• Users of anabolic steroids are often athletes who are looking to promote muscle growth and increase their strength and energy.
• Anabolic steroids increase muscle size, but their use can also have many side effects, including mood swings, aggressive behavior, irritability, and acne.
• These substances can be detected in urine for up to 6 months.
• Treatment involves stopping use.

Anabolic steroids include the hormone testosterone and related drugs. Anabolic steroids have many physical effects, including promoting muscle growth and increasing strength and energy. Thus, these drugs are often used illegitimately to gain a competitive edge in sports. Users are often athletes, typically football players, wrestlers, or weight lifters, and most users are male. Anabolic steroids are used medically to treat low testosterone levels (hypogonadism) and sometimes to prevent muscles from wasting away in people who are confined to bed or who have severe burns, cancer, or AIDS.

The drugs may be taken by mouth, injected into a muscle, or applied to a skin as a gel or in a patch.

Athletes may take steroids for a certain period, stop, then start again several times a year. This process is called cycling. Athletes also often use many steroids at the same time (a practice called stacking), and they take them by different routes (by mouth, injection, or patch). They may also increase the dose through a cycle (called pyramiding). Pyramiding may result in very high doses. Cycling, stacking, and pyramiding are intended to enhance desired effects and minimize harmful effects, but little evidence supports these benefits.

At doses used to treat disorders, anabolic steroids cause few problems. However, athletes may take doses 10 to 50 times these doses.

Symptoms

Steroids increase muscle size. How much muscles increase depends directly on how much of the drug is taken.

Steroids have several psychologic effects (usually only with very high doses):

• Wide and erratic mood swings
• Irrational behavior
• Increased aggressiveness (steroid or roid rage)
• Irritability
• Increased sex drive (libido) in men and sometimes in women
• Depression

Increased acne is common in both sexes. Libido may increase or, less commonly, decrease. Aggressiveness and appetite may increase. In males, breast tissue may enlarge (gynecomastia), and testes may shrink and sperm count decrease. In females, masculinizing effects such as loss of head hair, excess body hair (hirsutism), an enlarged clitoris, and a deepened voice are common. Also, breast size may decrease, and tissues lining the vagina may thin and become less elastic (atrophy). Menstruation may change or stop. Gynecomastia in men and masculinizing effects in women may be irreversible.

In younger adolescents, steroids can interfere with the development of arm and leg bones.

Long-term use can cause production of excess red blood cells and abnormal levels of fats (lipids) in the blood. Low density lipoprotein (LDL)—the bad—cholesterol levels increase, and high density lipoprotein (HDL)—the good—cholesterol levels decrease.

Diagnosis

Urine tests are done to check for breakdown products of anabolic steroids. These products can be detected up to 6 months after use is stopped.

Prevention

Adolescents and young adults should be taught about the risks of taking steroids starting in middle school. Also, programs that teach alternative, healthy ways to increase muscle size and improve performance may be useful. Such programs emphasize good nutrition and weight training techniques.

Treatment

The main treatment is stopping use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders, may exist. Gynecomastia may require surgical reduction.

Last full review/revision January 2009 by Patrick G. O'Connor, MD, MPH