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Some anabolic steroid users continue using the drugs despite experiencing physical problems and problems in their social relationships. The percentage of those who continue use in spite of negative consequences is not known.
The term “anabolic steroids” is used to refer to a group of synthetic substances that mimic the effects of male sex hormones such as testosterone. The drugs promote in both males and females the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects).
Therefore, the proper term for these substances should be “anabolic-androgenic steroids,” throughout this site, they are referred to as the more commonly used term “anabolic steroids.”
Used for Medical Purposes
Anabolic steroids were originally developed in the 1930s to treat hypogonadism, a medical condition in which the testes do not produce enough testosterone. Currently, they are prescribed to treat steroid hormone deficiency, such as delayed puberty and some types of impotence
Sometimes, steroids are prescribed to counteract the wasting away of the body’s muscle mass due to diseases like some cancers and HIV infection.
Abused by Athletes
When early research with animals in the 1930s found that anabolic steroids could facilitate the growth of skeletal muscle, the drugs began to be abused for that purpose by bodybuilders and weightlifters. They later began to be abused by athletes in other sports because of their performance-enhancing capabilities.
Because their use can affect the outcome of sports competitions, anabolic steroids have been banned from use by all amateur and professional sports organizations.
In some countries, no prescription is needed for anabolic steroids. Therefore, most of the illicit steroids sold in gyms, competitions, and mail-order operations are smuggled into the United States. Some steroids are produced in illegal laboratories or diverted from pharmacies.
According to the National Institute on Drug Abuse, these are some commonly abused steroids:
Oral Steroids
- Anadrol (oxymetholone)
- Dianabol (methandrostenolone)
- Oxandrin (oxandrolone)
- Winstrol (stanozolol)
Injectable Steroids
- Deca-Durabolin (nandrolone decanoate)
- Depo-Testosterone (testosterone cypionate)
- Durabolin (nandrolone phenpropionate)
- Equipoise (boldenone undecylenate)
- Tetrahydrogestrinone (THG)
What Are Steroidal Supplements?
Steroidal supplements, promoted as hormone products or alternatives to anabolic steroids, are substances that claim to be converted into testosterone or similar compounds in the body. Many of these products are marketed and labeled as dietary supplements which can increase muscle mass and strength.
Up until 2004, substances called steroid supplements could be purchased legally at health food stores and other commercial outlets. But, in 2004, Congress passed amendments to the Controlled Substance Act making the sale of supplements like tetrahydrogestrinone (THG) and androstenedione (street name Andro) illegal.3
The exception to the new laws was dehydroepiandrosterone (DHEA).
The U.S. Food and Drug Administration (FDA) regularly issues public health advisory warnings about bodybuilding products that are represented to contain steroids or steroid-like substances.4 The warnings state: “These products are marketed as dietary supplements, they are NOT dietary supplements, but instead are unapproved and misbranded drugs.”
Because these steroid supplement products could increase testosterone levels in the body like anabolic steroids themselves, it is believed that their side effects could also be the same. Little research has been done on the side effects of these supplements, but the FDA warns they can be harmful.
Depending on the type, anabolic steroids can be taken orally, injected intramuscularly, or applied through the skin as gels or creams. When used for medical purposes, anabolic steroids can be taken by intramuscular or subcutaneous injection, orally, pellet implantation under the skin or by application to the skin via patches or gels.
However, the size of the dosages used by steroid abusers can be much larger than those used for legitimate medical purposes. When steroids are abused for nonmedical purposes they are usually injected or taken orally.
According to researchers, endurance athletes typically use dosages slightly below replacement levels of 5 to 10 mg/day.5 Sprinters will usually take 1.5 to 2 times replacement levels. Weight lifters and bodybuilders will take 10 to 100 times normal doses.
Women athletes use lower dosages than men, regardless of the sport for which they are training.
People who abuse anabolic steroids sometimes use different methods, or patterns, of usage based on their goals. Athletes may use steroids for a limited period of time to accomplish a specific goal, but bodybuilders may use steroids for long periods of time. They include:
Cycling
This method involves taking multiple doses over a specific period of time, stopping for a period, and then starting again. Typically, users will take steroids for six weeks to 16 weeks at a time, followed by several weeks of taking low doses or no steroids at all.
Athletes who know they are going to be tested – for example, during a specific event or competition – will time their cycle in hopes of passing the drug test. Cycling is also used to try to minimize the undesirable side-effects of steroids use.
According to Dr. James Tolliver a pharmacologist with the DEA, the reasons that users report that they use cycling include:5
- Ensure peak performance during competition
- Prevent detection of steroid use
- Reduction of adverse effects
- Reduction of tolerance development
- Stacking
When abusers combine different types of steroids—such as those taken orally as well as those injected—it is called stacking. The idea behind the practice is that the different kinds interact to produce a greater effect.
