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Anabolic Steroids


Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;

Rika O’Malley

, MD, Grand Strand Medical Center

Reviewed/Revised Dec 2022

Anabolic steroids are synthetic (man-made) versions of testosterone that are used to increase muscle size.

  • Anabolic steroids are hormones that promote muscle growth and increase strength and energy.

  • Anabolic steroids can also have many side effects, including psychologic (mood swings, aggressive behavior, irritability) and physical (acne, masculinizing effects in women, breast enlargement in men).

  • 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, bodybuilders, or weight lifters, and most users are male.

Anabolic steroids are used medically to treat low testosterone levels (hypogonadism Effects of Aging on the Male Reproductive System It is not clear whether aging itself or the disorders associated with aging cause the gradual changes that occur in men's sexual functioning. The frequency, duration, and rigidity of erections... read more ) 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 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 and Signs of Anabolic Steroid Use

Anabolic steroids have physical and psychologic effects. The more drug is taken, the greater the effect.

Physical effects

The main physical effect of anabolic steroids is

  • Increased muscle size

Other physical effects include

Gynecomastia in men and masculinizing effects in women may be irreversible.

Increased acne is common in both sexes. Libido may increase or, less commonly, decrease. Aggressiveness and appetite may increase. In younger adolescents, steroids can interfere with the development of arm and leg bones.

Psychologic effects

Steroids have several psychologic effects (usually only with 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

Diagnosis of Anabolic Steroid Use

  • Urine tests

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 of Anabolic Steroid Use

Adolescents and young adults should be taught about the risks of taking anabolic 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 of Anabolic Steroid Use

  • Stopping use of steroids

The main treatment is stopping use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders, may exist. Gynecomastia Breast enlargement in men Breast disorders occur infrequently in men. Breast disorders include Breast enlargement Breast cancer Breast enlargement in males is called either gynecomastia or pseudogynecomastia. Gynecomastia... read more (enlarged breast tissue in men) may require surgical reduction.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • National Institute on Drug Abuse (NIDA): Anabolic steroid–specific information from the federal agency that supports scientific research into drug use and its consequences and supplies information about commonly used drugs, research priorities and progress, clinical resources, and grant and funding opportunities.

  • Substance Abuse and Mental Health Services Administration (SAMHSA): US Department of Health agency that leads public health efforts to improve behavioral health and provides resources, including treatment locators, toll-free helplines, practitioner training tools, statistics, and publications on a variety of substance-related topics.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Androderm, AndroGel, Andro-L.A., Aveed, AXIRON, Delatestryl, Depo-Testosterone, FORTESTA, JATENZO, KYZATREX, Natesto, STRIANT, Testim, Testoderm, Testopel, TLANDO, Virilon, Vogelxo, XYOSTED
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