NIDA Info & Facts: Steroids (Anabolic-Androgenic)

Anabolic-androgenic steroids are man-made substances related to male sex hormones. “Anabolic” refers to muscle-building, and “androgenic” refers to increased masculine characteristics. “Steroids” refers to the class of drugs. These drugs are available legally only by prescription, to treat conditions that occur when the body produces abnormally low amounts of testosterone, such as delayed puberty and some types of impotence. They are also prescribed to treat body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass. Abuse of anabolic steroids, however, can lead to serious health problems, some irreversible.

Today, athletes and others abuse anabolic steroids to enhance performance and also to improve physical appearance. Anabolic steroids are taken orally or injected, typically in cycles of weeks or months (referred to as “cycling”), rather than continuously. Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. In addition, users often combine several different types of steroids to maximize their effectiveness while minimizing negative effects (referred to as “stacking”).
Health Hazards
The major side effects from abusing anabolic steroids can include liver tumors and cancer, 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 side effects include kidney tumors, severe acne, and trembling. In addition, there are some gender-specific side 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 — growth halted prematurely through premature skeletal maturation and accelerated puberty changes. This means that adolescents risk remaining short for the remainder of their lives if they take anabolic steroids before the typical adolescent growth spurt.
In addition, people who inject anabolic steroids run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.

Scientific research also shows that aggression and other psychiatric side effects may result from abuse of anabolic steroids. Many users report feeling good about themselves while on anabolic steroids, but researchers report that extreme mood swings also can occur, including manic-like symptoms leading to violence. Depression often is seen when the drugs are stopped and may contribute to dependence on anabolic steroids. Researchers report also that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.


Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. 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 anabolic steroids before trying any other illicit drug. Of these 9.3 percent, 86 percent first used opioids to counteract insomnia and irritability resulting from the anabolic steroids.
Extent of Use
Monitoring the Future (MTF) Survey *

MTF annually assesses drug use among the Nation’s 8th, 10th, and 12th grade students. Annual** use of anabolic steroids remained stable at under 1.5 percent for students in 8th, 10th, and 12th grades in the early 1990s, then started to rise. Peak rates of annual use occurred in 2002 for 12th-graders (2.5 percent), in 2000 and 2002 for 10th-graders (2.2 percent), and in 1999 and 2000 for 8th-graders (1.7 percent). Eight-graders reported significant decreases in lifetime and annual steroid use in 2004, as well as a decrease in perceived availability of these drugs. A significant decrease in lifetime use was also measured among 10th-graders for 2004.

