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Anabolic-androgenic steroids (AAS) 

are synthetically produced variants of 

the naturally occurring male sex hormone testosterone. “Anabolic” refers 

to muscle-building, and “androgenic” 

refers to increased male sexual characteristics. “Steroids” refers to the class 

of drugs. These drugs can be legally 

prescribed to treat conditions resulting 

from steroid hormone deficiency, such 

as delayed puberty, as well as diseases that result in loss of lean muscle 

mass, such as cancer and AIDS.

How Are AAS Abused?

Some people, both athletes and nonathletes, abuse AAS in an attempt to 

enhance performance and/or improve 

physical appearance. AAS are taken 

orally or injected, typically in cycles 

rather than continuously. “Cycling” 

refers to a pattern of use in which steroids are taken for periods of weeks or 

months, after which use is stopped for 

a period of time and then restarted. In 

addition, users often combine several 

different types of steroids in an attempt 

to maximize their effectiveness, a practice referred to as “stacking.” 

How Do AAS Affect the 

Brain?

The immediate effects of AAS in the 

brain are mediated by their binding to androgen (male sex hormone) 

and estrogen (female sex hormone) 

receptors on the surface of a cell. This 

AAS–receptor complex can then shuttle 

into the cell nucleus to influence patterns of gene expression. Because of 

this, the acute effects of AAS in the 

brain are substantially different from 

those of other drugs of abuse. The 

most important difference is that AAS 

are not euphorigenic, meaning they 

do not trigger rapid increases in the 

neurotransmitter dopamine, which is 

responsible for the “high” that often 

drives substance abuse behaviors. 

However, long-term use of AAS can 

eventually have an impact on some of 

the same brain pathways and chemicals—such as dopamine, serotonin, 

and opioid systems—that are affected 

by other drugs of abuse. Considering 

the combined effect of their complex 

direct and indirect actions, it is not surprising that AAS can affect mood and 

behavior in significant ways.

AAS and Mental Health

Preclinical, clinical, and anecdotal 

reports suggest that steroids may 

contribute to psychiatric dysfunction. 

Research shows that abuse of anabolic 

steroids may lead to aggression and 

other adverse effects.1 For example, 

although many users report feeling 

good about themselves while on anabolic steroids, extreme mood swings 

can also occur, including manic-like 

symptoms that could lead to violence.2

Steroids (Anabolic-Androgenic)
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Researchers have also observed that 

users may suffer from paranoid jealousy, extreme irritability, delusions, 

and impaired judgment stemming from 

feelings of invincibility.

Addictive Potential

Animal studies have shown that AAS 

are reinforcing—that is, animals 

will self-administer AAS when given 

the opportunity, just as they do with 

other addictive drugs.3,4 This property is more difficult to demonstrate 

in humans, but the potential for AAS 

abusers to become addicted is consistent with their continued abuse despite 

physical problems and negative effects 

on social relations.5 Also, steroid abusers typically spend large amounts of 

time and money obtaining the drug: 

this is another indication of addiction. Individuals who abuse steroids 

can experience withdrawal symptoms 

when they stop taking AAS—these 

include mood swings, fatigue, restlessness, loss of appetite, insomnia, 

reduced sex drive, and steroid cravings, all of which may contribute to 

continued abuse. One of the most 

dangerous withdrawal symptoms is 

depression—when persistent, it can 

sometimes lead to suicide attempts. 

Research also indicates that some 

users might turn to other drugs to 

alleviate some of the negative effects 

of AAS. For example, a study of 227 

men admitted in 1999 to a private 

treatment center for dependence on 

heroin or other opioids found that 9.3 

percent had abused AAS before trying any other illicit drug. Of these, 86 

percent first used opioids to counteract 

insomnia and irritability resulting from 

the steroids.6

What Other Adverse Effects 

Do AAS Have on Health?

Steroid abuse can lead to serious, 

even irreversible health problems. Some 

of the most dangerous among these 

include liver damage; jaundice (yellowish pigmentation of skin, tissues, and 

body fluids); fluid retention; high blood 

pressure; increases in LDL (“bad” 

cholesterol); and decreases in HDL 

(“good” cholesterol). Other reported 

effects include renal failure, severe 

acne, and trembling. In addition, there 

are some gender- and age-specific 

adverse effects:

•	 For men—shrinking of the testicles, 

reduced sperm count, infertility, 

baldness, development of breasts, 

increased risk for prostate cancer 

•	 For women—growth of facial hair, 

male-pattern baldness, changes in 

or cessation of the menstrual cycle, 

enlargement of the clitoris, deepened voice 

•	 For adolescents—stunted growth 

due to premature skeletal maturation and accelerated puberty 

changes; risk of not reaching 

expected height if AAS is taken 

before the typical adolescent 

growth spurt 

In addition, people who inject AAS run 

the added risk of contracting or transmitting HIV/AIDS or hepatitis, which 

causes serious damage to the liver.
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What Treatment Options 

Exist?

There has been very little research 

on treatment for AAS abuse. Current 

knowledge derives largely from the 

experiences of a small number of physicians who have worked with patients 

undergoing steroid withdrawal. They 

have learned that, in general, supportive therapy combined with education 

about possible withdrawal symptoms 

is sufficient in some cases. Sometimes, 

medications can be used to restore the 

balance of the hormonal system after 

its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization 

may be needed.

How Widespread Is AAS 

Abuse?

Monitoring the Future Survey†

Monitoring the Future is an annual 

survey used to assess drug use among 

the Nation’s 8th-, 10th-, and 12thgrade students. While steroid use 

remained stable among all grades 

from 2007 to 2008, there has been 

a significant reduction since 2001 for 

nearly all prevalence periods (i.e., 

lifetime,†† past-year, and past-month 

use) among all grades surveyed. The 

exception was past-month use among 

12th-graders, which has remained 

stable. Males consistently report higher 

rates of use than females: for example, 

in 2008, 2.5 percent of 12th-grade 

males, versus 0.6 percent of 12thgrade females, reported past-year use.

Anabolic Steroid Use by Students

2008 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade

Lifetime†† 1.4% 1.4% 2.2%

Past Year 0.9% 0.9% 1.5%

Past Month 0.5% 0.5% 1.0%

Other Information Sources

For a list of street terms used to refer 

to steroids and other drugs, visit 

www.whitehousedrugpolicy.gov/

streetterms/default.asp. 

For additional information on the 

effects of anabolic-androgenic steroids 

and information on healthy alternatives, please visit NIDA’s Web site on 

steroids, www.steroidabuse.org.
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†

 These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, 

National Institutes of Health, Department of Health and Human Services, and conducted by the University of 

Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes 

since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at 

www.drugabuse.gov.

†† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during 

the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days 

preceding an individual’s response to the survey.

References 

1 Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in 

normal men: A randomized controlled trial. Arch Gen Psychiatry 57(2):133–140, 2000.

2 Pope HG Jr, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry

145(4):487–490, 1988.

3 Arnedo MT, Salvador A, Martinez-Sanchis S, Gonzalez-Bono E. Rewarding properties of testosterone in intact male 

mice: A pilot study. Pharmacol Biochem Behav 65:327–332, 2000.

4 DiMeo AN, Wood RI. Self-administration of estrogen and dihydrotestosterone in male hamsters. Horm Behav

49(4):519–526, 2006.

5 Brower KJ. Anabolic steroid abuse and dependence. Curr Psychiatry Rep 4(5):377–387, 2002.

6 Arvary D, Pope HG Jr. Anabolic-androgenic steroids as a gateway to opioid dependence. N Engl J Med

342:1532, 2000.

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

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.