Anabolic steroids are synthetic, or human-made, variations of the male sex hormone testosterone. Both males and females have testosterone produced in their bodies: males in the testes and females in the ovaries and other tissues. The proper term for these compounds is anabolic-androgenic steroids. "Anabolic" refers to muscle building, and "androgenic" refers to increased male sex characteristics such as those experienced by males during puberty. People often think of anabolic steroids when someone refers to steroids, but steroids may also refer to corticosteroids. These steroids imitate cortisone hormones produced by the body's adrenal glands in response to stress. There are also other performance-enhancing drugs (PEDs) that people sometimes mistakenly refer to as steroids.
Once viewed as a problem only associated with bodybuilder and professional athletes, steroids' abuse is much more common in today's society. The problem is widespread throughout society, including school-age children, athletes, business professionals, or people who are merely wanting to look more attractive. The National Institute on Drug Abuse estimates that more than half a million 8th and 10th-grade students are now using steroids. Increasing numbers of high school seniors don't believe they are risky.
When used illegally or abused, there are several sources for obtaining the drug. The most common is smuggling steroids into the United States from other countries such as Mexico and European countries. Smuggling from these areas is more straightforward because a prescription is not required to purchase steroids, which are then sold on America's black market. These drugs are also available from prescriptions that have been sold or obtained illegally and then sold for profit. Less frequently, but still occurring, steroids are manufactured in clandestine laboratories, usually overseas, and smuggled into the country.
Anabolic-Androgenic Steroids, which we will refer to as AAS from here on, are frequently produced in pharmaceutical laboratories. But, in nations where stricter laws are present, they are also made in small home-made underground laboratories, usually from raw substances imported from abroad. In these countries, the majority of steroids are obtained illegally through the black-market trade.
When purchased illegally, these drugs are rarely called "steroids" and instead are referred to by street names. Examples of street or slang names for steroids include Gear, Juice, Roids, Arnolds, Gym Candy, Pumpers, Stackers, Weight Gainers, and many more.
The History of Steroids
Anabolic steroids were developed in the late 1930s primarily to treat hypogonadism, a condition in which the testes do not produce sufficient testosterone for average growth, development, and sexual functioning. These compounds' primary medical uses are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other diseases. During the 1930s, scientists discovered that anabolic steroids could facilitate skeletal muscle growth in laboratory animals, which led to abuse of the compounds first by bodybuilders and weightlifters and then by athletes in other sports.
The history of the U.S. legislation on AAS goes back to the late 1980s when the U.S. Congress considered placing AAS under the Controlled Substances Act following the controversy over Ben Johnson's victory at the 1988 Summer Olympics in Seoul. AAS were added to Schedule III of the Controlled Substances Act in the Anabolic Steroids Control Act of 1990.
The same act also introduced more stringent controls with higher criminal penalties for offenses involving the illegal distribution of AAS and human growth hormone. By the early 1990s, after AAS were scheduled in the U.S., several pharmaceutical companies stopped manufacturing or marketing the products in the U.S.
In the U.S., Canada, and Europe, illegal steroids are sometimes purchased just as any other illegal drug, through dealers who can obtain the drugs from several sources. Illegal AAS are sometimes sold at gyms and competitions and through the mail but may also be obtained through pharmacists, veterinarians, and physicians. Also, many counterfeit products are sold as AAS, in particular via mail order from websites posing as overseas pharmacies. In the U.S., black-market importation continues from Mexico, Thailand, and other countries where steroids are more readily available, as they are legal.
Steroid abuse is prevalent in the sports world because some athletes want to win or rise to the top, no matter the cost. The problem is exacerbated by professional athletes who abuse the drugs.
What do steroids look like?
Effects of Steroids
A variety of side effects can occur when anabolic steroids are misused, ranging from mild effects to ones that are harmful or even life-threatening. Most are reversible if the user stops taking the drugs. However, others may be permanent or semi-permanent. People who inject steroids increase their risk of contracting or transmitting HIV/AIDS or hepatitis.
