Anabolic Steroid Abuse
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“Anabolic steroids” is the familiar name for
synthetic substances related to the male sex hormones (androgens). They promote
the growth of skeletal muscle (anabolic effects) and the development of male
sexual characteristics (androgenic effects), and also have some other effects.
The term “anabolic steroids” will be used throughout this report
because of its familiarity, although the proper term for these compounds is
“anabolic-androgenic” steroids. Anabolic steroids were developed
in the late 1930s primarily to treat hypogonadism, a condition in which the
testes do not produce sufficient testosterone for normal growth, development,
and sexual functioning.
The primary
medical uses of thesecompounds are to treat delayed puberty, some types of
impotence, and wasting of the body caused by HIV infection or other diseases.
During the 1930s, scientists discovered that anabolic steroids could facilitate
the growth of skeletal muscle in laboratory animals, which led to use of the
compounds first by bodybuilders and weightlifters and then by athletes in
other sports. Steroid abuse has become so widespread in athletics that it
affects the outcome of sports contests. More than 100 different anabolic steroids
have been developed, but they require a prescription to be used legally in
the United States. Most steroids that are used illegally are smuggled in from
other countries, illegally diverted from U.S. pharmacies, or synthesized in
clandestine laboratories.
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In the United States, supplements such as dehydroepiandrosterone (DHEA) and
androstenedione (street name Andro) can be purchased legally without a prescription
through many commercial sources including health food stores. They are often
referred to as dietary supplements, although they are not food products. They
are often taken because the user believes they have anabolic effects. Steroidal
supplements can be converted into testosterone (an important male sex hormone)
or a similar compound in the body.
| Commonly Abused Steroids |
Oral Steroids
- Anadrol (oxymetholone)
- Oxandrin (oxandrolone)
- Dianabol (methandrostenolone)
- Winstrol (stanozolol)
|
Injectable Steroids
- Deca-Durabolin (nandrolone decanoate)
- Durabolin (nandrolone phenpropionate)
- Depo-Testosterone (testosterone cypionate)
- Equipoise (boldenone undecylenate)
|
Whether such conversion produces
sufficient quantities of
testosterone to promote muscle
growth or whether the supplements
themselves promote muscle
growth is unknown. Little is
known about the side effects of
steroidal supplements, but if
large quantities of these compounds
substantially increase
testosterone levels in the body,
they also are likely to produce
the same side effects as anabolic
steroids.
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Recent evidence suggests that steroid abuse among adolescents is on the rise.
The 1999 Monitoring the Future study, a NIDA-funded survey of drug abuse among
adolescents in middle and high schools across the United States, estimated
that 2.7 percent of 8th- and 10th-graders and 2.9 percent of 12th-graders
had taken anabolic steroids at least once in their lives. For 10th-graders,
that is a significant increase from 1998, when 2.0 percent of 10th-graders
said they had taken anabolic steroids at least once. For all three grades,
the 1999 levels represent a significant increase from 1991, the first year
that data on steroid abuse were collected from the younger students. In that
year, 1.9 percent of 8th-graders, 1.8 percent of 10th-graders, and 2.1 percent
of 12th-graders reported that they had taken anabolic steroids at least once.
Few data exist on the extent of steroid abuse by adults. It has been estimated
that hundreds of thousands of people aged 18 and older abuse anabolic steroids
at least once a year.
Among both adolescents and
adults, steroid abuse is higher
among males than females.
However, steroid abuse is growing
most rapidly among young
women.
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One of the main reasons people give for abusing steroids is to improve their
performance in sports. Among competitive bodybuilders, steroid abuse has been
estimated to be very high. Among other athletes, the incidence of abuse probably
varies depending on the specific sport.
Another reason people give for taking steroids is to increase their muscle
size and/or reduce their body fat. This group includes some people who have
a behavioral syndrome (muscle dysmorphia) in which a person has a distorted
image of his or her body. Men with this condition think that they look small
and weak, even if they are large and muscular. Similarly, women with the syndrome
think that they look fat and flabby, even though they are actually lean and
muscular.
