Steroid-induced avascular necrosis of the femoral head (SANFH) is a metabolic disease, which occurs due to improper use of glucocorticoid drugs in clinic, resulting in damage to the internal blood supply system of the femoral head and the death of bone cells and bone marrow tissue components, which may lead to structural changes of the femoral head, collapse of the femoral head and dysfunction of joints. Due to frequent collapse of the femoral head and dysfunction of the hip joint, adult steroid-induced avascular necrosis of the femoral head is a challenging orthopedic disease. Eventually, patients need total hip arthroplasty, which will seriously endanger the quality of their daily life. However, the pathogenesis of the disease is still unclear. In recent years, with the further development of precision medicine and extensive and in-depth research on stem cells and molecular biology, people are studying the exact pathogenesis of SANFH and exploring more new treatments. This review discusses several main theories about the pathogenesis of SANFH.