Several types of steroids exist, but the term is regularly used to refer to anabolic-androgenic steroids. The anabolic characteristic of the drug means it boosts muscle growth. The androgenic component refers to the drug’s ability to stimulate male characteristics.
Steroids have become highly stigmatized in American society. They’re often viewed as dangerous substances that are only used by cheaters in sport or competition. In reality, a large portion of people who use steroids do not compete. While the side effects can be serious, the media and other sources may exaggerate some of the negative effects.
Dr. Tracy Olrich, a professor in the Department of Physical Education and Sport at Central Michigan University, told DrugRehab.com that the risks of steroid use are still unclear.
“There are definitely risks,” said Olrich, who studies ethical and social dimensions of steroid use. “There is a greater chance of heart attack. There is no question about that. You will likely have some elevation of blood pressure. With things like damage to the liver, it depends on what you’re taking. The injectables bypass the liver.”
In general, people who use steroids differ from people who use other illicit drugs. People who regularly inject heroin, cocaine or methamphetamine are often believed to have severe substance use disorders. People who inject steroids aren’t necessarily addicted.
“With a lot of other drugs, you may smoke it first and then move to a pill and then an injectable,” Olrich said. “If you’ve done your homework with steroids, you skip the pills because you know there is going to be greater damage to the liver and kidney.”
People who use steroids usually don’t seek a high from the drug. They want to cause physical changes to excel in competition or improve their physical appearance. Improving physical appearance can lead to increased social recognition and attention, which boosts self-esteem.
“There are definitely risks. There is a greater chance of heart attack. There is no question about that. You will likely have some elevation of blood pressure. With things like damage to the liver, it depends on what you’re taking. The injectables bypass the liver.”
“Most of the time people want to gain mass or size,” Olrich said. “They don’t anticipate a lot of the other ‘benefits’ that happen. I say benefits in quotation marks — those social recognition types of things.”
Research suggests that social recognition contributes to the addictive potential of steroids. People begin to crave attention and praise from others. Other studies indicate steroids influence the reward system in the brain, which is characteristic of other addictive substances.
Congress outlawed nonmedical use of androgenic-anabolic steroids when it passed the Anabolic Steroids Control Act of 1990. The law made steroids Schedule III controlled substances, meaning they have less potential for abuse than Schedule I drugs such as Ecstasy, Adderall or methamphetamine. They have higher potential for abuse than Schedule IV drugs such as Xanax or Valium.
The term steroid refers to numerous substances, including vitamin D, that have similar chemical structures. An anabolic-androgenic steroid is a type of steroid that produces muscle-building effects.
Anabolic-androgenic steroids, hereafter referred to as steroids, are related to the male sex hormone testosterone. Testosterone is the most common androgen in males.
Androgens are sex hormones that contribute to the development of male characteristics such as facial hair, muscle mass, sex drive and aggression. Men produce more androgen than women, who produce it in small amounts.
Doctors prescribe steroids to treat muscle loss caused by diseases. However, some people take the drugs without a prescription to boost muscle mass, improve athletic performance or change their physical appearance.
Steroids often come in creams, patches, gels and liquid formulations. To use steroids, you put the cream, gel or patch on the skin, or you inject or swallow the liquid. Because steroids cause a number of detrimental side effects, people who use them without a prescription take them in ways that may limit the negative side effects.
Steroid plans include:
However, no research proves that these techniques decrease the negative side effects of using steroids, according to the National Institute on Drug Abuse. Research does indicate that the drugs have addictive properties.
Dr. Ruth Wood, chair of the Department of Integrative Anatomical Sciences in the Keck School of Medicine of the University of Southern California, told Drug Rehab.com that steroid users often exhibit several signs of addiction.
“People tend to use more over time,” Wood said. “They tend to use more than they intended. They experience psychological effects when they stop using them. Those are all suggestive of addiction.”
People who use steroids can develop tolerance and dependence on the drugs. That means they have to take higher doses of the drugs to feel the same effects, and they experience withdrawal symptoms when they stop taking the drugs. Many people take steroids despite the risk of negative consequences. Tolerance, dependence and using drugs despite negative side effects are all characteristics of addiction.
Research suggests that steroids have psychologically addictive properties and physiologically addictive properties. Psychologically, steroid users may become addicted to the attention they receive after winning a competition or receiving social recognition for weight loss or muscle mass.
