<p>Steroidal drugs, including corticosteroids, sex hormones, and anabolic agents, are widely used in human medicine, veterinary practice, and animal production. As a result of their extensive use, these compounds are increasingly recognized as contaminants of emerging concern in aquatic environments. Their widespread use, incomplete metabolism in the human body, and improper disposal have resulted in the frequent detection of these compounds in surface waters, sediments, and wastewater effluents. This review critically examines the major sources, global occurrence, environmental fate, and ecological risks associated with steroidal drug contamination in aquatic ecosystems. This review emphasizes compound-specific persistence, bioaccumulation, and endocrine-disrupting effects that adversely affect aquatic organisms, including fish, amphibians, and invertebrates, leading to reproductive abnormalities, altered behavior, and population-level impacts. The review further evaluates conventional and advanced wastewater treatment technologies, highlighting the limitations of existing systems and the potential of emerging remediation strategies such as advanced oxidation processes, adsorption techniques, constructed wetlands, and bioremediation approaches. By integrating recent global case studies and mechanistic insights, this review highlights the urgent need for improved monitoring, sustainable management practices, and regulatory frameworks to mitigate the long-term ecological and human health risks posed by steroidal drug pollution in aquatic environments.</p> Graphical Abstract <p></p>