Doctors sometimes prescribe anabolic steroids to treat medical conditions, but people also use them illegally in some sports settings. Different types include bulking, performance, and cutting steroids.
People may use anabolic steroids illegally to improve muscle mass, performance, and endurance and to shorten recovery time between workouts. Street names include Arnolds, gym candy, pumpers, roids, and stackers.
The drugs are artificially derived from the hormone testosterone. Testosterone is important for promoting and maintaining muscle growth and developing secondary male sex characteristics, such as a deep voice and facial hair.
Anabolic steroids, also called anabolic-androgenic steroids (AASs), can help build muscle and improve athletic performance, but they can also have significant adverse effects, especially when used incorrectly.
Research links long term, non-medical use of AASs to heart problems, unwanted physical changes, and increases in all-cause mortality and premature death. There is growing concern worldwide about the non-medical use of steroids and their effects.
AASs are synthetic versions of the hormone testosterone. They affect many body parts, including the muscles, bones, hair follicles, liver, kidneys, blood, immune system, reproductive system, and central nervous system.
During puberty, increases in testosterone levels enable the development of characteristics such as facial and body hair growth, increased height and muscle mass, a deepening voice, and the sex drive.
Testosterone can also contribute to competitiveness, self-esteem, and aggressiveness.
How do people use anabolic steroids?
According to the National Institute on Drug Abuse (NIDA), continuous use of AASs can lead to problems such as tolerance, meaning a person needs higher doses to achieve the same effects. They may even cause the body to stop producing its own testosterone.
Some people use AASs continuously, but others try to minimize their possible adverse effects through different patterns of use, such as:
- Cycling: The person takes AASs in cycles of 6 to 12 weeks (known as the “on” period), followed by 4 weeks to several months off.
- Stacking: People combine several different types of steroids or incorporate other supplements in an attempt to maximize the effectiveness of the steroids.
- Pyramiding: Some people take the steroids in
6, 12, or 18 week cycles , gradually reducing the dose instead of beginning or ending a cycle abruptly. - Plateauing: People may overlap, stagger, or substitute different types of steroids in an attempt to avoid developing a tolerance.
However, NIDA highlights that more research is necessary to understand if these methods have the desired effects or reduce any associated risks of AASs.
There are
Some AASs only have medicinal uses, such as testosterone undecanoate (Nebido). Oxymetholone (Anadrol) is an example of a steroid with both medicinal and performance uses.
Others, such as nandrolone (Anadur), have no therapeutic use, but athletes use them.
People choose different types for different purposes, such as:
- bulking steroids for building muscle
- performance steroids for strength and endurance
- cutting steroids for burning fat
Other reasons for use may include healing or recovery and enhancement of metabolism.
How people take AASs
For both medical and illegal purposes, people can take AASs in the following ways:
- by mouth
- as pellets implanted under the skin
- by injection
- through the skin as a cream or gel
The table below outlines some examples of oral and injectable steroids:
| Oral forms | Injectable forms |
|---|---|
| fluoxymesterone (Halotestin, Android F, Oreton), or “Halo” | boldenone undecylenate (Equipoise), or “EQ” |
| mesterolone (Androviron) | methenolone enanthate (Primobolan), or “Primo” |
| methandienone (Dianabol), or “Dbol” | nandrolone decanoate (Deca Durabolin), or “Deca” |
| methyltestosterone (Android, Metandren, Testred , Methitest) | nandrolone phenpropionate (Durabolin), or “NPP” |
| oxandrolone (Anavar, Oxandrin), or “Var” | testosterone cypionate (Depotest) |
| oxymetholone (Anadrol), or “Drol” | testosterone enanthate (Andro-Estro) |
| stanozolol (Winstrol), or “Winny” | testosterone propionate (Test) |
AASs travel through the bloodstream to the muscle tissue, where they
Healthcare professionals use some types of steroids in medical treatment. For example, corticosteroids can help people with asthma breathe by reducing inflammation in the airways.