Most anabolic steroids users are male, and among male students, past year use of these substances was reported by 1.3 percent of 8th-graders, 2.3 percent of 10th-graders, and 3.3 percent of 12th-graders in 2004.
Anabolic steroids are:
· Synthetic substances related to the male sex hormones (androgens). They promote growth of skeletal muscle (anabolic effect) and the development of male sexual characteristics (androgenic effects), and also have other effects. (The term "anabolic steroids" will be used throughout this bulletin because of its familiarity, although the proper term for these compounds is "anabolic/androgenic" steroids.)
· Used by doctors to treat conditions that occur when the body produces abnormally low amounts of testosterone, such as delayed puberty and some types of impotence, and also to treat body wasting in patients with AIDS and other diseases.
· Legally available in the United States only by prescription. Anabolic steroid abusers obtain drugs that have been made in clandestine laboratories (sometimes with poor quality control standards), smuggled from other countries, or diverted illegally from U.S. pharmacies.
· Distinct from steroidal supplements. In the United States, supplements such as dehydroepiandrosterone (DHEA) and androstenedione (street name Andro) can be purchased legally without a prescription through many commercial sources including health food stores. They are often taken because the user believes they have anabolic effects.
Anabolic steroid abuse is:
· Increasing among adolescents, and most rapidly among females. The 1999 Monitoring the Future study, a NIDA-funded survey of drug abuse among middle school and high school students across the United States, recorded that 2.7 percent of 8th-graders, 2.7 percent of 10th-graders, and 2.9 percent of 12th-graders reported having taken anabolic steroids at least once in their lives. These figures represent increases since 1991 of approximately 50 percent among 8th- and 10th-graders and 38 percent among 12th-graders.
· Probably widespread among athletes and would-be sports competitors at all levels, although few data are available to provide exact estimates of prevalence. Many anabolic steroid abusers are unwilling to report the practice, because the International Olympic Committee and many other amateur and professional sports organizations have banned anabolic steroids.
· Motivated in most cases by a desire to build muscles and improve sports performance. Some individuals are motivated by erroneous perceptions of their own bodies (that is, a mistaken belief that they look underweight or obese) and others by a desire to prevent recurrence of physical or sexual attacks they have experienced.
Anabolic steroids are taken:
· Orally as tablets or capsules (Anadrol® [oxymetholone], Oxandrin® [oxandrolone], Dianabol® [ methandrostenolone], Winstrol® [stanozolol], and others); by injection into muscles (Deca-Durabolin® [nandrolone decanoate], Durabolin® [nandrolone phenpropionate], Depo-Testosterone® [testosterone cypionate], Equipoise® [boldenone undecylenate], and others); or by ointment preparations rubbed into the skin. Doses taken by abusers can be up to 100 times more than the doses used for treating medical conditions.
· In combinations, a practice called "stacking." Abusers frequently take two or more anabolic steroids together, mixing oral and/or injectable types, sometimes adding drugs such as stimulants or painkillers. The rationale for stacking is a belief-which has not been tested by science-that the different drugs interact to produce a greater effect on muscle size than could be obtained by simply increasing the dose of a single drug.
· In cyclic dosage regimens, a practice called "pyramiding." At the beginning of a cycle, the person starts with low doses of the stacked substances and then gradually increases the doses for 6 to 12 weeks. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle during which the person continues to train, but without drugs. Abusers believe that pyramiding allows the body time to adjust to the high doses, and the drug-free cycle allows time for the body's hormonal system to recuperate. As with stacking, the perceived benefits of pyramiding have not been substantiated scientifically.
Health consequences associated with anabolic steroid abuse include:
· In boys and men, reduced sperm production, shrinking of the testicles, impotence, difficulty or pain in urinating, baldness, and irreversible breast enlargement (gynecomastia).
· In girls and women, development of more masculine characteristics, such as decreased body fat and breast size, deepening of the voice, excessive growth of body hair, and loss of scalp hair, as well as clitoral enlargement.
· In adolescents of both sexes, premature termination of the adolescent growth spurt, so that for the rest of their lives, abusers remain shorter than they would have been without the drugs.
· In males and females of all ages, potentially fatal liver cysts and liver cancer; blood clotting, cholesterol changes, and hypertension, each of which can promote heart attack and stroke; and acne. Although not all scientists agree, some interpret available evidence to show that anabolic steroid abuse-particularly in high doses-promotes aggression that can manifest itself as fighting, physical and sexual abuse, armed robbery, and property crimes such as burglary and vandalism. Upon stopping anabolic steroids, some abusers experience symptoms of depressed mood, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, headache, muscle and joint pain, and the desire to take more anabolic steroids.
· In injectors, infections resulting from the use of shared needles or nonsterile equipment, including HIV/AIDS, hepatitis B and C, and infective endocarditis, a potentially fatal inflammation of the inner lining of the heart. Bacterial infections can develop at the injection site, causing pain and abscess.
To encourage youths to avoid anabolic steroid abuse:
· Present a balanced picture of what these drugs can do for them and to them. Most adolescents know that anabolic steroids build muscles and can increase athletic prowess. Research has shown that failure to acknowledge these potential benefits creates a credibility problem and can actually make youths more likely to try the drugs.
· Make use of the authority of coaches and the team ethos. In the most promising program currently under study, coaches and team leaders are trained to educate team members about the effects of anabolic steroid abuse, both desirable and adverse, in the general context of training. They also provide information about nutrition and, of course, exercise and other training techniques for improving performance without the steroid abuse by as much as 50 percent and also reduces alcohol abuse among teammates.
· It is uncertain whether drug testing programs can discourage anabolic steroid abuse. However, the first scientific studies of this practice are currently under way.

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