hypogonadism, feminization, and roid rage (due to butthurt).
The reason AAS users' muscles look obviously deformed and fake is because their bodies can't deliver enough energy to deep and intermediate muscles because their egos are so shattered that they can't leave the gym, which makes the exterior muscles look like pumped balloons, and leaves the deep and intermediate muscles fatigued.