Anabolic Steroids

Anabolic steroids are synthetic versions of the naturally occurring male sex hormone, testosterone. They have two main effects: they build muscle size and strength, and they bring about male characteristics in the body. Testosterone causes male characteristics to appear during puberty in boys, including enlargement of the penis, hair growth on the face and pubic area, muscular development, and deepened voice. Females also produce natural testosterone, but ordinarily in much smaller amounts than males.

Although anabolic steroids are sometimes referred to simply as steroids, they are in fact only one kind of steroid. They are not to be confused with corticosteroids, such as prednisone and cortisone, which are commonly used to treat illnesses such as arthritis, colitis, and asthma. Street or slang terms for anabolic steroids include "roids" and "juice."

Bodybuilders and Olympic athletes began using these drugs in the middle of the twentieth century. In 1998 a study reported that 6.6 percent of American male high-school seniors had tried anabolic steroids. This study made it clear that elite athletes were not the only ones taking these drugs. By 1991 anabolic steroids were added by federal law to a list of controlled substances that are recognized to have value as prescribed medicines but also have a potential for abuse. Some synthetic anabolic steroids are neither regulated by the Food and Drug Administration nor listed as controlled substances in the United States and have been sold over the counter as nutritional supplements in the United States since 1994.

Medical Uses of Anabolic Steroids

Anabolic steroids are prescribed by physicians to treat a variety of medical conditions. The most accepted use is for treating boys and men unable to produce normal levels of their own testosterone, a condition known as testosterone deficiency or hypogonadism. Anabolic steroids are also used to treat:

• a rare skin condition called hereditary angioedema
• certain forms of anemia (deficiency of red blood cells)
• advanced breast cancer
• endometriosis (a painful condition in females in which tissue usually found only in the uterus develops in other body parts)
• osteoporosis, a condition in which bone loss occurs
• impotency and low sexual desire
• as a male birth control pill
• Acquired Immune Deficiency Syndrome (AIDS) to stimulate appetite, weight gain, strength, and improvements in mood

Nonmedical Uses of Anabolic Steroids

Nonmedically, anabolic steroids are used to enhance athletic performance, physical appearance, and fighting ability. Because society tends to reward people who look physically fit and attractive with many benefits and recognition, some individuals see anabolic steroids as a means to those benefits. There are three groups of users:

1. The athlete group aims to win at any cost. The athlete also believes, sometimes correctly, that the competitor is using anabolic steroids. The athlete seeks to attain the glory of victory, social recognition and popularity, and financial rewards such as college scholarships or major league contracts.
2. The aesthete group aims to create a beautiful body, as if to make the body into a work of art. Aesthetes may be competitive bodybuilders, or aspiring models, actors, or dancers. They put their bodies on display to obtain admiration and financial rewards.
3. The fighter group seeks to enhance the ability to fight or intimidate. They include body guards, security guards, prison guards, police, soldiers, bouncers, and gang members. These people depend on fighting for their very survival.

Whether anabolic steroids actually work to improve performance and appearance has been debated. Invariably, users believe they do, but some studies have failed to confirm this view.

The Consequences of Anabolic Steroid Use

Anabolic steroids have been associated with a variety of dangerous effects. In some cases anabolic steroids have even been fatal. Reported deaths in nonmedical users have occurred from liver disease, cancer, heart attacks, strokes, and suicide. Clearly, anyone using anabolic steroids should have his or her health monitored by a physician.

Psychiatric Effects. A serious, life-threatening consequence has been violent aggression toward other people. Previously mild-mannered individuals have committed murder and lesser assaults while taking anabolic steroids. Although such incidents are uncommon, most studies have found that high doses of anabolic steroids increase feelings and thoughts of aggressiveness. "Roid rage" is a slang expression used to describe the aggressive feelings, thoughts, and behaviors the drugs can produce.

Anabolic steroids can induce mood swings. Users commonly report that they feel energetic, confident, and even euphoric during a cycle of use. They may have a decreased need for sleep or find it difficult to sleep because of their high energy level. Such feelings may give way to feeling down, depressed, irritable, and tired between cycles of use. The appetite may also swing widely. During on cycles, huge quantities of food may be consumed to support the body's requirements for muscle growth and energy. During off cycles, appetite may diminish.

Psychosis, an even more dangerous consequence, means that a person cannot distinguish between what is real and what is not. For example, a psychotic person may believe that other people intend harm when no real threat exists, or that an impossible, life-threatening stunt can be performed without difficulty. Such false beliefs are called delusions. Most psychiatric effects of anabolic steroids tend to disappear soon after use is discontinued, although a depressed mood may last for several months.

