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HLT 214 - Substance Use and Abuse - Textbook

Chapter 12: Anabolic Steroids

Learning Objectives

At the conclusion of this chapter, students will be able to:

  1. Demonstrate an understanding of the history of use and abuse of anabolic steroids.
  2. Demonstrate an understanding of the possible mechanisms of action for anabolic steroids
  3. Become familiar with the scientific literature regarding various performance enhancing drugs used by athletes.
  4. Demonstrate an understanding of the acute and chronic effects and the special risks of anabolic steroids in teens.


The use of performance enhancing drugs (PED) in sports, doping, has been practiced for over a hundred years. Early cases of drug use to enhance athletic performance were admitted to without consequence to athletes or coaches. Among the most popular PEDs are anabolic steroids, human growth hormone, erythropoietin, beta-blockers, stimulants and diuretics. The anabolic steroid testosterone was first synthesized in Germany in 1935. Most anabolic steroid users are male non-athletes aiming to improve their appearance by building muscle and use of steroids is strongly tied to a male body image disorder called muscle dysmorphia. In 1969, the International Olympic Committee initiated drug tests for athletes at the Olympic Games. As levels of illicit traffic in steroids increased, congress passed the Anabolic Steroid Act of 1990. This Act identified anabolic steroids as a separate drug class and categorized over two dozen drugs as controlled substances.1-3

The Use and Abuse of Anabolic Steroids

Anabolic steroids are synthetic variations of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids. "Anabolic" refers to muscle building, and "androgenic" refers to increased male sex characteristics. Some common names for anabolic steroids are Gear, Juice, Roids, and Stackers. Health care providers can prescribe steroids to treat various medical conditions, including delayed puberty. But some athletes and bodybuilders misuse these drugs to boost performance or improve their physical appearance. Athletes may have stimulants in their body for one of three main reasons: inadvertent consumption in a propriety medicine; deliberate consumption for misuse as a recreational drug and deliberate consumption to enhance performance. People who misuse anabolic steroids usually take them orally, inject them into muscles, or apply them to the skin as a gel or cream. These doses may be 10 to 100 times higher than doses prescribed to treat medical conditions.

Short-term effects

Misuse of anabolic steroids might lead to negative mental effects, such as:

  • paranoid (extreme, unreasonable) jealousy
  • extreme irritability and aggression (“roid rage”)
  • delusions—false beliefs or ideas
  • impaired judgment
  • mania

Long-term effects

Anabolic steroid misuse might lead to serious, even permanent, health problems such as:

  1. kidney problems or failure
  2. liver damage and tumors
  3. enlarged heart, high blood pressure, and changes in blood cholesterol, all of which increase the risk of stroke and heart attack, even in young people
  4. increased risk of blood clots

Several other effects are gender- and age-specific:

In men:

  • shrinking testicles
  • decreased sperm count
  • baldness
  • development of breasts
  • increased risk for prostate cancer

In women:

  • growth of facial hair or excess body hair
  • decreased breast size
  • male-pattern baldness
  • changes in or stop in the menstrual cycle
  • enlarged clitoris
  • deepened voice

In teens:

  • stunted growth (when high hormone levels from steroids signal to the body to stop bone growth too early)
  • stunted height (if teens use steroids before their growth spurt)

Some of these physical changes, such as shrinking sex organs in men, can add to mental side effects such as mood disorders.

Anabolic Steroid Use Disorder

Anabolic steroids work differently from other drugs of abuse; they do not have the same short-term effects on the brain. The most important difference is that steroids do not directly activate the reward system to cause a “high”; they also do not trigger rapid increases in the brain chemical dopamine, which reinforces most other types of drug taking behavior. Even though anabolic steroids do not cause the same high as other drugs, they can lead to a substance use disorder. A substance use disorder occurs when a person continues to misuse steroids, even though there are serious consequences for doing so. The most severe form of a substance use disorder is addiction. People might continue to misuse steroids despite physical problems, high costs to buy the drugs, and negative effects on their relationships. These behaviors reflect steroids' addictive potential. Research has further found that some steroid users turn to other drugs, such as opioids, to reduce sleep problems and irritability caused by steroids.4,5

Chapter Review and Discussion Questions

  1. What are the health effects of steroid abuse?
  2. List some performance enhancing drugs.
  3. What are the health hazards of steroid abuse in the youth.
  4. Describe gender specific effects of steroid abuse.
  5. Are anabolic steroids addictive?