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Steroid Withdrawal and Detox

Anabolic-androgenic steroid (AAS) abuse can lead to psychological dependence and physical dependence, but not in the same sense as cocaine, heroin or other illicit drugs. Studies have shown tolerance rates of 20% and withdrawal symptoms in 84% of AAS users. Long-term male users may develop protracted hypogonadism (diminished functional activity of the testes) following withdrawal, which may persist for years. In some cases, severe depression can cause suicidal thoughts and suicide in former users. Research indicates depressive symptoms may last up to a year after stopping AAS use. In an attempt to self-treat highly distressing withdrawal symptoms, users frequently resume taking these drugs, leading to a vicious cycle of dependence.1,2,3

Withdrawal Symptoms

  • Fatigue
  • Mood swings
  • Restlessness
  • Insomnia
  • Loss of appetite
  • Anorexia
  • Craving for steroids
  • Depression
  • Diminished sex drive3,4

Steroid Detox Treatment

Abuse of AAS drugs is associated with a unique form of denial and rationalization since they do not produce intoxication like alcohol or other illicit drugs. An AAS addict tends to justify the beneficial effects including enhanced performance and increased muscle mass, while denying any negative side effects. The initial goal is to get the addict to admit he or she has a problem and come to terms with the fact that professional intervention is necessary to resolve it.4

In most circumstances, detoxification does not require a specific pharmacological intervention. Supportive medical care may be necessitated for liver toxicity, severe acne, headaches, muscle cramps and joint pain. Administration of hormonal replacement therapy may be indicated in severe cases of hypothalamic suppression of the gonadotropins. In addition to pharmacological treatment, behavioral interventions are crucial if psychiatric symptoms including depression and suicidal thoughts are present.4,5

When drug treatment principles devised for other substance addictions are followed, treatment may be divided into three phases: inpatient detoxification, inpatient or outpatient short-term rehab and long-term aftercare recovery. Inpatient detox is typically only advised if a person presents with psychiatric symptoms such as psychosis or severe depression. It is also necessary if a person has co-occurring drug abuse, which is not uncommon among AAS addicts. Individual, group, 12-step programs and a range of other psychotherapeutic modalities are incorporated into rehab. Rigorous physical therapy and exercise are mandated due to the extreme physical fitness mindset of the typical AAS abuser.4

Acne Case Study

A 21-year-old amateur bodybuilder came to a clinic feeling generally ill. His body temperature was slightly elevated and he had massive, deep ulcerations, abscesses and pustules on his chest and upper back. Persistent questioning revealed a history of continuous abuse of AASs (testosterone enanthate 250 mg and metandienona 30 mg twice a week). Physicians confirmed the diagnosis of severe AAS-induced acne conglobate. Additional lab work showed a substantial impairment in sperm concentration and reduced testicular volume. Skin lesions improved quickly after discontinuation of AAS abuse and antiseptic and antibiotic therapy, although the extensive scarring was thought to be permanent.6

  1. Pope HG, Khalsa JH, Bhasin S. Body Image Disorders and Abuse of Anabolic-Androgenic Steroids Among Men. JAMA. Published online December 08, 2016. doi:10.1001/jama.2016.17441.
  2. Mhillaj E, Morgese MG, Tucci P, Bove M, Schiavone S, Trabace L. Effects of anabolic-androgens on brain reward function. Front Neurosci. 2015;9:295. doi:10.3389/fnins.2015.00295.
  3. Confirm Biosciences website. http://www.confirmbiosciences.com/knowledge/drug-facts/steroids/ Accessed February 20, 2017.
  4. Giannini AJ, Miller N, Kocjan DK. Treating steroid abuse: a psychiatric perspective. Clin Pediatr. 1991 Sep;30(9):538-42.
  5. Anabolic Steroid Abuse. National Institute of Drug Abuse website. https://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse/what-treatments-are-effective-anabolic-steroid-abuse Updated August 2006. Accessed February 20, 2017.
  6. Gerber PA, Kukova G, Meller S, Neumann NJ, Homey B. The dire consequences of doping. Lancet. 2008 Aug 23;372(9639):656. doi: 10.1016/S0140-6736(08)61278-7.
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