Many users try stacking in hopes of increasing the effectiveness of the combination of steroids, but there is no scientific evidence to back that theory up.
According to the DEA’s Dr. Tolliver:5
- Injectables may be stacked with oral preparations
- Short-acting steroids may be stacked with longer-acting steroids
- Stacking is never done in medical practice
Pyramiding
In this method, users start with low doses then increase the dosage or the frequency until they reach a peak at mid-cycle. Then they gradually reduce the dosage or frequency down to zero. Typically, the pyramid cycle will last six to 12 weeks. This is usually followed by a cycle when the user continues to train or exercise without taking steroids.
Pyramid users believe the method gives the body time to adjust to the high dosages and the drug-free period allows the body’s hormonal system time to recuperate. But again, the theory is not supported by scientific research.
The negative side effects linked to anabolic steroid abuse can range from those that are mildly annoying to those that can be life-threatening. Steroid abusers report experiencing health effects that range from developing acne problems to having heart attacks and liver cancer.6
Most of the effects of using anabolic steroids are reversible when the person stops using the drugs, but some can be permanent.
According to the National Institute on Drug Abuse, most of the information the agency has gathered about the long-term effects of anabolic steroids has been obtained from case reports and not from formal epidemiological studies.7 Most of the research conducted on long-term steroid effects thus far has been done with animal studies.
Some Effects Show Up Years Later
The prevalence of life-threatening effects of steroid abuse seems to be very low from case studies, but the NIDA reports that serious adverse effects may be underreported and underrecognized because they sometimes do not appear until years after the abuse.7
Anabolic steroid abuse can affect many different bodily systems. The following are some of those effects include the following.
Hormonal System Effects
The disruption that steroid abuse causes to the body’s normal production of hormones can cause some changes that are reversible and some changes that are irreversible. Reduced sperm production and shrinking of the testicles are two changes that can be reversed once the steroids are no longer used.
Male-pattern baldness and breast development (gynecomastia) in men are two of the side effects of steroid abuse that cannot be reversed.5 One study found that a majority of male bodybuilders experienced testicular atrophy and/or gynecomastia.6
Women who abuse anabolic steroids can experience masculinization. Their voices can become deeper, their breast size and body fat can decrease, the clitoris can become enlarged and the skin can become coarse. Women can lose scalp hair, but experience excessive growth of body hair.
With long-term steroid abuse, some of these changes in women can become irreversible, particularly the deepened voice.
According to the latest research available regarding anabolic steroids, there are several physical and mental effects of steroid abuse on males and females.7
Short-term adverse effects in men may include:
- Abnormal liver function
- Acne
- Bleeding (usually nose)
- Decreased HDL cholesterol levels
- Decreased semen volume
- Decreased sperm production and motility
- Elevated blood pressure
- Enlargement of the breast (gynecomastia)
- Fluid retention leading to swelling
- Frequent or continuing erections
- Increased LDL cholesterol levels
- Prostate enlargement
- Shrinkage of the testicles
- Skin tissue damage at the site of injection
Short-term adverse effects in prepubertal boys may include:
- Decrease in the total height achieved
- Fluid retention leading to swelling
- Increased frequency of penile erections
- Painful, prolonged penile erections
- Penis enlargement
- Precocious sexual development
Short-term adverse effects in women:
- Acne
- Decreased breast size
- Deepening of the voice
- Enlargement of the clitoris
- Fluid retention leading to swelling
- Increased body and facial hair growth
- Male pattern baldness
- Menstrual irregularities (missed or no periods)
- Oily skin
- Tissue damage at injection site
There is a limited amount of scientific research about the long-term effects of anabolic steroid abuse on men or women. The “possible” long-term effects listed below come mostly from case studies.2
Long-term consequences of anabolic steroid abuse in men and women may include:
- Adverse cardiovascular effects
- Cancer of the prostate (men only)
- Liver cancer
- Liver dysfunction
- Liver tumors
Other potential risks faced by anabolic steroid abusers in men and women:
- Hepatitis infections
- HIV infection (needle sharing)
- Skin infections
- Violent trauma
Musculoskeletal System
Anabolic steroid abuse in male children can cause stunted growth. Normally, rising level of testosterone and other sex hormones trigger the growth spurt that takes place during puberty. It also provides the signals to tell the bones to stop growing. When steroid abuse artificially increases these sex hormone levels it can prematurely signal the bones to stop growing.
Side effects of steroids on the musculoskeletal system can include short stature (if taken by adolescents) and tendon rupture.
