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Anabolic-androgenic steroids (AAS) 

are manufactured substances related to

male sex hormones (e.g., 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, but also

body wasting in patients with AIDS and

other diseases that result in loss of lean

muscle mass.

How are AAS Abused?

Some people, both athletes and 

non-athletes, abuse AAS in an attempt 

to enhance performance and/or improve

physical appearance. AAS are taken

orally or injected, typically in cycles of

weeks or months interrupted by shorter

resting periods (this is referred to as

“cycling”). In addition, users often combine several different types of steroids, 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 and estrogen receptors, which

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 that they

do not trigger rapid increases in the 

neurotransmitter dopamine, which are

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

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

Taken together, the 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, many users report feeling

good about themselves while on anabolic steroids, but extreme mood swings

can also occur, including manic-like

symptoms that could lead to violence.2

Researchers have also observed that

users may suffer from paranoid jealousy,

Steroids (Anabolic-Androgenic)
June 2008 Page 2 of 4

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 selfadminister AAS when given the opportunity, just as they do with other addictive

drugs.3 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.4 Also, steroid

abusers typically spend large amounts 

of time and money obtaining the drugs,

which is another indication of addiction.

Individuals who abuse steroids can

experience withdrawal symptoms when

they stop taking AAS, such as mood

swings, fatigue, restlessness, loss of

appetite, insomnia, reduced sex drive,

and steroid cravings, all of which may

contribute to the need for continued

abuse. One of the most dangerous 

withdrawal symptoms is depression,

because, 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.5

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 them 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;

adolescents risk not reaching their

expected height if they take AAS

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†

Monitoring the Future is an annual survey used to assesses drug use among

the Nation’s 8th-, 10th-, and 12th-grade

students. Steroid use among all three

grades remained unchanged from 

2006 to 2007, for both boys and girls,

although significant reductions were

noted since 2001 for lifetime and 

past-year use among all grades, and 

for past-month use among 8th and 

10th graders. Among seniors in 2007, 

past-year steroid use was reported by

2.3 percent of boys versus 0.6 percent

of girls.

“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.

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 website on steroids,

www.steroidabuse.org

Anabolic Steroid Use by Students

2007 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade

Lifetime 1.5% 1.8% 2.2%

Past Year 0.8 1.1 1.4

Past Month 0.4 0.5 1.0
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Data Source

† These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, DHHS, 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.

References

1

Pope HG Jr, Kouri EM, Hudson MD. 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, 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 Brower KJ. Anabolic steroid abuse and dependence. Curr Psychiatry Rep 4(5):377–387, 2002.

5 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.