What are 

anabolic steroids?

nabolic 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 these

from the director

Since the 1950s, some athletes

have been taking anabolic steroids

to build muscle and boost their 

athletic performance. Increasingly,

other segments of the population

also have been taking these compounds. The Monitoring the Future

study, which is an annual survey 

of drug abuse among adolescents

across the country, showed a significant increase from 1998 to 1999 in

steroid abuse among middle school

students. During the same year, 

the percentage of 12th-graders who

believed that taking these drugs

causes “great risk” to health, declined from 68 percent to 62 percent.

Studies show that, over time,

anabolic steroids can indeed take a

heavy toll on a person’s health. The

abuse of oral or injectable steroids 

is associated with higher risks for

heart attacks and strokes, and the

abuse of most oral steroids is associated with increased risk for liver

problems. Steroid abusers who share

needles or use nonsterile techniques

when they inject steroids are at risk

for contracting dangerous infections, such as HIV/AIDS, hepatitis B

and C, and bacterial endocarditis.

Anabolic steroid abuse can also

cause undesirable body changes.

These include breast development

and genital shrinking in men, 

masculinization of the body in

women, and acne and hair loss 

in both sexes.

These and other effects of steroid

abuse are discussed in this Research

Report, which is one of a series of

reports on drugs of abuse. NIDA

produces this series to increase

understanding of drug abuse and

addiction and the health effects

associated with taking drugs. 

We hope that this compilation of

scientific information on anabolic

steroids will help the public recognize the risks of steroid abuse.

Alan I. Leshner, Ph.D.

Director

National Institute on Drug Abuse

U.S. Department of Health and Human Services • National Institutes of Health

ResearchReport NATIONAL INSTITUTE ON DRUG ABUSE

SERIES

“

A

1998

2%

4%

2

0

Lifetime Use

(10th-Graders)

1999

70%

50

30

0

1998

Perceived Risk of Harm

(Seniors)

1999

From 1998 to 1999, the Monitoring the Future Survey reported an increase in lifetime use of steroids 

among 10th-graders and a decrease in perceived risk of harm among seniors.

68%

62%

2.7%
compounds 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. 

What are steroidal

supplements?

I

n 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.

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.

What is the 

scope of steroid

abuse in the

United States?

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.

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)

2NIDA RESEARCH REPORT SERIES
Among both adolescents and

adults, steroid abuse is higher

among males than females.

However, steroid abuse is growing most rapidly among young

women.

Why do people

abuse anabolic

steroids?

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.

How are anabolic

steroids used? 

S

ome anabolic steroids are

taken orally, others are

injected intramuscularly, and

still others are provided in gels

Lifetime Use of Steroids: 8th-Graders, 10th-Graders, and Seniors (1991-1999)

8th Grade

10th Grade

12th Grade

3.0%

2.5

2.0

1.5

1.0

0.5

0

1991 1992 1993 1994 1995 1996 1997 1998 1999

Percentage Who Ever Used Steroids

NIDA RESEARCH REPORT SERIES3
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.

What are 

the health 

consequences of

steroid abuse?

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.

Hormonal system

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.

4NIDA RESEARCH REPORT SERIES
Musculoskeletal system

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.

Liver

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.

Skin

Steroid abuse can cause acne,

cysts, and oily hair and skin.

Infection

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.

What effects 

do anabolic

steroids have 

on behavior? 

C

ase reports and small 

studies indicate that anabolic

steroids, particularly in high

doses, increase irritability and

aggression. Some steroid abusers

report that they have committed

NIDA RESEARCH REPORT SERIES5

Hormonal system

■ men

• infertility

• breast development

• shrinking of the 

testicles

■ women

• enlargement of 

the clitoris

• excessive growth 

of body hair

■ both sexes 

• male-pattern 

baldness

Musculoskeletal system

■ short stature

■ tendon rupture

Cardiovascular system

■ heart attacks

■ enlargement of the

heart’s left ventricle

Liver

■ cancer

■ peliosis hepatis

Skin

■ acne and cysts

■ oily scalp

Infection

■ HIV/AIDS

■ hepatitis

Psychiatric effects

■ homicidal rage

■ mania

■ delusions

Possible Health

Consequences of 

Anabolic Steroid Abuse
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.

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.

Are anabolic

steroids addictive?

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.

6NIDA RESEARCH REPORT SERIES
What can be 

done to prevent

steroid abuse?

E

arly 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.

What treatments

are effective for

anabolic steroid

abuse? 

F

ew 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.

Where can I get

further scientific

information about

steroid abuse?

F

act sheets on anabolic

steroids, other illicit drugs,

and related topics can be

ordered free, in English and

Spanish, by calling NIDA 

Infofax at 1-888-NIH-NIDA 

(1-888-644-6432) or, for those

with hearing impairment, 

1-888-TTY-NIDA (1-888-889-6432).