Aside from mental effects, steroid use commonly causes severe acne. It also causes the body to swell, especially in the hands and feet. Some of these physical changes, such as shrinking sex organs in men, can add to mental side effects such as mood disorders. Misuse of anabolic steroids might lead to adverse mental effects, such as:
- paranoid (extreme, unreasonable) jealousy
- intense irritability and aggression ("roid rage")
- delusions—false beliefs or ideas
- impaired judgment
Anabolic steroid misuse might lead to severe, even permanent, health problems such as:
- kidney problems or failure
- liver damage and tumors
- enlarged heart, high blood pressure, and changes in blood cholesterol, all of which increase the risk of stroke and heart attack, even in young people
- increased risk of blood clots
Several other effects are gender and age-specific:
- shrinking testicles
- decreased sperm count
- development of breasts
- increased risk for prostate cancer
- growth of facial hair or excess body hair
- decreased breast size
- male-pattern baldness
- changes in or stop in the menstrual cycle
- enlarged clitoris
- deepened voice
- stunted growth (when high hormone levels from steroids signal to the body to stop bone growth too early)
- stunted height (if teens use steroids before their growth spurt)
People who misuse steroids might experience withdrawal symptoms when they stop use, including:
- loss of appetite
- sleep problems
- decreased sex drive
- steroid cravings
One of the more severe withdrawal symptoms is depression, which can sometimes lead to suicide attempts.
Anabolic steroids are seldom associated with acute overdose or one that occurs in one sitting. Instead, anabolic steroid overdose is an accumulation of negative effects over long-term use, also referred to as chronic overdose. Extended anabolic steroid abuse can result in a serious set of adverse effects, such as those discussed above in the lists.
Although it is rare, there are a few ways steroid misuse can cause death.
- Heart attacks and strokes. Steroid misuse can lead to atherosclerosis, where fat builds up inside arteries and makes it hard for blood to flow. When blood flow to the heart is blocked, a heart attack can occur. If blood flow to the brain is blocked, a stroke can occur.
- HIV. People who inject anabolic steroids using needles might share dirty drug injection equipment that can spread serious viral infections such as HIV/AIDS or hepatitis (a liver disease).
- Depression. Steroid misuse can lead to depression, especially during withdrawal. In rare cases, this can contribute to destructive behaviors, including suicide.
- Cancer. There is some scientific evidence that repeated misuse of anabolic steroids can contribute to liver and prostate cancer development.
Mixing steroids with other drugs, including alcohol, can be especially dangerous.
If the person is slowly overdosing on anabolic steroids, professional substance abuse treatment is the best option for their health and survival. Chronic anabolic steroid overdose may not seem like a medical emergency, but it can eventually result in severe consequences to a person's mental and physical health.
Even though anabolic steroids do not cause the same high as other drugs, they can lead to a substance use disorder. A substance use disorder occurs when a person abuses steroids, even though there are severe consequences. The most severe form of a substance use disorder is addiction. People might continue to misuse steroids despite physical problems, high costs to buy the drugs, and adverse effects on their relationships. These behaviors reflect steroids' addictive potential. Research has further found that some steroid users turn to other drugs, such as opioids, to reduce sleep problems and irritability caused by steroids.
About 32% of people who misuse anabolic steroids become dependent. Users often spend exorbitant amounts of money on steroids and have difficulty stopping because of depression and anxiety problems. For the athlete, this anxiety and depression are compounded because steroid use is directly linked to their competitive performance. Steroid users can suffer from withdrawal symptoms if they develop a dependency and stop using the drug. Withdrawal symptoms may include fatigue, restlessness, loss of appetite, problems sleeping, decreased libido, and a craving for the drug. In addition to the negative psychological connotations of quitting, users may become dependent because they don't want to withdraw.
As with any addiction, when substance abuse begins, the drugs are not the problem. They are a solution to the problem. For the steroid-dependent person, this problem could be something like their performance as an athlete. Perhaps they were struggling physically and in their career, and one day they were offered steroids by a friend before a workout. Not knowing how dangerous they were, they took them thinking this would be a one-time thing. But their performance was so much better when working out that they completely shattered their previous personal records and recovered much more quickly. Before their next competition, they ask their friend for another dose. Of course, they win. This being their first win in a while, they begin to doubt their abilities without steroids. Soon, they start taking them regularly. As you can see, they think that the steroid is solving their problem. But soon, they will discover the drawbacks and effects form abusing the drug. These consequences often compel the person to use more steroids to compensate. The cycle can become vicious.