Physiologically, the pleasure and reward systems in the brain may adapt to steroids, causing users to feel pleasure from the drug and crave it. Changes in these systems are characteristic of alcohol and other addictive drugs, including cocaine and methamphetamine.
“Anything that has an addiction is going to have some kind of brain reward to it,” Olrich said. “Physiologically, there must be something going on. But with steroids, so many of the rewards are social recognition in various ways.”
For more than 20 years, Olrich has studied the experiences of steroid users by interviewing them. He said he’s consistently heard that people who take the drugs believe they’re addicted, but they may not be addicted in the same way as people addicted to other drugs.
“Just about everybody talked about how addictive they are,” Olrich said. “They say, ‘This addiction is so strong.’ But half the people we talked to aren’t using anymore. If you’re addicted to alcohol or cocaine, you’re battling it.”
Olrich said some people may battle steroid addiction, but many people can quit using steroids if their environment changes.
“When their life circumstances change, it seems to be something they can walk away from,” Olrich said. “If a person is no longer part of a team or no longer involved in a hardcore bodybuilding gym, they can walk away.”
Olrich’s research focuses on the psychological side effects of steroids, but Wood’s research focuses more on the physiological side effects. She studies how steroids affect animals.
“We know that animals will voluntarily self-administer steroids, which suggests that there may be some inherent reward capacity,” Wood said. “We know that animals develop tolerance to steroids. They will take more over time.”
Studying animals has advantages because animals don’t have psychological motivations for using steroids. They aren’t trying to gain the attention of others by building muscle, and they aren’t trying to win competitions.
“When you give animals a chance to use steroids, you’re eliminating the whole question of their morphology or their bigger muscles because animals don’t care,” Wood said. “Therefore, if animals will voluntarily take steroids, then you can say definitively that there is some element of reward.”
Most people who take steroids do so to improve their physical appearance, excel in competition or build muscle mass. Both Wood and Olrich said steroid users research steroids and spend time thinking about the consequences before they begin using.
Thus, a typical profile of a person who uses steroids differs from the profile of a person with an alcohol or drug use disorder. Many people who try illicit drugs do so compulsively. Others are unaware of the risks before they begin taking the drugs, such as people who become addicted to prescription painkillers prescribed by doctors.
People often take alcohol or other drugs to relieve stress or get high, but people who use steroids have different motivations.
“It’s not a recreational drug,” Olrich said. “It’s not something you’re taking for a temporary high. It’s something where you want to have some kind of physiological impact.”
Although people have different motivations for using steroids than illicit drugs, co-occurring steroid and alcohol or drug use has been a concern for decades.
A 2011 review of 18 studies published between 1995 and 2010 found an association between steroid use and alcohol or illicit drug use. Studies have had mixed results in identifying an association between steroids and tobacco or cannabis use, according to the 2011 review published in the journal Drug and Alcohol Dependence.
The authors of the review believed there could be several explanations for why steroid users also consumed alcohol or other drugs.
These explanations include:
The research isn’t as clear regarding the prevalence of tobacco or cannabis use among steroid users. Some studies have found support for an association between the drugs, but the majority of studies reviewed did not.
Steroids can be classified as anabolic-androgenic steroids or corticosteroids. Health professionals use corticosteroids to treat inflammation or problems with the immune system caused by conditions such as arthritis, asthma or autoimmune diseases. Types of corticosteroids include glucocorticoids and mineralocorticoids.
Anabolic-androgenic steroids can be classified as exogenous or endogenous. Exogenous refers to substances that are not naturally produced by the body, and endogenous refers to substances naturally produced by the body. High levels of an endogenous substance on a steroid test can indicate steroid use.
Steroids can also be classified as oral or injectable:
People who take steroids usually take substances to decrease the risk of negative side effects or to restart hormone production that is disrupted by steroid use. These substances have not been scientifically proven to reduce the risk of short- or long-term side effects, according to NIDA.
The majority of steroid users are male, but a small number of women use steroids. People who use steroids tend to have years of experience working out or training, and they spend time learning about nutrition, exercise and how the body works.
“People who we’ve interviewed usually started in college,” Olrich said. “Other researchers found the average user was white, male and about 30 years old. He’s gainfully employed. This is something where someone usually begins at college age or slightly beyond.
