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NIDA Community Drug Alert Bulletin - Anabolic

Steroids

Anabolic steroids are:

 Synthetic substances related to the male sex hormones (androgens). They

promote growth of skeletal muscle (anabolic effect) and the development of

male sexual characteristics (androgenic effects), and also have other effects.

(The term "anabolic steroids" will be used throughout this bulletin because of

its familiarity, although the proper term for these compounds is

"anabolic/androgenic" steroids.)

 Used by doctors to treat conditions that occur when the body produces

abnormally low amounts of testosterone, such as delayed puberty and some

Steroid

abusers often

do not realize

that over

time, these

drugs can take

a heavy toll on

their health.

Dear Colleague;

Since the 1950s, some athletes have taken anabolic steroids to

build muscles and boost their athletic performance.

Increasingly, other segments of the population also have been

taking these synthetic substances. The Monitoring the Future

study, an annual survey of drug abuse among middle and high

school students across the country, showed a significant

increase from 1998 to 1999 in anabolic steroid abuse among

middle schoolers. 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. Abuse of oral or

injectable anabolic steroids is associated with increased risk for

heart attacks and strokes, and the abuse of most oral anabolic

steroids is associated with increased risk for severe liver

problems, including hepatic cancer. People who share needles

or use nonsterile injection techniques put themselves 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. Men may develop enlarged breasts and women's

bodies may become masculinized. Both sexes can develop

acne and hair loss.

This Community Drug Alert Bulletin summarizes some of the

latest scientific information on anabolic steroids. NIDA also has

established a Web site to provide scientific information about

anabolic steroids: http://www.steroidabuse.org. As research

produces new information, NIDA will continue to make every

effort to quickly disseminate these findings via the Web site

and subsequent Alerts. Our objective is to keep the Nation's

communities up-to-date concerning the risks of abusing

anabolic steroids and science-based approaches to preventing

and treating such abuse.

Sincerely,

Alan I. Leshner, Ph.D.

Director

CDAB Home

Information on Anabolic

Steroids

 Anabolic Steroids Are...

 Anabolic Steroid Abuse

 How Steroids Are Taken

 Health Consequences of

Steroid Abuse

 Discouraging Youths From

Abusing Steroids

More information on Anabolic

Steroids

SteroidAbuse.gov

Web Site

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types of impotence, and also to treat body wasting in patients with AIDS and

other diseases.

 Legally available in the United States only by prescription. Anabolic steroid

abusers obtain drugs that have been made in clandestine laboratories

(sometimes with poor quality control standards), smuggled from other

countries, or diverted illegally from U.S. pharmacies.

 Distinct from steroidal supplements. In the United States, supplements such as

dehydroepiandrosterone (DHEA) and androstenedione (street name Andro) can

be purchased legally without a perscription through many commercial sources

including health food stores. They are often taken because the user believes

they have anabolic effects.

Anabolic steroid abuse is:

 Increasing among adolescents, and most rapidly among females. The 1999

Monitoring the Future study, a NIDA-funded survey of drug abuse among

middle school and high school students across the United States, recorded that

2.7 percent of 8th-graders, 2.7 percent of 10th-graders, and 2.9 percent of

12th-graders reported having taken anabolic steroids at least once in their

lives. These figures represent increases since 1991 of approximately 50 percent

among 8th- and 10th-graders and 38 percent among 12th-graders.

 Probably widespread among athletes and would-be sports competitors at all

levels, although few data are available to provide exact estimates of

prevalence. Many anabolic steroid abusers are unwilling to report the practice,

because the International Olympic Committee and many other amateur and

professional sports organizations have banned anabolic steroids.

 Motivated in most cases by a desire to build muscles and improve sports

performance. Some individuals are motivated by erroneous perceptions of their

own bodies (that is, a mistaken belief that they look underweight or obese) and

others by a desire to prevent recurrence of physical or sexual attacks they

have experienced.

