Anabolic-androgenic steroids (AASs) are a Schedule III drug, meaning they have less abuse potential than Schedule I and II drugs. Anabolic refers to muscle-building and androgenic pertains to increased male sex characteristics. Also, AASs come in various forms including pills, creams, patches, tablets, injections or drops placed under the tongue. In addition, common street names include juice, gym candy, pumpers, andro, stackers, steroids and gear. In the U.S., AASs are used medically for testosterone deficiency, delayed puberty, anemia and to treat symptoms of wasting conditions like cancer and AIDS. Also, they are used illegally to boost performance or improve physical appearance.1,2,3 Someone using steroids may become addicted and need the assistance of substance abuse treatment programs.
The synthetically manufactured testosterone hormones in AASs mimic the effects of natural hormones. In addition, they help build muscles by increasing nitrogen retention and synthesis of protein, increase appetite and stimulate bone growth. In addition to testosterone, many other synthetically manufactured hormones have been developed in recent years, including the following.3
Steroid Brand Names
- Deca Durabolin
- Sustanon 250
- Testosterone Cypionate
- Testosterone Enanthate3
In 1849, German scientist Arnold Adolph Berthold discovered the testes influenced masculine behavior by secreting an unknown substance into the bloodstream, although it was many years before widespread steroid misuse occurred. In addition, it began in earnest with drugs being distributed to weightlifters at gyms in the 1950s. Also, steroid abuse has plagued professional sports for more than 60 years and has been widely publicized, especially in the last decade. AASs are primarily abused by bodybuilders, athletes and fitness “buffs” who claim steroids give them a competitive advantage and/or improve physical performance. Purported benefits include increased lean body mass, strength, aggressiveness and reduced recovery time between workouts.4
Famed bodybuilder Arnold Schwarzenegger, who many presumed achieved his impressive physique naturally, admitted to using steroids when they were legal, which no doubt helped him attain Mr. Universe and Mr. Olympia titles. The abuse of AASs garnered huge media attention most recently due to steroid doping in Major League Baseball, the Olympics and professional cycling. After years of denial, famed cyclist Lance Armstrong was forced to admit use after a fellow bicyclist presented testimony, resulting in his being stripped of seven Tour de France titles and an Olympic bronze. In October 2012, the U.S. Anti-Doping Agency released more than 1,000 pages of evidence supporting allegations against him, including the use of AASs and several other banned substances.5
People who abuse AASs typically take them orally, inject them into their muscles or apply them topically (cream, gel or patch) at doses 10 to 100 times higher than those prescribed medically. Addiction therapy programs can help with the symptoms experienced from steroid abuse. Illicit steroids are often sold at gyms, sporting competitions and via mail order, putting buyers at risk of ingesting adulterated or contaminated products.1,2 In addition, some athletes are under the misconception they can avoid the detrimental effects and maximize the desired results in the following ways.2
- Cycling: Taking doses for a period of time, stopping for a period and then restarting
- Stacking: Combining two or more different types of steroids
- Pyramiding: Slowly increase the dose or frequency of abuse, reach a peak amount and then gradually taper off
Stats and Facts
- In 2013, 4.1% of 12-graders admitted taking AASs, with 41% saying they were easy to obtain. An estimated 62% of 12-graders acknowledged steroids are harmful to one’s health.6
- In 2016, an estimated 0.50% of eight-graders, 0.70% of 10th-graders and 1.00% of 12-graders used AASs in the past year.7
- The use of performance-enhancing drugs in athletes is estimated at 5% to 31%.These substances include AASs, human growth hormone, creatine, erythropoietin, amphetamines, stimulants and beta-hydroxy-beta-methylbutyrate.8
- A recent analysis estimates 2.9 million to 4.0 million individuals in the U.S., nearly all of whom are male, have used AASs at some point in their lives.9
- An estimated 57% of teen steroid users said they felt like they needed to take these drugs because of images they saw in muscle magazines.10
- Four out of 10 teens who used steroids said the decision to take performance-enhancing drugs was inspired by professional athletes who took them.10
In the adolescent population, pediatricians and other physicians should be alert for AAS abuse. While mandated laboratory testing is expensive and impractical, a thorough medical history and examination can provide meaningful clues such as behavioral and physical changes. Also, if steroid abuse is detected, psychotherapeutic treatment modalities are necessary through inpatient residential rehab or outpatient addiction treatment programs to help prevent continued abuse and relapse. In addition, for professional athletes, the onus is on coaches, team managers, and regulating doping organizations to enforce and punish the use of banned substances. Typically, a steep fine and suspension prevents future instances of abuse in many athletes.
- Drug Facts – Anabolic Steroids. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugfacts/anabolic-steroids Updated March 2016. Accessed February 19, 2017.
- What are Anabolic Steroids? Drugs website. https://www.drugs.com/article/anabolic-steroids.html Updated May 4, 2014. Accessed February 19, 2017.
- Confirm Biosciences website. http://www.confirmbiosciences.com/knowledge/drug-facts/steroids/ Accessed February 19, 2017.
- 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 19, 2017.
- Lance Armstrong Admits To Using Performance-Enhancing Drugs. NPR website. http://www.npr.org/sections/thetwo-way/2013/01/17/169650077/lance-armstrong-to-admit-to-using-performance-enhancing-drugs Published January 17, 2013. Accessed February 19, 2017.
- Anabolic Steroid Use Statistics. Statistic Brain website. http://www.statisticbrain.com/anabolic-steroid-use-statistics/ Published August 8, 2016. Accessed February 19, 2017.
- Monitoring the Future Study: Trends in Prevalence of Various Drugs. Drug Abuse website. https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs Accessed February 19, 2017.
- Sport Psychiatry: An Emerging Specialty. Psychiatry Advisor website. http://www.psychiatryadvisor.com/therapies/addressing-psychiatric-disorders-in-athletes/article/577388/Published December 6, 2016. Accessed February 19, 2017.
- 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
- 20 Incredible Statistics of Steroid Use in Professional Sports. Health Research Funding website. http://healthresearchfunding.org/20-incredible-statistics-steroid-use-professional-sports/ Published January 5, 2015. Accessed February 19, 2017.