“They know what the side effects are, but they’ve spent enough time studying it to where they know which risks are exaggerated. They know which things are temporary and which things are long-term.”
Steroid use is most common among bodybuilders and competitive weight lifters, according to numerous studies.
Research suggests that risk factors for steroid use include:
However, bodybuilders and competitive weight lifters aren’t the only people who use steroids. Body guards, construction workers, law enforcement and other professionals who rely on physical strength in the workplace may use steroids.
Fitness models, actors and others who rely on physical appearance for work or competition might use steroids to lose weight, improve their physique or recover from long work shifts. All of these people can use steroids to shorten recovery time between workouts and improve workout results.
“Steroid use has moved from the province of elite athletes into high school athletic programs and neighborhood fitness centers,” Wood wrote in a 2008 article published in Frontiers in Neuroendocrinology. “For teens and young adults, steroids represent a shortcut to a lean and muscular physique. For aging baby boomers, steroids help stave off age-related declines in muscle mass.”
Athletes from Eastern European countries and the Soviet Union began using steroids in the 1950s. It didn’t take long for competitors from the United States and other countries to begin using the drugs.
The International Olympic Committee outlawed steroids from competition in 1976. However, many drug tests couldn’t reliably detect androgens until the 1980s. Throughout the 1990s and early 2000s, steroid use increased.
The popularity of steroids remained stable among 8th- and 10th-grade boys from 1991 to 1998, according the Monitoring the Future survey. In 1999, steroid use among this group nearly doubled. Steroid use among high school seniors gradually increased from 1992 to 2000. Use among youth peaked in the early 2000s and has gradually declined to all-time lows in 2016.
Percent of Students Who Reported Lifetime Use of Steroids: 8th, 10th, and 12th Grade Combined
A rare event occurred before the new millennium, when 12th graders’ perceived risk of steroid use dropped sharply between 1998 and 2000. University of Michigan researchers speculated that publicity of Major League Baseball players using steroids to chase the sport’s home run record could have reduced teens’ perceptions of risks.
Steroids can contribute to dramatic muscle growth and fitness improvements, but they also cause a range of negative side effects. Several side effects are well-documented and are likely to affect a majority of steroid users. Other side effects may occur only among certain populations.
Life-threatening side effects, such as an increased risk for heart attack, are obviously negative, but other side effects could be considered positive or negative depending on a person’s reason for taking the drugs.
“Most people who are using them illicitly are interested in building muscle and reducing fat,” Wood said. “They aren’t necessarily interested in the androgenic effects, so those would be considered negative side effects.”
In men, steroids can cause testicles to shrink and breasts to grow. The drugs can decrease sperm count and cause baldness or prostate cancer. In women, steroids can cause voice deepening, the growth of facial hair, changes in menstrual cycle, enlarged clitoris and excess body hair. Other side effects occur in both men and women.
Additional short-term side effects of anabolic steroids include:
Long-term side effects of steroids include:
In teenagers, steroids can stunt growth because increased hormone levels tell the body to stop growing bones. If they’re used before a growth spurt, steroids can stunt height.
The side effect most commonly characterized in popular culture may not be as prevalent as once believed. “Roid rage” refers to uncontrollable anger, loss of temper or dramatic mood swings caused by steroids.
“In terms of mood and emotion, I would argue that there seems to be an elevation of whatever mood you already have,” Olrich said. “If you’re feeling happy, you’re feeling really happy. If you feel depressed, you’re probably feeling quite depressed.”
Olrich said that only one participant in his studies talked about experiencing roid rage. However, most participants said they had to “keep it in check” and be aware of how the drug could influence their mood.
“Guys who were bouncers say, ‘You just have to be careful when you’re working the door. You have to keep things tempered,’” Olrich said.
Three human studies suggest that high doses of steroids increased feelings of aggression and irritability. The side effect varied among participants, though. Animal studies have also revealed increased aggression after steroid administration, according to NIDA.
“We don’t really know to what extent the effects of steroids are going to be influenced by pre-existing personality conditions,” Wood said. “Perhaps, people who are more aggressive are more likely to take steroids, and they may be in fact more sensitive to the aggression-promoting effects of steroids.”
Some evidence indicates that steroids increase the chances of someone participating in high-risk behaviors such as driving without a seatbelt, carrying a weapon, being involved in a homicide or committing suicide, Wood said.