Some people who abuse steroids to boost muscle size have experienced physical
or sexual abuse. They are trying to increase their muscle size to protect
themselves. In one series of interviews with male weightlifters, 25 percent
who abused steroids reported memories of childhood physical or sexual abuse,
compared with none who did not abuse steroids. In a study of women weightlifters,
twice as many of those who had been raped reported using anabolic steroids
and/or another purported muscle-building drug, compared to those who had not
been raped. Moreover, almost all of those who had been raped reported that
they markedly increased their bodybuilding activities after the attack. They
believed that being bigger and stronger would discourage further attacks because
men would find them either intimidating or unattractive.
Finally,
some adolescents abuse steroids as part of a pattern of high-risk behaviors.
These adolescents also take risks such as drinking and driving, carrying a
gun, not wearing a helmet on a motorcycle, and abusing other illicit drugs.
While conditions such as muscle dysmorphia, a history of physical or sexual
abuse, or a history of engaging in high-risk behaviors may increase the risk
of initiating or continuing steroid abuse, researchers agree that most steroid
abusers are psychologically normal when they start abusing the drugs.
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Some anabolic steroids are taken orally, others are injected intramuscularly,
and still others are provided in gels or creams that are rubbed on the skin.
Doses taken by abusers can be 10 to 100 times higher than the doses used for
medical conditions.
Steroid abusers typically “stack” the drugs, meaning that they take two or
more different anabolic steroids, mixing oral and/or injectable types and
sometimes even including compounds that are designed for veterinary use. Abusers
think that the different steroids interact to produce an effect on muscle
size that is greater than the effects of each drug individually, a theory
that has not been tested scientifically.
Often, steroid abusers also “pyramid” their doses in cycles of 6 to 12 weeks.
At the beginning of a cycle, the person starts with low doses of the drugs
being stacked and then slowly increases the doses. In the second half of the
cycle, the doses are slowly decreased to zero. This is sometimes followed
by a second cycle in which the person continues to train but without drugs.
Abusers believe that pyramiding allows the body time to adjust to the high
doses and the drug-free cycle allows the body’s hormonal system time to recuperate.
As with stacking, the perceived benefits of pyramiding and cycling have not
been substantiated scientifically.
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Anabolic steroid abuse has been associated with a wide range of adverse side
effects ranging from some that are physically unattractive, such as acne and
breast development in men, to others that are life threatening, such as heart
attacks and liver cancer.
Most are reversible if the abuser stops taking the drugs, but some are permanent.
Most data on the long-term effects of anabolic steroids on humans come from
case reports rather than formal epidemiological studies. From the case reports,
the incidence of life-threatening effects appears to be low, but serious adverse
effects may be under-recognized or under-reported. Data from animal studies
seem to support this possibility. One study found that exposing male mice
for one-fifth of their lifespan to steroid doses comparable to those taken
by human athletes caused a high percentage of premature deaths.
Steroid abuse disrupts the normal
production of hormones in the
body, causing both reversible
and irreversible changes.
Changes that can be reversed
include reduced sperm production
and shrinking of the testicles
(testicular atrophy). Irreversible
changes include male-pattern
baldness and breast development
(gynecomastia). In one study of
male bodybuilders, more than
half had testicular atrophy, and
more than half had gynecomastia.
Gynecomastia is thought to
occur due to the disruption of
normal hormone balance.
In the female body, anabolic
steroids cause masculinization.
Breast size and body fat decrease,
the skin becomes coarse, the
clitoris enlarges, and the voice
deepens. Women may experience
excessive growth of body
hair but lose scalp hair. With
continued administration of
steroids, some of these effects
are irreversible.
Rising levels of testosterone and
other sex hormones normally
trigger the growth spurt that
occurs during puberty and adolescence.
Subsequently, when
these hormones reach certain
levels, they signal the bones to
stop growing, locking a person
into his or her maximum height.
When a child or adolescent takes
anabolic steroids, the resulting
artificially high sex hormone
levels can signal the bones to
stop growing sooner than they
normally would have done.
