December 30th, 2008

Anabolic-androgenic steroids (AAS), commonly know as anabolic steroids, are manufactured substances related to male sex hormones (e.g., testosterone). “Anabolic” refers to muscle-building and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, but also body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass.

How are AAS Abused?

Some people, both athletes and non-athletes, abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected, typically in cycles of weeks or months interrupted by shorter resting periods (this is referred to as “cycling”). In addition, users often combine several different types of steroids, a practice referred to as “stacking.”

How Do AAS Affect the Brain?

The immediate effects of AAS in the brain are mediated by their binding to androgen and estrogen receptors, which can then shuttle into the cell nucleus to influence patterns of gene expression. Because of this, the acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference is that AAS are not euphorigenic, meaning that they do not trigger rapid increases in the neurotransmitter dopamine, which are responsible for the “high” that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways and chemicals—such as dopamine, serotonin, and opioid systems—that are affected by drugs of abuse. Considering the combined effect of their complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.

AAS and mental health
Taken together, the preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects.1 For example, many users report feeling good about themselves while on anabolic steroids, but extreme mood swings can also occur, including manic-like symptoms that could lead to violence.2 Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Addictive potential
Animal studies have shown that AAS are reinforcing; that is, animals will self-administer AAS when given the opportunity, just as they do with other addictive drugs.3 This property is more difficult to demonstrate in humans, but the potential for AAS abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations.4 Also, steroid abusers typically spend large amounts of time and money obtaining the drugs, which is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking AAS, such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to the need for continued abuse. One of the most dangerous withdrawal symptoms is depression, because, when persistent, it can sometimes lead to suicide attempts.

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of AAS. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused AAS before trying any other illicit drug. Of these, 86 percent first used opioids to counteract insomnia and irritability resulting from the steroids.5

What Other Adverse Effects do AAS Have on Health?

Steroid abuse can lead to serious, even irreversible health problems. Some of the most dangerous among them include liver damage, jaundice (yellowish pigmentation of skin, tissues, and body fluids), fluid retention, high blood pressure, increases in LDL (bad cholesterol), and decreases in HDL (good cholesterol). Other reported effects include renal failure, severe acne, and trembling. In addition, there are some gender- and age-specific adverse effects:

  • For men—shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer
  • For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
  • For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes; adolescents risk not reaching their expected height if they take AAS before the typical adolescent growth spurt

In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.

What Treatment Options Exist?

There has been very little research on treatment for AAS abuse. Current knowledge derives largely from the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with education about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be needed.

How Widespread is AAS Abuse?

Monitoring the Future*
Monitoring the Future is an annual survey used to assesses drug use among the Nation’s 8th-, 10th-, and 12th-grade students. Steroid use among all three grades remained unchanged from 2006 to 2007, for both boys and girls, although significant reductions were noted since 2001 for lifetime and past-year use among all grades, and for past-month use among 8th and 10th graders. Among seniors in 2007, past-year steroid use was reported by 2.3 percent of boys versus 0.6 percent of girls.

Anabolic Steroid Use by Students
2007 Monitoring the Future Survey
   8th Grade  10th Grade  12th Grade
Lifetime 1.5% 1.8% 2.2%
Past Year 0.8 1.1  1.4 
Past Month 0.4 0.5  1.0 
“Lifetime” refers to use at least once during a respondent’s lifetime.
“Past year” refers to use at least once during the year preceding an individual’s response to the survey.
“Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.


Article adapted by Weblog from NIDA.

* These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan’s Institute for Social Research. The survey has tracked 12th graders’ illicit drug use and related attitudes since 1975; in 1991, 8th and 10th graders were added to the study.

1 Pope HG Jr, Kouri EM, Hudson MD. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: a randomized controlled trial. Arch Gen Psychiatry 57(2):133–140, 2000. 
2 Pope HG, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry 145(4):487–490, 1988.
3 Arnedo MT, Salvador A, Martinez-Sanchis S, Gonzalez-Bono E. Rewarding properties of testosterone in intact male mice: a pilot study. Pharmacol Biochem Behav 65:327–332, 2000.
4 Brower KJ. Anabolic steroid abuse and dependence. Curr Psychiatry Rep 4(5):377–387, 2002.
5 Arvary D, Pope HG Jr. Anabolic-androgenic steroids as a gateway to opioid dependence. N Engl J Med 342:1532, 2000.

Revised 6/08