Anabolic Steroid Abuse

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Prescription Drug Abuse Statistics

Anabolic steroid abuse facts

  • Anabolic steroids are used illegally to increase muscle, decrease fat, and enhance athletic performance and body appearance.
  • Anabolic steroids act by increasing the androgenic testosterone effects within the body.
  • Anabolic steroids can lead to potentially fatal side effects.
  • Anabolic steroids may be addictive, and users may go through withdrawal.
  • Prevention requires community education, as well as reviewing why adolescents may want to start using the drugs and understanding the risks involved.

What are anabolic steroids?

Anabolic steroids are one type of performance-enhancing drug or medication. They mimic testosterone in the body to enhance performance by making muscle cells larger and by allowing the body to recover more quickly from the stress of exercise. Slang for anabolic steroids is roids.

Performance-enhancing drugs are no longer just for bodybuilders or pro athletes who are willing to try illegal and potentially dangerous means to improve their body's function. These drugs are being used every day by people of all ages, from middle-school, high-school, and college students to older recreational athletes.

There are two types of steroids that are naturally produced in the body:

Catabolic steroids or glucocorticoids are part of the body's response to stress. The word catabolic comes from the Greek word meaning to "throw down," and these steroids help break down large chemicals into smaller ones. For example, cortisol helps glycogen (a large molecule that is stored in the liver) metabolize into glucose, a small molecule that can be used for energy by the body. Cortisol naturally is manufactured in the adrenal glands and is required for many of the basic functions of the body, including glucose metabolism, the immune response to infection, and protein, fat, and carbohydrate metabolism. Prescription medications, such as prednisone (Deltasone, Liquid Pred), hydrocortisone (Westcort), and dexamethasone (Decadron [discontinued], DexPak), are examples of steroids that are used to reduce inflammation and treat a range of illnesses from asthma and COPD to rheumatoid arthritis and allergic reactions. Low-dose hydrocortisone is the active ingredient in creams that help treat the inflammation from insect bites, poison ivy, eczema, and other local skin irritations.

Anabolic androgenic steroids are steroids that mimic testosterone in the body. Anabolic refers to the properties of these drugs to increase production of proteins that act as building blocks for muscle cells, bone, and other tissues within the body. The androgenic response (andro=male + genic=formation) describes the increased male features (secondary sexual characteristics) that occur as a result of androgenic steroids, including facial, body, and pubic hair, deepened voice, and increased sex drive or libido.

There are medical indications for prescribing these medications. Some include the following:

  • Inadequate testosterone production in the body, either because of inborn errors of metabolism or because of illnesses that decrease production
  • Certain types of anemia
  • Recovery from major illness or injury, including burns, where the body's metabolism needs to be increased to produce more protein
  • An adjunct treatment for certain types of breast cancer
  • Hereditary angioedema
  • HIV wasting syndrome
  • Growth failure and short statures in the pediatric population

Some physicians believe that the decreased testosterone levels that occurs normally with aging is an indication for replacement therapy with anabolic steroids, but their use in otherwise healthy older patients is still controversial because of the potential serious side effects.

There are many different types of anabolic steroids that have been manufactured over the past decades. The goal of chemists is to promote the anabolic effect of the drug while decreasing the androgenic side effects that can be life-threatening. Examples of anabolic steroids include the following:

Quick GuidePrescription Drug Abuse: Know The Warning Signs

Prescription Drug Abuse: Know The Warning Signs
Learn about the physical and emotional side effects of steroid abuse.

Steroid Abuse

The term anabolic refers to the muscle-building properties of these manmade substances. Available legally only by prescription, anabolic steroids are sometimes prescribed by doctors to treat conditions in which testosterone levels are abnormally low, or in certain chronic conditions such as AIDS that are associated with loss of muscle mass. Athletes, bodybuilders, and other people sometimes abuse anabolic steroids in order to improve performance and physical appearance.

Why do people abuse anabolic steroids?

People abuse steroids for a variety of reasons, but most do it to increase body performance and appearance. There may be peer pressure to use anabolic steroids in some sports because of a fear that normal training will not be enough to succeed. There is also the perception that other athletes are abusing steroids and gaining an unfair advantage.