Cardiovascular system
Steroid abuse has been associated
with cardiovascular diseases
(CVD), including heart attacks
and strokes, even in athletes
younger than 30. Steroids contribute
to the development of
CVD, partly by changing the
levels of lipoproteins that carry
cholesterol in the blood. Steroids,
particularly the oral types, increase
the level of low-density
lipoprotein (LDL) and decrease
the level of high-density lipoprotein
(HDL). High LDL and low
HDL levels increase the risk of
atherosclerosis, a condition in
which fatty substances are
deposited inside arteries and
disrupt blood flow. If blood is
prevented from reaching the
heart, the result can be a heart
attack. If blood is prevented from
reaching the brain, the result can
be a stroke.
Steroids also increase the risk
that blood clots will form in
blood vessels, potentially disrupting
blood flow and damaging
the heart muscle so that it
does not pump blood effectively.
Steroid abuse has been associated
with liver tumors and a rare
condition called peliosis hepatis,
in which blood-filled cysts form
in the liver. Both the tumors and
the cysts sometimes rupture,
causing internal bleeding.
Steroid abuse can cause acne,
cysts, and oily hair and skin.
Many abusers who inject anabolic
steroids use nonsterile
injection techniques or share
contaminated needles with
other abusers. In addition, some
steroid preparations are manufactured
illegally under nonsterile
conditions. These factors
put abusers at risk for acquiring
life-threatening viral infections,
such as HIV and hepatitis B
and C. Abusers also can develop
infective endocarditis, a bacterial
illness that causes a potentially
fatal inflammation of the inner
lining of the heart. Bacterial
infections also can cause
pain and abscess formation
at injection sites.
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Case reports and small studies indicate that anabolic steroids, particularly
in high doses, increase irritability and aggression. Some steroid abusers
report that they have committed aggressive acts, such as physical fighting,
committing armed robbery, or using force to obtain something. Some abusers
also report that they have committed property crimes, such as stealing from
a store, damaging or destroying others’ property, or breaking into a house
or a building. Abusers who have committed aggressive acts or property crimes
generally report that they engage in these behaviors more often when they
take steroids than when they are drug-free.
| Possible Health Consequences of Anabolic Steroid
Abuse |
| Hormonal system |
- men
- infertility
- breast development
- shrinking of the testicles
- women
- enlargement of the clitoris
- excessive growth of body hair
- both sexes
|
| Musculoskeletal system |
- short stature
- tendon rupture
|
| Cardiovascular system |
- heart attacks
- enlargement of the heart’s left ventricle
|
| Liver |
|
| Skin |
- acne and cysts
- oily scalp
|
| Infection |
|
| Psychiatric effects |
- homicidal rage
- mania
- delusions
|
Some researchers have suggested that steroid abusers may commit aggressive
acts and property crimes not because of steroids’ direct effects on the brain
but because the abusers have been affected by extensive media attention to
the link between steroids and aggression. According to this theory, the abusers
are using this possible link as an excuse to commit aggressive acts and property
crimes.
One way to distinguish between these two possibilities is to administer
either high steroid doses or placebo for days or weeks to human volunteers
and then ask the people to report on their behavioral symptoms. To date, four
such studies have been conducted. In three, high steroid doses did produce
greater feelings of irritability and aggression than did placebo; but in one
study, the drugs did not have that effect. One possible explanation, according
to researchers, is that some but not all anabolic steroids increase irritability
and aggression.
Anabolic steroids have been reported also to cause other behavioral effects,
including euphoria, increased energy, sexual arousal, mood swings, distractibility,
forgetfulness, and confusion. In the studies in which researchers administered
high steroid doses to volunteers, a minority of the volunteers developed behavioral
symptoms that were so extreme as to disrupt their ability to function in their
jobs or in society. In a few cases, the volunteers’ behavior presented a threat
to themselves and others.
In summary, the extent to which steroid abuse contributes to violence and
behavioral disorders is unknown. As with the health complications of steroid
abuse, the prevalence of extreme cases of violence and behavioral disorders
seems to be low, but it may be underreported or underrecognized.
