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Steroid Facts and FAQs

Many misconceptions exist about anabolic-androgenic steroids (AASs). The term steroid is often used interchangeably for legal steroids such as corticosteroids and AASs, which are illicit. The following steroid FAQs help dispel the many myths and misinformation available online on sites purporting the benefits of AASs.

Why Do AASs Cause Acne?

One of the most common side effects of AASs is the development of acne on the face, chest and back. This is caused by the increased activity of sebaceous glands in response to elevated levels of androgen hormones. High concentrations of androgens can increase the size and growth rate of the sebaceous glands, which in turn leads to greater production of sebum. High levels of sebum can increase the incidence of clogged pores and induce the growth of acne-causing bacteria. Raised levels of sebum can also cause inflammation in and around the follicles, making acne worse and contributing to tissue damage and acne scarring. In general terms, AASs with a relatively high androgenic to anabolic profile have a higher risk of producing acne. In addition, genetic factors play a role in how androgenic side effects impact an individual. If a person struggled with acne during puberty or any time as an adult, the odds of developing severe AAS-induced acne is greater.1

How Does AAS Abuse Impact the Brain?

AASs do not have the same short-term effects on the brain as many other illicit drugs. The key difference is they do not trigger rapid increases in the brain chemical dopamine, which causes the “high” driving people to abuse other substances. Yet long-term steroid abuse can act on some of the same brain pathways and chemicals, including dopamine, serotonin and opioid receptors, thereby possibly explaining their significant impact on mood and behavior.2

A large systematic neuroimaging investigation of AAS users found smaller overall gray matter, cortical and putamen volume, and thinner cortex in weightlifters who used AASs compared to those who did not. Generally, stronger effects were seen with increasing AAS exposure and in users without any other substance abuse problems. Prolonged AAS use has been associated with a range of psychiatric symptoms and disorders as well as cognitive deficits. These findings could potentially connect underlying brain changes to behavioral symptoms, but more research is needed.3

Is Co-Occurring Drug Abuse Common in AAS Users?

Clinical and epidemiological data have shown the abuse of AASs in humans is often associated with the abuse of psychotropic drugs, including cocaine, opiates, alcohol, cannabis, amphetamine and MDMA. These surveys suggest the abuse of AASs opens the door to other dependency-inducing drugs. Different animal model studies have investigated AAS exposure effects on neurochemical and behavioral response to other addictive substances. Consistent with reported higher alcohol intake in AAS abusers, increased voluntary alcohol consumption after cessation of AAS administration was observed in male adult rats. Moreover, studies demonstrate pre-treatment with AASs dose-dependently increases neurochemical and behavioral effects related to the reward system induced by psychostimulant drugs like cocaine and MDMA.4

How Are Steroids Abused?

People abuse AASs by taking as much as 100 times the normal therapeutic dose. This often includes taking two or more steroids concurrently, a practice called “stacking.” Another common practice is “cycling,” in which abusers alternate periods (six to 16 weeks duration) of high doses with periods of low doses or no drug use at all. “Pyramiding” is the term used for slowly escalating steroid use in which the number of drugs used at one time and or the dose and frequency of one or more steroids are increased. Once the peak is reached mid-cycle, the dose is gradually tapered off toward the end of the cycle. In addition, AAS users often abuse other drugs concurrently, many of which are associated with inherent health risks that may be compounded when taken with AASs. For example, clenbuterol is a steroid-like substance and popular among AAS users, although it is actually a beta-2-agonist. Clenbuterol causes similar side effects as amphetamines (e.g. increases heart rate, blood pressure and sweating) and is illegal in the U.S. for human consumption. Adulterated, potentially dangerous pills are sold on the black market.5,6

Abused AAS Alternatives

  • Human chorionic gonadotropin
  • Human growth hormone
  • Insulin-like growth factor
  • Insulin
  • Clenbuterol
  • Erythropoietin (EPO)
  • Gamma-hydroxybutyrate (GHB)
  • Vitamins and amino acids5
  1. Anabolic Steroids and Acne. The Science of Acne website. http://thescienceofacne.com/anabolic-steroids-and-acne/ Accessed February 20, 2017.
  2. Drug Facts – Anabolic Steroids. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugfacts/anabolic-steroids Updated March 2016. Accessed February 20, 2017.
  3. Bjørnebekk A, Walhovd KB, Jørstad ML, et al. Structural Brain Imaging of Long-Term Anabolic-Androgenic Steroid Users and Nonusing Weightlifters. Biol Psychiatry. 2016 Jun 30. pii: S0006-3223(16)32529-X. doi: 10.1016/j.biopsych.2016.06.017.
  4. 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.
  5. Steroid Abuse in Today’s Society. U.S. Drug Enforcement Administration website. https://www.deadiversion.usdoj.gov/pubs/brochures/steroids/professionals/ Published March 2004. Accessed February 20, 2017.
  6. Fat Burners: Clenbuterol for Weight Loss. Super Skinny Me website. http://www.superskinnyme.com/clenbuterol.html Accessed February 20, 2017.
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