Cardiovascular System
Because steroid abuse can change the levels of lipoproteins that carry cholesterol in the blood, abusers can develop cardiovascular diseases.
Steroid use, particular oral steroids, has been shown to reduce the level of high-density lipoprotein (“good cholesterol”) and increase the level of low-density lipoprotein (“bad cholesterol”), resulting in the increased risk for atherosclerosis, which can cause heart attack and stroke.
Steroid abuse can also increase the risk of blood clots forming in the blood vessels. Effects of steroid abuse on the cardiovascular system include:7
- Decreases in HDL
- Enlargement of the heart’s left ventricle
- Heart attacks
- High blood pressure
- Increased blood clotting
- Increases in LDL
- Spasms of the coronary arteries
Liver
Research has found that anabolic steroid abuse can cause tumors to form in the liver. Steroids can also cause a rare condition known as peliosis hepatis, in which blood-filled cysts form in the liver. Internal bleeding can occur when either the tumors or the cysts rupture.
Side effects of steroid abuse on the liver include:
- Cancer
- Peliosis hepatis
- Tumors
Skin
Effects of steroid abuse on the skin can include:
- Fluid retention
- Jaundice
- Oily scalp and skin
- Severe acne and cysts
Infections
Because some who abuse steroids inject the drugs and use nonsterile injection techniques or share contaminated needles with other abusers, they are at increased risk for developing HIV and hepatitis B and C like all other injection drug users.
Additionally, injection steroid users can develop endocarditis, an infection that can cause inflammation of the inner lining of the heart, a condition which can be fatal.
Indications are that high doses or anabolic steroids increase irritability and aggression which may be caused by secondary hormonal changes. As with the health effects of steroids, most of the information about the behavioral effects of steroid abuse comes from case reports and small studies.
In these case studies, anabolic steroid abusers report that when they are taking steroids they are more likely to engage in aggressive behavior such as fighting, armed robbery, burglary, theft, and vandalism than they are when they are drug-free, according to the National Institute on Drug Abuse.
The NIDA reports four studies in which volunteers were given high dosages of anabolic steroids.7 In three of the studies, the volunteers reported greater feelings of aggression and irritability, although the effects varied widely between individuals.
Research Results Vary
In the fourth study, no such link to irritability and aggression was reported. The researchers speculated that it may be because some steroids, but not all, increase aggression.
In a few controlled studies, aggression or adverse behavior was reported after steroid abuse, but only by a minority of the volunteers in the studies.2
Anger, Hostility, Aggression or Violent Behavior
According to steroid abuse researchers, anger, irritability, hostility, aggression and/or violent behavior:
- Increased likelihood with higher doses
- Minor provocations evoke exaggerated responses
- Occurs in some but not all anabolic steroid users
- Presents danger to law enforcement
- Presents danger to spouse, family, and friends
- Unpredictable who will respond
Psychological Effects of Steroid Abuse
There have been some reports of psychotic and manic reactions in both men and women who abuse anabolic steroids, but these have been rare occurrences and researchers believe they have most likely occurred in users with prior mental illness.8
It is not known scientifically to what extent anabolic steroid use has on violence and behavioral disorders. The prevalence of extreme cases of violence among steroid abusers appears to be low, but as with the health effects, extreme violence could be underreported or underrecognized.
Some other psychological effects of steroid abuse that have been reported include:
- Hallucinations and delusions
- Manic behavior
- Mood swings
Prompts Other Drug Use?
Some research has found that use of anabolic steroids may cause users to turn to other drugs to alleviate the negative effects. One study found that 9.3% of men who were being treated for heroin or other opioid abuse had abused steroid before doing any other drugs.7
Of that 9.3% in treatment, 86% said they initiated opioid use to counteract insomnia and irritability caused by their steroid use.
Some individuals who abuse anabolic steroids can develop patterns of behavior that are typical symptoms of people who are addicted. Those behaviors include continuing use despite negative consequences, spending excessive time and effort in obtaining drugs, and experiencing withdrawal symptoms when they stop using.
Some anabolic steroid users continue using the drugs despite experiencing physical problems and problems in their social relationships. The percentage of those who continue use in spite of negative consequences is not known.
Classic Addiction Symptoms
Many steroid abusers spend large amounts of time and money to obtain the drugs they use. When they stop taking steroids, users can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids.
Other withdrawal symptoms reported in case studies of people coming off anabolic steroids use include:9
- Anorexia
- Apathy
- Decreased sex drive
- Difficulty concentrating
- Fatigue (extreme tiredness)
- Feelings of anxiety
- Headaches
- Insomnia
- Muscle and joint pain
One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to suicide attempts, the NIDA reports. Research reveals that if untreated, depression associated with anabolic steroid withdrawal can persist for a year or longer after use of the drug stops.