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An undetermined percentage of steroid abusers become addicted to the drugs,
as evidenced by their continuing to take steroids in spite of physical problems,
negative effects on social relations, or nervousness and irritability. Also,
they spend large amounts of time and money obtaining the drugs and experience
withdrawal symptoms such as mood swings, fatigue, restlessness, loss of appetite,
insomnia, reduced sex drive, and the desire to take more steroids. The most
dangerous of the withdrawal symptoms is depression, because it sometimes leads
to suicide attempts. Untreated, some depressive symptoms associated with anabolic
steroid withdrawal have been known to persist for a year or more after the abuser
stops taking the drugs.
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Early attempts to prevent steroid abuse concentrated on drug testing and on
educating students about the drugs’ adverse effects. A few school districts
test for abuse of illicit drugs, including steroids, and studies are currently
under way to determine whether such testing reduces drug abuse.
Research on steroid educational programs has shown that simply teaching students
about steroids’ adverse effects does not convince adolescents that they personally
can be adversely affected. Nor does such instruction discourage young people
from taking steroids in the future. Presenting both the risks and benefits
of anabolic steroid use is more effective in convincing adolescents about
steroids’ negative effects, apparently because the students find a balanced
approach more credible and less biased, according to the researchers. However,
the balanced approach still does not discourage adolescents from abusing steroids.
A more sophisticated approach has shown promise for preventing steroid abuse
among players on high school sports teams. In the ATLAS program, developed
for male football players, coaches and team leaders discuss the potential
effects of anabolic steroids and other illicit drugs on immediate sports performance,
and they teach how to refuse
offers of drugs. They also discuss
how strength training and proper
nutrition can help adolescents
build their bodies without the
use of steroids. Later, special
trainers teach the players proper
weightlifting techniques. An
ongoing series of studies has
shown that this multicomponent,
team-centered approach reduces
new steroid abuse by 50 percent.
A program designed for adolescent
girls on sports teams,
patterned after the program
designed for boys, is currently
being tested.
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Few studies of treatments for anabolic steroid abuse have been conducted. Current
knowledge is based largely on the experiences of a small number of physicians
who have worked with patients undergoing steroid withdrawal. The physicians
have found that supportive therapy is sufficient in some cases. Patients are
educated about what they may experience during withdrawal and are evaluated
for suicidal thoughts. If symptoms are severe or prolonged, medications or
hospitalization may be needed.
Some medications that have been used for treating steroid withdrawal restore
the hormonal system after its disruption by steroid abuse. Other medications
target specific withdrawal symptoms—for example, antidepressants to treat
depression, and analgesics for headaches and muscle and joint pains.
Some patients require assistance beyond simple treatment of withdrawal symptoms
and are treated with behavioral therapies.
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NIDA Steroid Abuse
Web Site
NIDA
National Clearinghouse for
Alcohol and Drug Information (NCADI)
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Addiction: A chronic, relapsing
disease, characterized by compulsive
drug-seeking and abuse and by longlasting
chemical changes in the brain.
Anabolic effects: Drug-induced
growth or thickening of the body’s
nonreproductive tract tissues—including
skeletal muscle, bones, the larynx,
and vocal cords—and decrease in
body fat.
Analgesics: A group of medications
that reduce pain.
Androgenic effects: A drug’s
effects upon the growth of the
male reproductive tract and the
development of male secondary
sexual characteristics.
Antidepressants: A group of
medications used in treating depressive
disorders.
Cardiovascular system:
The heart and blood vessels.
Hormone: A chemical substance
formed in glands in the body and
carried in the blood to organs and
tissues, where it influences function,
structure, and behavior.
Musculoskeletal system:
The muscles, bones, tendons, and
ligaments.
Placebo: An inactive substance,
used in experiments to distinguish
between actual drug effects and effects
that are expected by the volunteers in
the experiments.
Sex hormones: Hormones that
are found in higher quantities in one
sex than in the other. Male sex hormones
are the androgens, which
include testosterone; and the female
sex hormones are the estrogens and
progesterone.
Withdrawal: Symptoms that occur
after chronic use of a drug is reduced
or stopped.
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