Anabolic steroids are taken:

 Orally as tablets or capsules (Anadrol® [oxymetholone], Oxandrin®

[oxandrolone], Dianabol® [ methandrostenolone], Winstrol® [stanozolol], and

others); by injection into muscles (Deca-Durabolin® [nandrolone decanoate],

Durabolin® [nandrolone phenpropionate], Depo-Testosterone® [testosterone

cypionate], Equipoise® [boldenone undecylenate], and others); or by ointment

preparations rubbed into the skin. Doses taken by abusers can be up to 100

times more than the doses used for treating medical conditions.

 In combinations, a practice called "stacking." Abusers frequently take two or

more anabolic steroids together, mixing oral and/or injectable types,

sometimes adding drugs such as stimulants or painkillers. The rationale for

stacking is a belief-which has not been tested by science-that the different

drugs interact to produce a greater effect on muscle size than could be

obtained by simply increasing the dose of a single drug.

 In cyclic dosage regimens, a practice called "pyramiding." At the beginning of a

cycle, the person starts with low doses of the stacked substances and then

gradually increases the doses for 6 to 12 weeks. In the second half of the

cycle, the doses are slowly decreased to zero. This is sometimes followed by a

second cycle during 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 time for the body's hormonal system to

recuperate. As with stacking, the perceived benefits of pyramiding have not

been substantiated scientifically.

Health consequences associated with anabolic steroid abuse

include:

 In boys and men, reduced sperm production, shrinking of the testicles,

impotence, difficulty or pain in urinating, baldness, and irreversible breast

enlargement (gynecomastia).

 In girls and women, development of more masculine characteristics, such as

decreased body fat and breast size, deepening of the voice, excessive growth

of body hair, and loss of scalp hair, as well as clitoral enlargement.

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 In adolescents of both sexes, premature termination of the adolescent growth

spurt, so that for the rest of their lives, abusers remain shorter than they

would have been without the drugs.

 In males and females of all ages, potentially fatal liver cysts and liver cancer;

blood clotting, cholesterol changes, and hypertension, each of which can

promote heart attack and stroke; and acne. Although not all scientists agree,

some interpret available evidence to show that anabolic steroid abuseparticularly in high doses-promotes aggression that can manifest itself as

fighting, physical and sexual abuse, armed robbery, and property crimes such

as burglary and vandalism. Upon stopping anabolic steroids, some abusers

experience symptoms of depressed mood, fatigue, restlessness, loss of

appetite, insomnia, reduced sex drive, headache, muscle and joint pain, and

the desire to take more anabolic steroids.

 In injectors, infections resulting from the use of shared needles or nonsterile

equipment, including HIV/AIDS, hepatitis B and C, and infective endocarditis, a

potentially fatal inflammation of the inner lining of the heart. Bacterial

infections can develop at the injection site, causing pain and abscess.

To encourage youths to avoid anabolic steroid abuse:

 Present a balanced picture of what these drugs can do for them and to them.

Most adolescents know that anabolic steroids build muscles and can increase

athletic prowess. Research has shown that failure to acknowledge these

potential benefits creates a credibility problem and can actually make youths

more likely to try the drugs.

 Make use of the authority of coaches and the team ethos. In the most

promising program currently under study, coaches and team leaders are

trained to educate team members about the effects of anabolic steroid abuse,

both desirable and adverse, in the general context of training. They also

provide information about nutrition and, of course, exercise and other training

techniques for improving performance without the steroid abuse by as much as

50 percent and also reduces alcohol abuse among teammates.

 It is uncertain whether drug testing programs can discourage anabolic steroid

abuse. However, the first scientific studies of this practice are currently under

way.

Access NIDA's specialized Web site, http://www.steroidabuse.gov/. Additional

information on other illicit drugs can be accessed through NIDA's home page on the

World Wide Web: http://www.drugabuse.gov/.

NIDA Community Alert Bulletin on Steroid Abuse was published in April, 2000

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