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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

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.

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Medical Editor:

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.

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In this Article

• Anabolic steroid abuse facts
• What are anabolic steroids?
• Why do people abuse anabolic steroids?
• How do people abuse anabolic steroids?
• Are anabolic steroids addictive?
• What are the psychological and physical side effects of anabolic steroid abuse?
• How are anabolic steroid abuse and addiction diagnosed?
• What is the treatment for anabolic steroid abuse and addiction?
• Can anabolic steroid abuse and addiction be prevented?
• Where can I get more information on anabolic steroid abuse?
• Anabolic Steroid Abuse Index

Like alcohol or street drugs, the common signs of addiction include cravings for the drug, requiring more drug to get the same effect, and withdrawal symptoms should the drug be stopped. These are all behaviors that can apply to anabolic steroids. 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."

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 and can lead to shrunken testicles and decreased sperm count, baldness, and breast development (gynecomastia).

In females, steroids will lead to masculinization with loss of body fat and breast size, swelling of the clitoris, 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. Acne is often present along with cyst formation in the skin. Hair can also become oily.

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 increase 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 psychologic 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 anabolic steroid abusers 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.