People who use steroids to enhance their appearance by increasing muscle and decreasing fat may suffer from muscle dysmorphia or abnormal perception of their own body. Males may think that they are perpetually too small and weak, and females may think themselves fat, even though that perception may not be actually true.

Bodybuilders and weight lifters are not the only athletes to think that anabolic steroid use is their road to success. Athletes, from strength sports like football and throwing the discus to speed sports like track sprinters and speed skaters, have attempted to use steroids to enhance performance and increase the efficiency of their training.

How do people abuse anabolic steroids?

Though most anabolic steroids need to be injected into the body to be effective, some may be taken by mouth and others used as a cream or gel and applied to the skin. The user will try to take enough anabolic steroid to increase the ability to exercise and allow muscles to grow while minimizing the risk of side effects and the potential of being caught. Usually steroids are taken in cycles with regular injections followed by periods of rest. Numerous books and web sites discuss the benefits and risks of different techniques to maximize the effect of a variety of steroids on the body. There is a large underground illegal industry that has grown to meet the demand for anabolic steroids and also provides methods to try to avoid detection.

Cycling, stacking, and pyramiding are three common ways that anabolic steroid abusers take their drugs. Cycling refers to taking a steroid for a period of time, stopping for the body to rest, and then restarting again. If more than one type of steroid is used at a time, this is called stacking. There is the belief that using two or more steroids at a time increases the effectiveness of each. Pyramiding combines the cycling and stacking. One or more steroids are begun in a low dose and the dose gradually increased until halfway through the cycle where the amount is maximized and it is then tapered to zero by the end of the cycle.

Exercise programs are tailored so that more can be done as the effect of the steroid increases. The cycles of steroid use are usually six to 12 weeks long and may be followed by a rest period.

In athletes who use anabolic steroids, a cat and mouse game exists. They try to time their steroid injections so that the drug is out of their system if and when they are drug tested. Sometimes masking drugs are also taken to try to "beat" the test by making the test negative. Designer steroids are being continually developed to again prevent their use from being detected.

Are anabolic steroids addictive? What are the symptoms and signs of anabolic steroid abuse?

Like alcohol or street drugs, the common signs of addiction may develop with the use of steroids. These include drug cravings, requiring more drug to get the same effect, and withdrawal symptoms should the drug be stopped. The following is a statement from the National Institute of Drug Abuse concerning anabolic steroids:

"An undetermined percentage of steroid abusers may become addicted to the drugs, as evidenced by their continued abuse despite physical problems and negative effects on social relations. Also, steroid abusers typically spend large amounts of time and money obtaining the drugs, which is another indication that they may be addicted. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking steroids, such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings. The most dangerous of the withdrawal symptoms is depression, because it sometimes leads to suicide attempts. If left untreated, some depressive symptoms associated with anabolic steroid withdrawal have been known to persist for a year or more after the abuser stops taking the drugs."

What are the psychological and physical side effects of anabolic steroid abuse?

Anabolic steroids are used as performance-enhancing drugs to increase the ability to do work and exercise by abnormally stimulating muscle growth, power, and aerobic capacity. This increased function comes with a cost of potentially life-threatening side effects.

The complications of anabolic steroid abuse are a result of excess testosterone affecting almost all the organ systems in the body. Some of the effects are reversible and decrease when the drug abuse stops while others are permanent and irreversible.

In males, the excess steroid suppresses the normal testosterone production in the body. This can lead to shrunken testicles and decreased sperm count, baldness, and breast development (gynecomastia).

In females, anabolic steroid abuse can lead to masculinization with loss of body fat and breast size, swelling of the clitoris (which may be permanent and not resolve, even when the use of steroids is stopped), deepening of the voice, and the development of facial and body hair.

Life-threatening side effects include heart attack and stroke, the risk of forming blood clots (deep vein thrombosis and pulmonary embolus), liver cancer, and liver failure.

The skin is often affected by excess steroid use and the issues are similar to the adolescent male going through puberty with its testosterone spike. Hair can become oily.

Acne is often present. Acne conglobata is a particularly severe form of acne that can develop during steroid abuse or even after the drug has been discontinued. Infections are a common side effect of steroid abuse because of needle sharing and unsanitary techniques used when injecting the drugs into the skin. These are similar risks to IV drug abusers with increased potential to acquire blood-borne infections such as hepatitis and HIV/AIDS. Skin abscesses may occur at injection sites and may spread to other organs of the body. Endocarditis or an infection of the heart valves is not uncommon.