From 1991 to 2003, adolescent steroid use grew at an alarming rate, from 2.7% to 6.1%. In 2004, the NIDA estimated over half a million 8th and 10th graders were using anabolic steroids. Moreover, 1,084,000 adults, or 0.5% of the population, reported steroid use. According to Pediatrics in Review, steroid use is especially common among athletes who play football, baseball, and basketball and those who wrestle or take part in gymnastics. All of the major professional sports leagues test players for steroids. This still doesn't prevent them from using it. For example, although the NFL tests every player at least once each year, an anonymous survey of 2,552 retired players revealed that 16% of offensive linemen and 15% of defensive linemen had used PEDs.
Some athletes suffer from muscle dysmorphic disorder (MDD), which leads them to abuse steroids to "bulk up." MDD is a type of body dysmorphic disorder that leads to unhealthy behavior. MDD stems from the human inclination to compare ourselves to others. For some athletes, the intensely competitive nature of sports can heighten this inclination. Athletes who suffer from MDD are prone to unusual diets with an emphasis on protein and performance-enhancing supplements, steroid abuse, overexertion in the gym, and several maladaptive psychological tendencies. People who misuse anabolic steroids usually take them orally, inject them into muscles, or apply them to the skin as a gel or cream. These doses could be 10 to 100 times higher than doses prescribed to treat medical conditions.
How to help a loved one addicted to Steroids
If someone that you know is taking steroids, it’s not something to ignore. Even though steroid use has become normalized and even glorified in today’s society, it doesn’t mean that it’s safe. Steroid use is a serious and dangerous habit that can cause major health problems and even death. The first “don’t” when we discuss steroid use is don’t downplay it.
Many people who take steroids qualify as having substance use disorder. This means that they are addicted to steroids. For some reason, there’s a myth that steroids aren’t a drug or that people cannot become addicted to them. Sadly, this is untrue.
Much like alcohol, people can treat steroid addiction differently than addiction to other drugs. But substance use disorder is what it is, regardless of the substance used, so we must drop these stereotypes that prevent proper treatment. Steroid addiction responds to drug and alcohol rehabilitation in the same way that all addiction does, and so there is no need for people who abuse steroids to avoid treatment because they are “different” or think that they are not addicted.
Keep in mind that people who abuse steroids may be prone to heightened aggression and episodes of anger. For this reason, it is key to never approach them aggressively or try to force them into treatment. These types of situations are detrimental to any intervention, let alone one where the drug of choice can cause the person to behave aggressively.
People hide their addictions because they are ashamed and know it's wrong. They know that others would not approve, which is why they haven’t told you yet. This means that it is absolutely counterproductive to point out that what they are doing is bad or wrong or that you are upset or disappointed. This isn’t about you. It’s about helping them.
Try to be patient and understanding when you confront them about their steroid use and going to treatment. They will likely lie or minimize the problem and try to make you seem irrational or even at fault for their issues. Do not get into these things or argue. Continue to acknowledge them but refocus the conversation on your concern for them. If you stay calm and keep listening, they may tell you the truth.
If they continue their ways despite your best efforts, it may be wise to look into intervention. Professionals can help you strategize how to best get their cooperation, or they may even be able to come and assists you with the process. You can always call the number on this page to help find treatment options and interventionists near you. It is vital that you have an idea of where this is going when you approach them so that if they agree, you can act swiftly while they are still willing. This decision to get help may be fleeting and as they use more drugs may change. Take advantage of any willingness by being prepared and having treatment options ready.
