Anabolic steroids

• ALSO KNOWN AS: Anabolic-androgenic steroids; gym candy; pumpers; roids; stackers
• DEFINITION: Anabolic steroids are synthetic formulations structurally related to testosterone, the male sex hormone. The steroids are used illicitly to increase muscle size and strength.
• STATUS: Legal in the United States for specific medical applications. Nonmedical use is illegal.
• CLASSIFICATION: Schedule III controlled substance in the United States (possession, buying, and selling are illegal); schedule IV controlled substance in Canada (buying and selling are illegal); legal in Mexico
• SOURCE: Diversion from medical and veterinary practices and suppliers, produced in clandestine laboratories, and smuggled. Sold at gyms, in schools, and online.
• TRANSMISSION ROUTES: Intramuscular injection, pills, creams, and gels

History and Patterns of Use

Although commonly called anabolic steroids, these drugs are more correctly identified as anabolic-androgenic steroids. They have both anabolic properties, which promote the growth of skeletal muscle, and androgenic properties, which promote the development of male sexual characteristics.

Synthetic testosterones were first developed in the 1930s in Europe. After World War II (1939–45), they were used by sports officials in the Soviet bloc, especially East Germany, to enhance athletic strength and performance in both males and females. In 1956, John Ziegler, a US Olympic Team physician, developed methandrostenolone, which in 1958 became the first anabolic steroid licensed in the United States for medical use. Eventually, the danger and long-term risk of the use of anabolic steroids as muscle enhancers became apparent. The steroids were banned from use in Olympic competitions in 1976. However, doping, the use of steroids or other banned treatments or medications to improve athletic performance, remained a global issue in competitive sports.

The US Anabolic Steroids Control Act was passed in 1990, making anabolic steroids a schedule III controlled substance in the United States. Anabolic steroids have a range of medicinal applications, and are used to treat men with hypogonadism (low production of testosterone by the testes) and to treat boys with delayed puberty. Steroids are also used to facilitate tissue regrowth in persons with severe burns and to treat severe weight loss in persons with acquired immune deficiency syndrome (AIDS).

The illegal use of anabolic steroids, including among professional athletes, remained a major problem into the twenty-first century. Although anabolic steroids had been banned by virtually all major amateur and professional sports organizations, numerous cases of high-profile athletes using the drugs to enhance their performances continued to occur. Within Major League Baseball (MLB) especially, steroid use was rampant among players throughout the 1980s and 1990s, affecting the way baseball was played and leading to a major scandal in the 2000s. Later, MLB players who were suspected of, admitted to, or were suspended for doping in the early 2000s found themselves unable to earn enough votes to enter the Hall of Fame in the 2020s, no matter how they performed otherwise.

Another major doping scandal emerged in 2016 after Grigory Rodchenkov, a Russian doctor, exposed the existence of a state-sponsored doping program for Russian Olympic athletes. As part of this program, Russian athletes were given a number of banned substances, including anabolic steroids. While the Russian government denied these allegations, in 2019 the World Anti-Doping Agency banned the Russian Federation from participating in the Olympic Games and other major international competitions for four years (later reduced to two). Russian athletes could still participate in these competitions as long as they did so on a neutral team and not as a representative of Russia.

Steroid abusers take doses of anabolic steroids in quantities ten to one-hundred times greater than those doses used in medicine. Anabolic steroids, including formulations of bolderone and nandrolone, are usually injected. Methandrostenolone, oxymetholone, and stanozole are taken as pills. Steroid gels, creams, and transdermal patches are less effective when used alone, but many abusers employ a “stacking” regimen, in which topical, oral, and injectable formulations are combined to increase the total effect and to avoid detection of high levels of any one steroid in testing. New formulations of anabolic steroids that are not specifically restricted or that are not detectable using current screening methods are being developed and distributed. Well over fifty anabolic steroids have been identified as controlled substances in the United States. However, newer formulations based on molecules not screened by existing tests are always being developed. These newer steroids have proven popular among young people, especially those participating in competitive sports, most notably wrestling, football, and weightlifting. Additionally, the rise of social media in the 2010s and 2020s led to increased use of anabolic steroids among adolescents, as many young people were influenced by content promoting unrealistic body standards on social media platforms like TikTok, which contributed to overall body dissatisfaction and the use of performance-enhancing drugs.

Effects and Potential Risks

Unlike most other abused drugs, anabolic steroids do not cause immediate euphoria or other pleasurable feelings. They are used to promote rapid muscle growth and weight gain (also called bulking up) and to increase strength and sports prowess over time, making them appealing to people involved in bodybuilding and similar activities. A common adverse effect of high, prolonged dosing is “roid rage,” in which one experiences mood swings, anxiety, irritability, and aggressiveness. Other psychological effects such as depression and psychosis may be observed, and some evidence suggests that the risk of suicide may be increased by prolonged steroid use.

Abusers do not become physically addicted to anabolic steroids, but they can develop a compulsive reliance on them. Depression, headache, fatigue, loss of appetite, and insomnia may result if the drugs are discontinued. Depression may be long-lasting and can lead to suicidal thoughts and actions. In men, long-term abuse suppresses the sex drive, lowers or halts sperm production, and causes shrinking of the testicles. Severe acne may develop. In general, these adverse effects are reversible. Other characteristics, including breast development, may occur because some of the excess testosterone produced is converted into the female hormone estradiol. Such changes cannot be reversed.

In women, abuse leads to the emergence of extra muscle deposits, deeper voice, thicker and coarser body hair, male-pattern baldness, disruption of the menstrual cycle, and enlargement of the clitoris. Some of these changes are irreversible. Among younger abusers, high testosterone levels in the body can prematurely signal bones to stop growing and, thus, can stunt growth. In both males and females, steroid abuse contributes to the risk of heart attack and stroke. High levels of testosterone negatively impact cholesterol levels. Levels of bad cholesterol (low-density lipoprotein, or LDL) are increased, while those of good cholesterol (high-density lipoprotein, or HDL) are decreased. This causes a buildup of plaque in the arteries (atherosclerosis), which decreases or eventually blocks blood flow to the heart, leading to a heart attack, or blood flow to the brain, leading to a stroke. Liver disease too is a rare but potential risk of steroid abuse. Blood-filled cysts that develop in the liver may rupture and cause life-threatening internal bleeding. Kidney failure also can occur. Abusers who share or use contaminated needles are at risk of infection with HIV (human immunodeficiency virus) or with the hepatitis B or C viruses. Anabolic steroids are also considered likely carcinogens by the International Agency for Research on Cancer (IARC), a branch of the World Health Organization (WHO).

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