Psychiatric and psychological complications include manic behavior and psychosis, including hallucinations and delusions. Aggressive behavior is common and is often known as "roid rage."

Because the muscle growth can occur quickly, it can cause stress on the tendons that attach the muscle to bone and those who abuse anabolic steroids are at risk for tendon rupture.

Anabolic steroids can increase bone production, especially in the skull and face. Teeth can splay apart as the maxilla and mandible grow. There can be overgrowth of the forehead, giving an "Incredible Hulk" appearance. If adolescent teenagers abuse steroids before they have finished growing, these drugs can prematurely close bone growth plates, leading to short stature.

How are anabolic steroid abuse and addiction diagnosed?

The diagnosis of anabolic steroid abuse in high school, college, and professional athletes may occur with a failed drug test, but many people who abuse these drugs are never randomly tested. The diagnosis is often made when they present with one of the side effects of steroid use.

Once the potential diagnosis of drug abuse is considered, it is important that the health-care provider offer the opportunity for the patient to consider drug treatment options, just like any other addictive drug. However, the first step in diagnosis and treatment must be taken by the patient to admit there is a potential for abuse and their willingness to consider intervention and treatment.

What is the treatment for anabolic steroid abuse and addiction?

Counseling is the mainstay of therapy for anabolic steroid abuse. The patient and their support group, family and friends, need to appreciate that the approach to this addiction may be similar to addiction to other drugs and alcohol.

Depression and suicidal thoughts may occur when the steroids are stopped, and this potential must be monitored closely.

Withdrawal symptoms vary with each patient, and the health-care professional may need to prescribe short courses of medications to help with headaches, muscle aches, and insomnia.

Is it possible to prevent anabolic steroid abuse and addiction?

Prevention of steroid abuse begins at a young age. There is pressure even at middle school to take drugs to increase performance on the playing field and in the gym. As well, personal appearance and perception begin early on. Unrealistic expectations can drive adolescent boys and girls to try to achieve the often unrealistic image of models in fashion magazines and athletes in the gym.

Counseling and guidance that continues through high school and beyond has been shown to be effective in decreasing steroid use in the younger population.

According to the National Institute of Drug Abuse, the use of anabolic steroids continues to be a significant problem in the adolescent population. Their continuing monitoring studies found that in 2014 the following percentage of students used anabolic steroids in the past year:

  • 8th grade, 0.6%
  • 10th grade, 0.8%
  • 12th grade, 1.5%

Over their lifetime, 1.9% of the 12th graders had abused steroids.

Where can I get more information on anabolic steroid abuse?

While there are many web sites that teach people how to abuse anabolic steroids without getting caught, there are also many that can educate about their benefits, risks, and dangers. Examples include the following:

"Anabolic Steroid Abuse," National Institute on Drug Abuse
http://www.drugabuse.gov/drugs-abuse/steroids-anabolic

"NIDA InfoFacts: Steroids (Anabolic-Androgenic)," National Institute on Drug Abuse
http://www.drugabuse.gov/infofacts/
steroids.html

"Research Report Series - Anabolic Steroid Abuse," National Institute on Drug Abuse
http://www.nida.nih.gov/ResearchReports/
Steroids/anabolicsteroids5.html#addictive

REFERENCES:

United States. National Institute on Drug Abuse. "Monitoring the Future Study: Trends in Prevalence of Various Drugs." <https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs>.

United States. National Institute on Drug Abuse. "NIDA InfoFacts: Steroids (Anabolic-Androgenic)." July 2009. <http://www.drugabuse.gov/infofacts/steroids.html>.

Last Editorial Review: 10/23/2015

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Reviewed on 10/23/2015
References
REFERENCES:

United States. National Institute on Drug Abuse. "Monitoring the Future Study: Trends in Prevalence of Various Drugs." <https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs>.

United States. National Institute on Drug Abuse. "NIDA InfoFacts: Steroids (Anabolic-Androgenic)." July 2009. <http://www.drugabuse.gov/infofacts/steroids.html>.

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