Anabolic steroids are hormones that promote the development of muscle tissue. Testosterone is an anabolic steroid that is produced naturally by the gonads and adrenal glands and is responsible for masculine traits. Compounds related to testosterone were first synthesized in the 1930s and since then have been believed by some to promote athletic performance and the development of muscle strength and size. The medical literature, however, has not consistently supported this belief.

Anabolic steroids are used primarily by athletes and body builders. Males use them more commonly than females, by about a ten-to-one ratio. The actual prevalence of steroid abuse is not known, but some surveys have shown that upwards of 50 percent of athletes and 95 percent of body builders have used these drugs at one time or another. Use by teenagers and even preteenagers has been reported.

The abuse of anabolic steroids fits the working definition of addiction because users report a loss of control over the behavior and a continuation of use despite undesired physical consequences. A withdrawal syndrome characterized by depression, loss of sex drive, fatigue, restlessness, and craving has been described. Users often report taking more of the drug and using it over longer periods of time than they intended to, preoccupation with obtaining and using the drug, and significant impairment in their social and occupational functioning as a result of using it.

On the other hand, there are some characteristics of anabolic steroid abuse that differ from alcohol or drug addiction. For example, the initial motivation for using anabolic steroids is the belief that they will enhance physical appearance and athletic performance over time, whereas the motivation to use alcohol and drugs involves immediate change in mood. Anabolic steroid users are typically health conscious, and, before the onset of the abuse, often avoid alcohol or drugs.

Over the last several decades public awareness of the dangers of anabolic steroid abuse has increased. Most amateur, collegiate, and professional athletic associations have banned the use of these drugs and test for their presence in athletes.

Government oversight of the production and distribution of anabolic steroids has decreased the quantities that are diverted to illicit use, but the availability of foreign and illegally produced steroids has increased.

Anabolic steroids are typically taken in cycles of several weeks, during which the doses increase in a preset pattern that users call a pyramid. At the end of the cycle, the total dose may be many times the usual medical dose. Some athletes do only one or two cycles and stop. Those who complete at least five cycles are at higher risk for addiction.

Adverse effects of anabolic steroid use are both psychological and physical. The drug can cause irritability, aggressiveness, depression, and paranoia. (As many as two-thirds of heavy users have reported acting aggressively while under its influence.) Physical toxicity includes liver damage and jaundice, high blood pressure, strokes, premature baldness, reduced testicular size, and low sperm counts.

Steroid receptors are found in several areas of the brain that are involved in the control and regulation of emotion.

It is thought that overstimulation of these areas by massive doses of anabolic steroids and their metabolites may not only contribute to the psychological effects but may also increase levels of endogenous opiates. This may be the mechanism by which loss of control, withdrawal symptoms, and cravings occur.

Anabolic steroid users frequently abuse other drugs for a variety of purposes. Other hormones may be taken to counteract the undesired physical effects, and mood-altering drugs may be used to counteract the psychological effects. Because the user is thereby introduced to mood-altering drugs and to the drug culture, anabolic steroids are considered to be gateway drugs.

There is also some overlap between anabolic steroid abuse and eating disorders. Although once considered rare in males, bulimia nervosa has been identified in body builders and athletes, some of whom also abuse anabolic steroids.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information