There are no specific substance abuse treatment methods for steroid dependence, unlike other addictions like opioid use disorder. This is likely because it is less common and less understood than other forms. Steroid abuse is a relatively new phenomenon, so it is less studied since the drugs are much more modern than opioids or alcohol. Fortunately, steroid addiction responds to standard treatment approaches for all forms of addiction. Within these, the two formats for treating substance abuse are inpatient and outpatient. Inpatient treatment is the most common form of rehabilitation and is considered the gold standard due to its effectiveness. Inpatient treatment means that the person lives and stays at the facility for their treatment program duration. They do not come and go, and they have minimal access to the outside world.
This improves treatment outcomes because the person has fewer temptations and much more support for their recovery. Outpatient treatment is where the patient lives at home and travels to the facility to treatment sessions. These sessions may be daily at first, becoming less frequent as the patient becomes more stable. This is because outpatient treatment is used to help people adjust back to independence after completing inpatient treatment. But, while this is not recommended, some people utilize outpatient treatment as a primary rehabilitation program. This is usually because barriers prevent the person from attending inpatient treatment, such as childcare, employment, or school.
However, some people do utilize outpatient treatment for its convenience, and this usually backfires. There is very little support for someone new in recovery, and they can easily relapse. Among these two forms of treatment, there are many different styles of programs to choose from. It is important that you chose one that won't conflict with the core values you have. For example, if you are very religious and need a program that aligns with that, make sure you ask those questions. Any programs have now become secular so that they are more user friendly and can help more people. But each person is different, so make sure you spend some time speaking with the facility about your situation and goals. Also, be sure to be completely honest with them about your drug use and history. This way, they can make sure that they are the best fit for you, and if not, they will refer you to the correct level of care.
Between 1998 and 2000, there was a "sharp decline" in the perception of risk attached to steroid use among adolescents from 1991 to 2003, adolescent steroid use grew at an alarming rate, from 2.7% to 6.1%. In 2004, the NIDA estimated over half a million 8th and 10th graders were using anabolic steroids. Moreover, 1,084,000 adults, or 0.5% of the population, reported steroid use.
Scientific evidence indicates that anabolic steroid abuse among athletes may range between one and six percent. In 2017, high school seniors reported reduced perception of harm in occasional steroid use. Steroidal over-the-counter dietary supplements such as androstenedione were previously available without prescription through health food stores. However, these supplements are now illegal after amendments to the Anabolic Steroid Control Act of 2004.
Among 12th-graders, there was a different trend—from 2000 to 2004, past year steroid use increased, but in 2005 there was a significant decrease, from 2.5 percent to 1.5 percent. Some research has indicated prevalence rates for males being 6.4% which is significantly higher than the rate for females, at 1.6%.
More than a half-million 8th and 10th-grade students are now using these dangerous drugs, and increasing numbers of high school seniors don't believe steroids are risky. Another study indicated that 1,084,000 Americans, or 0.5 percent of the adult population, said they had used anabolic steroids.
Though statistics show that fewer teens are using anabolic steroids, they represent over 75% of steroid users overall.
Trends in Prevalence of Steroids for 8th Graders, 10th Graders, and 12th Graders; 2015 (in percent):
- 1.0 percent of 8th graders,
- 1.2 percent of 10th graders,
- 2.3 percent of 12th graders.
Common Terminology Surrounding Steroids
|Cycling||taking multiple doses of steroids for a while, stopping for a time, and then restarting.|
|Stacking||combining two or more different steroids and mixing oral or injectable types.|
|Pyramiding||slowly increasing the dose or frequency of steroid misuse, reaching a peak amount, and then gradually tapering off to zero.|
|Plateauing||alternating, overlapping, or substituting with another steroid to avoid developing a tolerance.|
|Androgenic||promoting masculine characteristics.|
|Anabolic||relating to muscle or tissue building.|
|Drug misuse||The use of illegal drugs or the use of prescription drugs in a manner other than as directed by a doctor, such as use in more significant amounts, more often, or longer than told to take a drug or using someone else's prescription.|
|Nonmedical use||taking prescribed or diverted prescription drugs (drugs not prescribed to the person using them) not in the way, for the reasons, in the amount, or during the period specified.|
|Overdose||injury to the body that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal.|
|Physical dependence||adaptation to a drug that produces symptoms of withdrawal when the drug is stopped.|