Anabolic-androgenic steroids are man-made substances related to male sex hormones. “Anabolic” refers to muscle-building, and “androgenic” refers to increased masculine characteristics. “Steroids” refers to the class of drugs. These drugs are available legally only by prescription, to treat conditions that occur when the body produces abnormally low amounts of testosterone, such as delayed puberty and some types of impotence. They are also prescribed to treat body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass. Abuse of anabolic steroids, however, can lead to serious health problems, some irreversible.
Today, athletes and others abuse anabolic steroids to enhance performance and also to improve physical appearance. Anabolic steroids are taken orally or injected, typically in cycles of weeks or months (referred to as “cycling”), rather than continuously. Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. In addition, users often combine several different types of steroids to maximize their effectiveness while minimizing negative effects (referred to as “stacking”).
One of the main reasons people give for abusing steroids is to improve their performance in sports. Among competitive bodybuilders, steroid abuse has been estimated to be very high. Among other athletes, the incidence of abuse probably varies depending on the specific sport.
Another reason people give for taking steroids is to increase their muscle size and/or reduce their body fat. This group includes some people who have a behavioral syndrome (muscle dysmorphia) in which a person has a distorted image of his or her body. Men with this condition think that they look small and weak, even if they are large and muscular. Similarly, women with the syndrome think that they look fat and flabby, even though they are actually lean and muscular.
Some people who abuse steroids to boost muscle size have experienced physical or sexual abuse. They are trying to increase their muscle size to protect themselves. In one series of interviews with male weightlifters, 25% who abused steroids reported memories of childhood physical or sexual abuse, compared with none who did not abuse steroids. In a study of women weightlifters, twice as many of those who had been raped reported using anabolic steroids and/or another purported muscle-building drug, compared to those who had not been raped. Moreover, almost all of those who had been raped reported that they markedly increased their bodybuilding activities after the attack. They believed that being bigger and stronger would discourage further attacks because men would find them either intimidating or unattractive.
Finally, some adolescents abuse steroids as part of a pattern of high-risk behaviors. These adolescents also take risks such as drinking and driving, carrying a gun, not wearing a helmet on a motorcycle, and abusing other illicit drugs.
While conditions such as muscle dysmorphia, a history of physical or sexual abuse, or a history of engaging in high-risk behaviors may increase the risk of initiating or continuing steroid abuse, researchers agree that most steroid abusers are psychologically normal when they start abusing the drugs.
Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are rubbed on the skin. Doses taken by abusers can be 10 to 100 times higher than the doses used for medical conditions.
Steroid abusers typically "stack" the drugs, meaning that they take two or more different anabolic steroids, mixing oral and/or injectable types and sometimes even including compounds that are designed for veterinary use. Abusers think that the different steroids interact to produce an effect on muscle size that is greater than the effects of each drug individually, a theory that has not been tested scientifically.
Often, steroid abusers also "pyramid" their doses in cycles of 6 to 12 weeks. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Abusers believe that pyramiding allows the body time to adjust to the high doses and the drug-free cycle allows the body's hormonal system time to recuperate. As with stacking, the perceived benefits of pyramiding and cycling have not been substantiated scientifically.
The major side effects from abusing anabolic steroids can include liver tumors and cancer, jaundice (yellowish pigmentation of skin, tissues, and body fluids), fluid retention, high blood pressure, increases in LDL (bad cholesterol), and decreases in HDL (good cholesterol). Other side effects include kidney tumors, severe acne, and trembling. In addition, there are some gender-specific side effects:
- For men — shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer.
- For women — growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice.
- For adolescents — growth halted prematurely through premature skeletal maturation and accelerated puberty changes. This means that adolescents risk remaining short for the remainder of their lives if they take anabolic steroids before the typical adolescent growth spurt.
In addition, people who inject anabolic steroids run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.
Scientific research also shows that aggression and other psychiatric side effects may result from abuse of anabolic steroids. Many users report feeling good about themselves while on anabolic steroids, but researchers report that extreme mood swings also can occur, including manic-like symptoms leading to violence. Depression often is seen when the drugs are stopped and may contribute to dependence on anabolic steroids. Researchers report also that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.
Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3% had abused anabolic steroids before trying any other illicit drug. Of these 9.3%, 86% first used opioids to counteract insomnia and irritability resulting from the anabolic steroids.
Monitoring the Future (MTF) annually assesses drug use among the Nation’s 8th, 10th, and 12th grade students. Annual use of anabolic steroids remained stable at under 1.5% or students in 8th, 10th, and 12th grades in the early 1990s, then started to rise. Peak rates of annual use occurred in 2002 for 12th-graders (2.5%), in 2000 and 2002 for 10th-graders (2.2%), and in 1999 and 2000 for 8th-graders (1.7%). Eighth-graders reported significant decreases in lifetime and annual steroid use in 2004, as well as a decrease in perceived availability of these drugs. A significant decrease in lifetime use was also measured among 10th-graders for 2004.
Very little data exists on the extent of steroid abuse by adults. It has been estimated that hundreds of thousands of people aged 18 and older abuse anabolic steroids at least once a year.
Most anabolic steroids users are male, and among male students, past year use of these substances was reported by 1.3% of 8th-graders, 2.3% of 10th-graders, and 3.3% of 12th-graders in 2004.
|
8th-Graders |
10th-Graders |
12th-Graders |
Lifetime |
1.9% |
2.4% |
3.4% |
Annual |
1.1 |
1.5 |
2.5 |
30-day |
0.5 |
0.8 |
1.6 |
|
The 2004 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the survey. The latest data are online at http://www.drugabuse.gov. Lifetime" refers to use at least once during a respondent's lifetime. "Annual" refers to an individual's drug use at least once during the year preceding their response to the survey. "30-day" refers to an individual's drug use at least once during the month preceding their response to the survey.
An undetermined percentage of steroid abusers become addicted to the drugs, as evidenced by their continuing to take steroids in spite of physical problems, negative effects on social relations, or nervousness and irritability. Also, they spend large amounts of time and money obtaining the drugs and experience withdrawal symptoms such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and the desire to take more steroids. The most dangerous of the withdrawal symptoms is depression, because it sometimes leads to suicide attempts. 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.
Early attempts to prevent steroid abuse concentrated on drug testing and on educating students about the drugs' adverse effects. A few school districts test for abuse of illicit drugs, including steroids, and studies are currently under way to determine whether such testing reduces drug abuse.
Research on steroid educational programs has shown that simply teaching students about steroids' adverse effects does not convince adolescents that they personally can be adversely affected. Nor does such instruction discourage young people from taking steroids in the future. Presenting both the risks and benefits of anabolic steroid use is more effective in convincing adolescents about steroids' negative effects, apparently because the students find a balanced approach more credible and less biased, according to the researchers. However, the balanced approach still does not discourage adolescents from abusing steroids.
A more sophisticated approach has shown promise for preventing steroid abuse among players on high school sports teams. In the ATLAS program, developed for male football players, coaches and team leaders discuss the potential effects of anabolic steroids and other illicit drugs on immediate sports performance, and they teach how to refuse offers of drugs. They also discuss how strength training and proper nutrition can help adolescents build their bodies without the use of steroids. Later, special trainers teach the players proper weightlifting techniques. An ongoing series of studies has shown that this multi-component, team-centered approach reduces new steroid abuse by 50 percent.
A program designed for adolescent girls on sports teams, patterned after the program designed for boys, is currently being tested.
Few studies of treatments for anabolic steroid abuse have been conducted. Current knowledge is based largely on the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. The physicians have found that supportive therapy is sufficient in some cases. Patients are educated about what they may experience during withdrawal and are evaluated for suicidal thoughts. If symptoms are severe or prolonged, medications or hospitalization may be needed.
Some medications that have been used for treating steroid withdrawal restore the hormonal system after its disruption by steroid abuse. Other medications target specific withdrawal symptoms for example, antidepressants to treat depression, and analgesics for head-aches and muscle and joint pains.
Some patients require assistance beyond simple treatment of withdrawal symptoms and are treated with behavioral therapies.
Source: NIDA, http://www.steroidabuse.org