What Treatments Are Effective for Steroid Abuse?
Treatment options recommended by the National Institute on Drug Abuse for anabolic steroid abuse are based more on case studies and physician experience rather than controlled studies. There has been very little research into treatment for steroid abuse.
The NIDA’s Research Report on anabolic steroids reported that few studies had been conducted on steroid treatment. These studies suggest that patients going through anabolic steroid withdrawal may only require supportive and educational therapy, in many cases. Though physicians need to evaluate them for suicidal thoughts due to steroid withdrawal.
If withdrawal symptoms listed above become severe or prolonged, patients are given medications to treat the specific withdrawal symptoms. For example, antidepressants for depression or analgesics for headaches and pain.
Some steroid withdrawal patients receive medication to help restore their hormonal systems. Others are treated with behavioral therapies for withdrawal symptoms that go beyond pharmacological treatment.
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
Preventing Steroid Abuse
Because the dangers of anabolic steroid abuse are so great and because there does exist a potential for some users to develop addictive-like behavior related to steroid use, efforts should be concentrated on preventing the use in the first place, especially among young student-athletes.
By far the most prevalent anabolic steroid prevention programs in the U.S. are those aimed at professional, Olympic and college athletes. Very few local school districts have established steroid prevention programs.
According to NIDA, an estimated 9% of secondary schools have drug testing programs for illicit drugs and less than 4% of high schools in the United States test their athletes for anabolic steroids.7
Even if such testing was more widespread, research has yet to clearly determine if drug testing is effective in reducing drug abuse. The NIDA is currently funding that research.
Scientific studies have shown that teaching youth about the adverse effects of steroids alone is not as effective in preventing steroid use as well as programs that present both the risks and benefits of using anabolic steroids. Students find a balanced approach more credible, the NIDA says.
Effective Prevention Programs Available
Although most secondary schools do not have official anabolic steroids prevention programs in place, there are programs available that have been shown to be effective in reducing steroid abuse, other substance abuse, and other risky behaviors.
Two of those programs, developed by Oregon Health & Science University and funded by the National Institute on Drug Abuse, are the Adolescents Training and Learning to Avoid Steroids (ATLAS) for high school football players and the Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) for school girls on sports teams.
The NIDA reports that these two sophisticated approaches have shown promise in preventing steroid abuse among high school sports players.
The ATLAS Program
The ATLAS program is designed to show high school football players that they can build powerful bodies and improve their athletic performance without using dangerous anabolic steroids.10
The program not only provides education about the harmful side effects of anabolic steroids but also provides nutrition and weight-training alternatives to using steroids. According to NIDA research, the program has been successful in reducing the participants’ intentions to use steroids while increasing their healthy behaviors.
One of the hallmarks of the ATLAS program is that the football coaches and team leaders are the ones who teach the players about the harmful effects of steroids and other illicit drugs on sports performance. They also discuss how to refuse if they are offered drugs.
In controlled studies of the ATLAS program, researchers compared athletes in 15 high schools who were in the program with a control group who did not receive the training.
Effects of the ATLAS Program
After one year in the program, the ATLAS-trained students had:
- Half the incidence of new anabolic steroids abuse
- Increased protection against steroid and other substance abuse
- Less abuse of alcohol, marijuana, amphetamines, and narcotics
- Less abuse of athletic enhancing supplements
- Less intention to abuse steroids in the future
- Lower likelihood of engaging in hazardous substance abuse behaviors
The study found that ATLAS-trained athletes had less interest in trying steroids, less desire to abuse them, better knowledge of alternatives to steroid abuse, improved body image, and increased knowledge of diet supplements.
The ATHENA Program
The Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) program were patterned after and similar to the ATLAS program, but designed for girls who participate in high school sports programs.
An early study of the ATHENA program found that before participating in the training, the control group and the ATHENA group exhibited similar risk behaviors.11 Participation in the ATHENA training significantly decreased those behaviors, the researchers found.
The female athletes who did not receive the ATHENA training were three times more likely to begin using diet pills during the sports season. They were twice as likely to abuse other body-shaping substances such as amphetamines, anabolic steroids, and muscle-building supplements during the season.
During the sports season, girls in the control group increased their use of diet pills, while those who received the ATHENA training, cut their diet pill use in half of their preseason usage.
Reduced Risky Behaviors
The ATHENA-trained girls reduced other risky behaviors. They were:
- Experienced fewer injuries during the sports season
- Less likely to be sexually active
- Less likely to ride in a car with a drinking driver
- More likely to wear seatbelts
The ATLAS and ATHENA programs for high school athletes has been endorsed by the United States Congress and the Substance Abuse and Mental Health Services Administration as a model program for secondary schools across the country.