Information on steroid abuse

also can be accessed through 

the NIDA Steroid Abuse Web 

Site (www.steroidabuse.org).

Information on illicit drugs 

in general can be accessed

through NIDA’s home page

(www.drugabuse.gov) or 

by contacting the National

Clearinghouse for Alcohol 

and Drug Information (NCADI)

Web Site (www.health.org).

NIDA RESEARCH REPORT SERIES7

NIDA Web Sites

www.drugabuse.gov

www.steroidabuse.org

NCADI

Web Site: www.health.org

Phone No.: 1-800-729-6686
References

Bahrke, M.S., Yesalis, C.E., and Wright, J.E.

Psychological and behavioral effects of endogenous

testosterone and anabolic-androgenic steroids: an

update. Sports Medicine 22(6): 367-390, 1996.

Blue, J.G., and Lombardo, J.A. Steroids and 

steroid-like compounds. Clinics in Sports Medicine

18(3): 667-689, 1999.

Bronson, F.H., and Matherne, C.M. Exposure to 

anabolic-androgenic steroids shortens life span of

male mice. Medicine and Science in Sports and

Exercise 29(5): 615-619, 1997.

Brower, K.J. Withdrawal from anabolic steroids. 

Current Therapy in Endocrinology and Metabolism

6: 338-343, 1997.

Elliot, D., and Goldberg, L. Intervention and prevention

of steroid use in adolescents. The American Journal

of Sports Medicine 24(6): S46-S47, 1996.

Goldberg, L., et al. Anabolic steroid education and 

adolescents: Do scare tactics work? Pediatrics

87(3): 283-286, 1991.

Goldberg, L., et al. Effects of a multidimensional 

anabolic steroid prevention intervention: The

Adolescents Training and Learning to Avoid Steroids

(ATLAS) Program. Journal of the American Medical

Association 276(19): 1555-1562, 1996.

Goldberg, L., et al. The ATLAS program: Preventing 

drug use and promoting health behaviors. 

Archives of Pediatrics and Adolescent Medicine

154: 332-338, 2000.

Gruber, A.J., and Pope, H.G., Jr. Compulsive weight 

lifting and anabolic drug abuse among women 

rape victims. Comprehensive Psychiatry

40(4): 273-277, 1999.

Gruber, A.J., and Pope, H.G., Jr. Psychiatric and 

medical effects of anabolic-androgenic steroid use 

in women. Psychotherapy and Psychosomatics

69: 19-26, 2000.

Hoberman, J.M., and Yesalis, C.E. The history of 

synthetic testosterone. Scientific American

272(2): 76-81, 1995.

Leder, B.Z., et al. Oral androstenedione administration

and serum testosterone concentrations in young

men. Journal of the American Medical Association

283(6): 779-782, 2000.

The Medical Letter on Drugs and Therapeutics. Creatine

and androstenedione–two “dietary supplements.”

40(1039): 105-106, 1998.

Middleman, A.B, et al. High-risk behaviors among high

school students in Massachusetts who use anabolic

steroids. Pediatrics 96(2): 268-272, 1995.

Pope, H.G., Jr., Kouri, E.M., and Hudson, M.D. Effects of

supraphysiologic doses of testosterone on mood and

aggression in normal men. Archives of General

Psychiatry 57(2): 133-140, 2000.

Porcerelli, J.H., and Sandler, B.A. Anabolic-androgenic

steroid abuse and psychopathology. Psychiatric

Clinics of North America 21(4): 829-833, 1998.

Porcerelli, J.H., and Sandler, B.A. Narcissism and 

empathy in steroid users. American Journal of

Psychiatry 152(11): 1672-1674, 1995.

Rich, J.D., Dickinson, B.P., Flanigan, T.P., and Valone,

S.E. Abscess related to anabolic-androgenic steroid

injection. Medicine and Science in Sports and

Exercise 31(2): 207-209, 1999.

Su, T.-P., et al. Neuropsychiatric effects of 

anabolic steroids in male normal volunteers. 

Journal of the American Medical Association

269(21): 2760-2764, 1993.

Sullivan, M.L., Martinez, C.M., Gennis, P., and

Gallagher, E.J. The cardiac toxicity of anabolic

steroids. Progress in Cardiovascular Diseases

41(1): 1-15, 1998.

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Yesalis, C.E. Androstenedione. Sport Dietary

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Yesalis, C.E. Trends in anabolic-androgenic steroid use

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Yesalis, C.E., Kennedy, N.J., Kopstein, A.N., and Bahrke,

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NIH Publication Number 00-3721

Printed 1991, Reprinted 1994, 1996

Revised April 2000

Feel free to reprint this publication.

8NIDA RESEARCH REPORT SERIES

Glossary

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.