Effects on the Liver. Anabolic steroids can affect the liver in various ways. Those available in pill form are more toxic to the liver than injectable forms of the drug. Most commonly, anabolic steroids cause the liver to release extra amounts of enzymes into the bloodstream. The liver enzymes usually return to normal levels when anabolic steroids are stopped. The liver also releases a substance called bilirubin, which in high amounts can cause the skin and the whites of the eyes to turn yellow (a condition called jaundice). Medical as well as nonmedical users can develop jaundice, a dangerous condition if left untreated. Jaundice can also signal other dangerous conditions of the liver, such as hepatitis. Liver tumors have been reported, some of them cancerous. Although more than half of the tumors disappeared when anabolic steroids were stopped, others resulted in death.

Effects on the Heart. Anabolic steroids can cause a decrease in a form of cholesterol known as good cholesterol. This effect in turn can increase the risk of heart attacks. When anabolic steroids are stopped, cholesterol levels return to normal. Studies have shown that anabolic steroids can cause small increases in blood pressure, also a risk factor for heart attacks and strokes. As a result of strenuous exercise, many athletes develop an enlarged heart that is not harmful. Some, but not all studies, however, suggest that drug users can develop an enlargement of the heart that is harmful.

Sexual Side Effects. Anabolic steroids can alter the levels of several sex-related hormones in the body, resulting in many adverse effects. In males, the prostate gland can enlarge, making it difficult to urinate; the testicles may shrink; and sterility can occur. These effects are, with few exceptions, reversible when anabolic steroids are stopped.

Male users can also develop enlarged breast tissue. Testosterone is changed in the body to estrogen, the female hormone, and thus the male anabolic steroid user has more estrogen than is normal. Painful lumps in the male breast may persist after stopping anabolic steroids, and they sometimes require surgical removal. Females, however, may undergo shrinkage of their breasts, as a response to higher amounts of male hormone than normal. Menstrual periods become irregular and sterility can occur in females as well. Anabolic steroid use in females may cause the voice to deepen and the clitoris to enlarge. These effects do not always reverse after stopping anabolic steroids. Women may also develop excessive hair growth in typically masculine patterns, such as on the chest and face. Finally, both males and females may experience increases and decreases in their desire for sex.

Other Effects. In children of both sexes before the onset of puberty, anabolic steroids can bring on the characteristics of male puberty. They can also cause the bones to stop growing prematurely, which can result in shorter adult heights than would otherwise occur. Anabolic steroid use can cause premature baldness in some individuals, and it can cause acne. The condition called sleep apnea (which causes people to stop breathing for short intervals during sleep) is worsened by taking anabolic steroids, as are tics, or muscle twitches, in those who already suffer from them.

Patterns of Illegal Anabolic Steroid Use

Anabolic steroids are commonly smuggled from countries where they are obtained over the counter without a prescription, and then sold illegally in the United States. Dealers and users typically connect in weight-lifting gyms. Users report that anabolic steroids are relatively easy to obtain.

Steroids can be taken as pills, through skin patches, and by injection. Injection occurs into large muscle groups (buttocks, thigh, or shoulder) or under the skin, but not into veins. Cases of AIDS have been reported in steroid users due to needle sharing. Illicit users (those who use the drugs illegally) typically consume 10 to 100 times the amounts ordinarily prescribed for medical purposes. The actual dose cannot always be determined, however, because drugs purchased on the illegal market do not always contain what the labels indicate. Law-enforcement officials have confiscated vials contaminated with bacteria.

Anabolic steroid users often use other drugs in order to:

• manage the unpleasant steroid side effects
• increase body-building effect
• avoid detection by urine testing

These drugs may themselves cause a range of side effects.

The Addictive Potential of Anabolic Steroids

As with other drugs of abuse, dependence on anabolic steroids occurs when a user reports several of the following symptoms:

• inability to stop or cut down use
• taking more drugs than intended
• continued use despite having negative effects
• tolerance, or needing more of a drug to get the same effect that was previously obtained with smaller doses
• withdrawal, or the uncomfortable effects experienced when use of the drug is stopped

As noted, many of the undesirable effects go away when anabolic steroids are stopped. However, stopping steroids may cause other symptoms to begin, such as depressed mood, fatigue, loss of appetite, difficulty sleeping, restlessness, decreased sex drive, headaches, muscle aches, and a desire for more anabolic steroids. The depression can become so severe that suicidal thoughts occur. The risk of suicide described previously is thought to be highest during the withdrawal period.

Studies indicate that between 14 percent and 57 percent of nonmedical users develop dependence on anabolic steroids, primarily in terms of the muscle-altering effects rather than the mood-altering effects. Some researchers have questioned whether anabolic steroids produce dependence at all, because most definitions of dependence require that drugs be taken primarily for their mood-altering effects.

see also Addiction: Concepts and Definitions; Adolescents, Drug and Alcohol Use; Complications from Injecting Drugs; Tolerance and Physical Dependence.