What are anabolic steroids? |

History 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 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.

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

The illegal use of anabolic steroids, including among professional athletes, remains a major problem. Newer formulations based on molecules not screened by existing tests are always being developed. These newer steroids are popular among teenage boys, especially those participating in competitive sports, most notably wrestling, football, and weightlifting. Although anabolic steroids are banned by virtually all major amateur and professional sports organizations, there have been numerous cases of high-profile athletes revealed to have used the drugs to enhance their performance. 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 public scandal. The US Drug Enforcement Administration has also noted a relatively high rate of steroid abuse among law enforcement officials, particularly police officers. 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.

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. 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 males, 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. Feminine 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 females, abuse leads to the emergence of masculine characteristics, including 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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