Anabolic steroids are a class of manmade drugs that are chemically related to the male hormone testosterone.
Anabolic steroids are more accurately called anabolic-androgenic steroids. This name defines their two principle characteristics. Anabolic means to synthesize or build up; thus, anabolic steroids increase skeletal muscle mass. Androgenic means involving male sexual characteristics. Anabolic steroids are related to testosterone and affect the body in many of the same ways as testosterone. Testosterone is the main hormone responsible for male sexual characteristics. It stimulates and maintains the male reproductive organs, stimulates development of bones and muscle, promotes skin and hair growth, and can influence emotions and sex drive. In males, the testes produce testosterone, and a small amount also is secreted by the adrenal glands. Women have only the small amount of testosterone produced by the adrenal glands.
Several hundred different types of anabolic steroids have been synthesized in attempts to maximize their benefits and minimize side effects. As of 2017, not a single anabolic steroid had been manufactured that was free of negative side effects. In many developing countries, anabolic steroids can be purchased without a prescription.
Concerns over the growing illicit market and the prevalence of abuse, combined with the possibility of harmful long-term effects of steroid use, led the United States Congress in 1991 to place anabolic steroids in Schedule III of the Controlled Substances Act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth.
On January 20, 2005, the Anabolic Steroid Control Act of 2004 took effect, amending and expanding the Controlled Substance Act by placing both anabolic steroids and prohormones (substances the body can convert into anabolic steroids) on the controlled substance list and making possession of the banned substances a federal crime. Possession of an anabolic steroid without a prescription is illegal and can result in a maximum one-year prison sentence and a minimum fine of $1,000 for the first offense. Some states have implemented additional penalties.
Anabolic steroid users often take extremely high doses of steroids; generally, 10–100 times the usual therapeutic dose. Doses taken can add up to 100 mg a day or more through “stacking,” or combining several different types or brands of steroids. Often athletes take these drugs on a schedule called “cycling,” in which they take steroids for a period of 12–16 weeks, followed by a steroid-free period. Another approach to illicit anabolic steroids use is “pyramiding,” in which doses are gradually increased to mid-cycle, then decreased to zero.
Most steroid users tend to be young and male. A 2010 national survey examining steroid use by high school seniors reflects this sharp gender divide, with only 0.3% of senior girls reporting use during the past 12 months, whereas past-year use by senior boys stood at 2.5% Steroid abuse has spread downward from elite and professional athletes to college and high school athletes and younger. According to a 2016 survey by the U.S. National Institute on Drug Abuse (NIDA), 9% of eighth graders, 1.3% of tenth graders, and 1.6% of twelfth graders had at some time used illicit steroids.
Anabolic steroids were first developed in the 1930s in Europe to treat conditions in which the testes did not secrete enough testosterone. Physicians tried using these drugs for many other purposes in the 1940s and 1950s with limited success. Disadvantages outweighed benefits for most purposes, and during the later decades of the twentieth century, medical use in North America and Europe was restricted to a few conditions. These include:
Shortly after the first anabolic steroids were synthesized, experimenters realized that these compounds caused an increase in muscle mass in laboratory animals. This soon led to the abuse of these drugs by bodybuilders and weightlifters. Anabolic steroid use spread to elite athletes looking for an edge in strength and speed. By the 1950s, some Olympic athletes, primarily from the Soviet Union, East Germany, and other Eastern European countries, were taking large doses of steroids that allowed them to dominate their sports. Many of the male athletes developed such enlarged prostate glands (a gland that surrounds the urethra and aids in semen production) that they needed a tube inserted into their urethra to urinate. Some of the female athletes developed so many male physical characteristics (e.g., low voices, facial hair, male musculature) that chromosome tests were necessary to prove that they were female.
Most illicit anabolic steroids are sold at gyms, bodybuilding competitions, and through the mail and Internet. Many of these substances or the raw materials to make them are smuggled into the United States from countries where their possession without a prescription is legal (e.g., China, Mexico). The drugs are available as pills and injectable liquids, as well as topical preparations such as gels and creams. Anabolic steroids commonly encountered on the illicit market include: boldenone (Equipoise), ethlestrenol (Maxibolin), fluoxymesterone (Halotestin), methandriol, methandrostenolone (Dianabol), methyltestosterone, nandrolone (Durabolin, Deca-Durabolin), oxandrolone (Anavar), oxymetholone (Anadrol), stanozolol (Winstrol), testosterone (including sustanon), and trenbolone (Finajet). In addition, new anabolic steroid compounds designated as “designer drugs,” specifically formulated to be undetectable by current drug tests, are constantly being developed. Many of these drugs are produced in unsanitary, illicit laboratories with little or no quality control. In addition, many counterfeit products that do not contain any steroids or that are mislabeled relative to the type and dose of steroid they contain are sold over the Internet.
Anabolic steroids also affect mental health. Their use can cause drastic mood swings, inability to sleep, depression, paranoia, jealousy, delusions, irritability, and feelings of anger and hostility. There is some evidence that young men may become more volatile and violent when taking these drugs, a condition known as “roid rage.” Steroids also may be psychologically and physically addictive to some users. Withdrawal symptoms may include steroid craving, decreased appetite, insomnia, fatigue, restlessness, reduced sex drive, depression, and suicidal thoughts.
In addition to these physical and mental side effects, steroid abuse brings other risks, some of which are connected to the way some steroids are manufactured and distributed. The drugs are often made in motel rooms, bathrooms, and warehouses in developing countries, and then smuggled into the United States. The potency, purity, and strength of the steroids produced this way are not regulated; therefore, users cannot know how much they are taking. Some users of injectable steroids share needles, increasing the risk of contracting HIV or hepatitis.