AASs are not a common treatment in general. However, doctors may prescribe testosterone for the following conditions:
- hypogonadism, a testosterone deficiency
- delayed puberty
- Klinefelter syndrome, in which a person has two or more X chromosomes and one Y chromosome
In the United States, an AAS is a
Non-medical use of steroids is not permitted in the United States. Under the Controlled Substance Act, unlawful possession and distribution are subject to federal and state laws.
As it is not legal for athletic purposes, there is no legal control over the quality or use of drugs sold for this purpose.
People may obtain illegal steroids through the internet and informal dealers. However, they may also be potentially available through anyone with prescriptive authority, including pharmacists, doctors, and veterinarians.
“Designer” steroids are sometimes available to enable athletes to pass doping tests. Their composition and use are entirely unregulated, adding to the hazards they pose.
Potential health risks associated with illegal steroid use in sport
Athletes may consume steroids on a trial-and-error basis, using information from other athletes, coaches, websites, or gym “gurus.” As a result, they may not have access to medical information and support that can keep them safe while using these drugs.
The adverse effects of AAS use depend on the product, the person’s age and sex, how much they use, and for how long.
Legally prescribed normal-dose anabolic steroids
- acne and blisters
- difficulty or pain when urinating
- enlarged male breasts, known as gynecomastia
- lower levels of “good” HDL cholesterol and higher levels of “bad” LDL cholesterol
- low sperm count and infertility
- changes in libido
- gingivitis and mouth irritation
- mood disorders
People will attend follow-up appointments and take periodic blood tests to monitor for unwanted effects.
Side effects of illegal use
Non-medical use of steroids can involve quantities
Incorrect use of steroids can lead to an increased risk of:
- cardiovascular problems, including:
- liver problems, including tumors
- short stature, in adolescents
- shrinking testicles
- testicular cancer
- decreased sperm production
- deepening of the voice
- increased facial and body hair
- male-pattern baldness
- shrinking female breasts
- abscesses at injection sites
Some of these changes may be permanent, even after stopping use.
People may also face risks due to the way they take steroids. For example, sharing needles to inject steroids increases the chance of contracting or transmitting bloodborne infectious diseases, such as hepatitis or HIV.
The use of unlicensed products also carries a risk of poisoning.
Psychiatric symptoms can develop in people who use steroids for a long time, including:
Long term, unregulated use of AASs can affect some of the same brain pathways and chemicals that are affected by other drugs, such as opiates. This can result in dependency and possibly addiction.
The American Psychological Association’s (APA) Diagnostic and Statistical Manual, fifth edition (DSM-5) considers abuse of and dependence on AASs a diagnosable condition.
Misuse of steroids can lead to withdrawal symptoms when someone stops taking them. Withdrawal symptoms may include:
- fatigue
- restlessness
- mood changes
- depression
- insomnia
- reduced sex drive
- cravings
The first step in treating anabolic steroid abuse is to discontinue use and to seek medical help to address any psychiatric or physical symptoms that might occur.
An addiction treatment facility or counselor may help.
Support is available
The first step in treating anabolic steroid dependency is to discontinue use and seek medical help.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides help for treating addiction. You can use their search tool to find a treatment center near you.
The following resources may also help:
- 988 Suicide & Crisis Lifeline: Call or text 988
- National Helpline: Treatment referral and information (available 24/7)
- Disaster Distress Helpline: Immediate crisis counseling related to disasters (available 24/7)
Anabolic steroids (AASs) are derived from the primary male hormone, testosterone. Doctors may prescribe them to treat hormonal conditions such as hypogonadism.
Some people use AASs illegally to boost muscle size, strength, and stamina or reduce the time it takes to recover between exercises.
Using AASs can cause many undesirable side effects and serious health conditions, such as cardiovascular and liver problems. Help from healthcare professionals and counselors is available for people dependent on AASs.