It can be difficult to tell if someone is using steroids. Professional athletes and competitors go to great lengths to conceal steroid use to avoid penalties for getting caught. Others hide steroid use because they don’t want to admit that their appearance is unnatural, or they want to avoid legal problems.
Stringent workout routines and diets can cause drastic changes in a person’s appearance or ability, making it difficult to determine if someone is using steroids. That’s why drug testing is the only way to confirm that someone is using steroids.
Signs that someone may be using steroids include:
People who use steroids may be protective of areas where they hide their drugs. They may guard their computer or phone to conceal their internet searches. They might try to hide packages that they receive in the mail, and they may be low on money because they’re spending it on steroids.
If you use steroids or decide to discontinue steroid use, you should speak with your doctor about the potential health side effects. Steroids can cause a number of short- and long-term health problems that may be preventable with medical attention.
Abruptly quitting steroid use can also cause withdrawal symptoms such as depression and suicidal thoughts. Counseling and therapy can help patients manage some psychological symptoms of withdrawal, and antidepressant medications may also be beneficial. Doctors may also prescribe pain relievers to treat headaches or muscle pain caused by steroid withdrawal.
Little research has been conducted on treatments for steroid abuse, but preliminary research suggests that physicians and therapists can help patients stop using the drugs, according to NIDA.
“Most of the athletes that we’ve interviewed have used for a reason and then are able to walk away,” Olrich said. “There is a greater tendency of the bodybuilders that we’ve interviewed to keep on using because they’re still in that environment.”
Thus, changing your environment may help you abstain from steroid use. People in recovery from alcohol or drug addiction often have to move from neighborhoods where they used to buy drugs or end relationships with friends who pressure them to use.
“Most of the athletes that we’ve interviewed have used for a reason and then are able to walk away. There is a greater tendency of the bodybuilders that we’ve interviewed to keep on using because they’re still in that environment.”
If you’re trying to quit using steroids, it may be helpful to quit going to a gym where steroid use is common or to stop interacting with people who encourage you to use.
The best way to prevent steroid use is to teach people about the benefits and risks of the drug. Unfortunately, the media doesn’t always effectively communicate the risks of steroids, and many steroid users learn about the drugs from friends. People may also underestimate the risks of using steroids because parents or mentors don’t talk to them about the risks.
“There is sort of a common assumption in the public that this is a problem of fairness in sports, and it’s not something we need to worry about in the general population,” Wood said. “In fact, steroid use is much more widespread than most people will acknowledge. We do need to worry about long-term health risks on a much wider range of the population than elite athletes.”
Fortunately, several organizations provide resources to educate teens and young adults about the dangers of steroid abuse. Evidence-based educational programs have also been developed to reduce youth steroid use.
“Steroid education programs have been found to be effective at the high school level,” Olrich said. “I would argue that steroid education plus steroids being illegal has helped reduce the amount of use.”
The parents and friends of Taylor E. Hooton, a 17-year-old who committed suicide after using steroids, founded the Taylor Hooton Foundation. The organization produces and delivers educational programs about steroids, human growth hormone and other performance-enhancing drugs to youth across North America.
The Partnership for Drug-Free Kids works with Major League Baseball to teach youth, parents and coaches about the health risks of steroids and other performance-enhancing drugs. The organizations also reward coaches and student-athletes who go to extra lengths to promote drug-free competition.
The Athletes Training and Learning to Avoid Steroids program is an evidence-based educational workshop that teaches student-athletes about steroids in an interactive setting. ATLAS is composed of 10 separate 45-minute sessions comprising a variety of lessons.
“Nobody’s standing up there saying, ‘You’re going to get this and this and this,’” Dr. Linn Goldberg, co-creator of ATLAS, said in a news release. “But while they’re laughing and playing this game, it’s imprinting on them that these are the side effects of steroids.”
In one exercise, student-athletes who correctly answer a question about steroids can boost their points by throwing a ball at a poster depicting a person with acne, receding hairline, shrunken testicles and other side effects of steroid use. Calling out and successfully hitting a target with the ball will double the points awarded.
Steroids can cause a range of negative short-term side effects and increase the risk of addiction and life-threatening, long-term side effects. No documented evidence supports the effectiveness of training programs aimed at reducing the risks of steroid use, and steroids can cause psychological and physiological symptoms of addiction.