Some health food stores sell what they call “natural steroids” over the counter. Because these natural steroids are not produced synthetically but are derived from plants and animals without any chemically alterations, they can, as of 2011, be legally be sold as dietary supplements in the United States. Nevertheless, natural steroids are just as dangerous as any other steroid drugs. They cause the same side effects and have the same uncertainties about strength and purity as illegal synthetic steroids.
Diagnosis is often difficult because anyone using anabolic steroids without a prescription and not under the direction of a physician is considered to be abusing the drug. Many athletes either do not understand what they are taking or strongly resist admitting that they are using performance-enhancing substances. Sudden increase in musculature, as well as other symptoms are clues that anabolic steroid abuse could be occurring. Virtually all major professional sports leagues in the United States test for steroids and other performance-enhancing drugs, as do most intercollegiate athletic leagues. The World Anti-Doping Agency (WADA) works to control abuse of all performance-enhancing substances at the international level. Many steroids are detectable in urine samples, but new designer compounds are constantly being developed in a deliberate attempt to make them undetectable by current tests.
Few studies of treatment for anabolic steroid abuse have been conducted. Knowledge as of 2017 is based largely on the experiences of a small number of physicians who have worked with individuals undergoing steroid withdrawal. These physicians have found that supportive therapy is sufficient in some cases. Patients are educated about what they may experience during withdrawal and are evaluated for suicidal thoughts. If symptoms are severe or prolonged, medications or hospitalization may be needed. Depression needs to be monitored closely.
Sometimes medications are used to restore hormone balance after its disruption by steroid abuse. Other medications target specific withdrawal symptoms; for example, antidepressants to treat depression, and analgesics (pain relievers) for headaches, muscle, and joint pains. Some individuals are psychologically addicted to steroids and benefit from behavioral therapies.
Anabolic steroid abuse is a treatable condition. Abusers can overcome the problem with the help of family members, support groups, psychotherapy, medication, treatment programs, and family counseling. These programs are customized to help teens and adults lead productive and normal lives. Heavy steroid use, even if it is stopped after a few years, may stunt growth and increase the risk of liver cancer. A steroid user who quits may experience severe depression that can lead to suicidal thoughts and suicide attempts or completion. The risk of depression and suicide is highest among teenage abusers.
Some physicians recommend that athletes using steroids avoid sudden discontinuance of all steroids simultaneously because their bodies may enter an immediate catabolic (metabolic breakdown of compounds) phase. This can lead to a considerable loss of strength and mass, increased fat and water in the body, and breast enlargement in males. Breast enlargement occurs because the low androgen level shifts the hormone balance in favor of estrogen compounds that suddenly become the dominant hormones.
See also Amenorrhea ; Blood pressure and exercise ; Bodybuilding ; Performance-enhancing drugs .
Melmed Schlomo, et al. Williams Textbook of Endocrinology. 13th ed. Philadelphia: Saunders Elsevier, 2016.
Safran, Marc R., et al. Instructions for Sports Medicine Patients. 2nd ed. Philadelphia: Elsevier Saunders, 2012.
Seidenberg, Peter H., and Anthony I. Beutler, eds. Sports Medicine Resource Manual. Philadelphia: Elsevier Saunders, 2008.
Colburn, Shaun. et al. “The Cost of Seeking an Edge: Recurrent Renal Infarction in Setting of Recreational Use of Anabolic.” Annals of Medicine & Surgery 14 (February 2017): 25–8.
Kovac, J. R., et al. “Men Regret Anabolic Steroid Use Due to a Lack of Comprehension Regarding the Consequences on Future.” Andrologia 47, no. 8 (October 2015): 872–8.
Murray, S. B., et al. “Anabolic Steroid Use and Body Image Psychopathology in Men: Delineating between Appearance Versus Performance-Driven Motivations” Drug and Alcohol Dependence 165 (August 1, 2016): 198–202.
Mayo Clinic Staff. “Performance-Enhancing Drugs: Know the Risks.” Mayo Foundation for Medical Education and Research. http://www.mayoclinic.com/health/performance-enhancing-drugs/HQ01105 (accessed March 7, 2017).
National Institute on Drug Abuse. “What Are Anabolic Steroids?” US Department of Health & Human Services. http://www.drugabuse.gov/infofacts/steroids.html (accessed March 7, 2017).
American College of Sports Medicine, 401 W. Michigan St., Indianapolis, IN, 46202-3233, (317) 6379200, Fax: (317) 634-7817, http://www.acsm.org .
National Institute on Drug Abuse, Office of Science Policy and Communications, Public Information and Liaison Branch, 6001 Executive Blvd., Rm. 5213, MSC 9561, Bethesda, MD, 20892-9561, (301) 443-1124, email@example.com, http://www.drugabuse.gov .
United States Anti-Doping Agency, 5555 Tech Center Dr., Ste. 200, Colorado Springs, CO, 80919, (719) 785-2000, (866) 601-2632, firstname.lastname@example.org, http://www.usada.org .
National Center for Drug Free Sport, 2735 Madison Ave., Kansas City, MO, 64108, (816) 474-8655, Fax: (816) 502-9287, email@example.com, http://www.drugfreesport.com .
National Institute on Drug Abuse, 6001 Executive Blvd., Rm. 5213, Bethesda, MD, 20892, (301) 443-1124, firstname.lastname@example.org, http://www.drugabuse.gov .
U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993-0002, (888) INFO-FDA (463-6332), http://www.fda.gov .
Tish Davidson, AM