- 0
Highlights & Basics
- Anabolic-androgenic steroid (AAS; also known as anabolic steroid) use is the illicit use of testosterone derivatives to improve athletic performance and/or to increase lean body mass and muscle size.
- Users take other drugs to minimize the unwanted effects of AASs, or to mask their use.
- Focus of treatment is supporting AAS discontinuation and managing complications associated with chronic AAS use.
- Cardiac complications are the major cause of sudden and premature death.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Anawalt BD. Diagnosis and management of anabolic androgenic steroid use. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2490-500.[Abstract][Full Text]
Handelsman DJ. Androgen misuse and abuse. Endocr Rev. 2021 Jul 16;42(4):457-501.[Abstract][Full Text]
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 484 (reaffirmed 2021): performance enhancing anabolic steroid abuse in women. Obstet Gynecol. 2011 Apr;117(4):1016-8.[Abstract][Full Text]
National Institute on Drug Abuse. Anabolic steroids and other appearance and performance enhancing drugs (APEDs). May 2023 [internet publication].[Full Text]
Pope HG Jr, Kanayama G. Body image disorders and anabolic steroid withdrawal hypogonadism in men. Endocrinol Metab Clin North Am. 2022 Mar;51(1):205-16.[Abstract]
1. Anawalt BD. Diagnosis and management of anabolic androgenic steroid use. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2490-500.[Abstract][Full Text]
2. Ding JB, Ng MZ, Huang SS, et al. Anabolic-androgenic steroid misuse: mechanisms, patterns of misuse, user typology, and adverse effects. J Sports Med (Hindawi Publ Corp). 2021 Dec 10;2021:7497346.[Abstract][Full Text]
3. Sagoe D, Molde H, Andreassen CS, et al. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol. 2014 May;24(5):383-98.[Abstract]
4. Havnes IA, Jørstad ML, Wisløff C. Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires. Subst Abuse Treat Prev Policy. 2019 May 16;14(1):20.[Abstract][Full Text]
5. Fitch KD. Androgenic-anabolic steroids and the Olympic Games. Asian J Androl. 2008 May;10(3):384-90.[Abstract]
6. Thirumalai A, Anawalt BD. Androgenic steroids use and abuse: past, present, and future. Urol Clin North Am. 2022 Nov;49(4):645-63.[Abstract]
7. Buckman JF, Farris SG, Yusko DA. A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug Alcohol Depend. 2013 Jul 1;131(1-2):50-5.[Abstract]
8. National Institute on Drug Abuse. Monitoring the future national survey results on drug use, 1975-2022: secondary school students. 2023 [internet publication].[Full Text]
9. McBride JA, Carson CC 3rd, Coward RM. The availability and acquisition of illicit anabolic androgenic steroids and testosterone preparations on the internet. Am J Mens Health. 2018 Sep;12(5):1352-7.[Abstract][Full Text]
10. Mullen C, Whalley BJ, Schifano F, et al. Anabolic androgenic steroid abuse in the United Kingdom: an update. Br J Pharmacol. 2020 May;177(10):2180-98.[Abstract][Full Text]
11. de Ronde W, Smit DL. Anabolic androgenic steroid abuse in young males. Endocr Connect. 2020 Apr;9(4):R102-R111.[Abstract][Full Text]
12. Zahnow R, McVeigh J, Bates G, et al. Identifying a typology of men who use anabolic androgenic steroids (AAS). Int J Drug Policy. 2018 May;55:105-12.[Abstract][Full Text]
13. Petersson A, Bengtsson J, Voltaire-Carlsson A, et al. Substance abusers' motives for using anabolic androgenic steroids. Drug Alcohol Depend. 2010 Sep 1;111(1-2):170-2.[Abstract]
14. Pope HG Jr, Kanayama G, Hudson JI, et al. Review article: anabolic-androgenic steroids, violence, and crime: two cases and literature review. Am J Addict. 2021 Sep;30(5):423-32.[Abstract]
15. Ip EJ, Doroudgar S, Lau B, et al. Anabolic steroid users' misuse of non-traditional prescription drugs. Res Social Adm Pharm. 2019 Aug;15(8):949-52.[Abstract]
16. Sagoe D, McVeigh J, Bjørnebekk A, et al. Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. Subst Abuse Treat Prev Policy. 2015 Mar 15;10:12.[Abstract][Full Text]
17. Hakansson A, Mickelsson K, Wallin C, et al. Anabolic androgenic steroids in the general population: user characteristics and associations with substance use. Eur Addict Res. 2012;18(2):83-90.[Abstract][Full Text]
18. Bond P, Smit DL, de Ronde W. Anabolic-androgenic steroids: how do they work and what are the risks? Front Endocrinol (Lausanne). 2022 Dec 19;13:1059473.[Abstract][Full Text]
19. Handelsman DJ. Androgen misuse and abuse. Endocr Rev. 2021 Jul 16;42(4):457-501.[Abstract][Full Text]
20. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 484 (reaffirmed 2021): performance enhancing anabolic steroid abuse in women. Obstet Gynecol. 2011 Apr;117(4):1016-8.[Abstract][Full Text]
21. Casavant MJ, Blake K, Griffith J, et al. Consequences of use of anabolic androgenic steroids. Pediatr Clin North Am. 2007 Aug;54(4):677-90, x.[Abstract]
22. Solimini R, Rotolo MC, Mastrobattista L, et al. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmacol Sci. 2017 Mar;21(1 suppl):7-16.[Abstract]
23. Torrisi M, Pennisi G, Russo I, et al. Sudden cardiac death in anabolic-androgenic steroid users: a literature review. Medicina (Kaunas). 2020 Nov 4;56(11):587.[Abstract][Full Text]
24. Melchert RB, Welder AA. Cardiovascular effects of androgenic-anabolic steroids. Med Sci Sports Exerc. 1995 Sep;27(9):1252-62.[Abstract]
25. Maior AS, Carvalho AR, Marques-Neto SR, et al. Cardiac autonomic dysfunction in anabolic steroid users. Scand J Med Sci Sports. 2013 Oct;23(5):548-55.[Abstract]
26. Blashill AJ, Calzo JP, Griffiths S, et al. Anabolic steroid misuse among US adolescent boys: disparities by sexual orientation and race/ethnicity. Am J Public Health. 2017 Feb;107(2):319-21.[Abstract]
27. Blashill AJ, Safren SA. Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys. Pediatrics. 2014 Mar;133(3):469-75.[Abstract]
28. Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. Subst Abuse Treat Prev Policy. 2014 Jul 2;9:27.[Abstract][Full Text]
29. Murray SB, Griffiths S, Mond JM, et al. Anabolic steroid use and body image psychopathology in men: delineating between appearance- versus performance-driven motivations. Drug Alcohol Depend. 2016 Aug 1;165:198-202.[Abstract]
30. Björk T, Skårberg K, Engström I. Eating disorders and anabolic androgenic steroids in males--similarities and differences in self-image and psychiatric symptoms. Subst Abuse Treat Prev Policy. 2013 Aug 19;8:30.[Abstract][Full Text]
31. Pope HG Jr, Khalsa JH, Bhasin S. Body image disorders and abuse of anabolic-androgenic steroids among men. JAMA. 2017 Jan 3;317(1):23-4.[Abstract]
32. Leone JE, Sedory EJ, Gray KA. Recognition and treatment of muscle dysmorphia and related body image disorders. J Athl Train. 2005 Oct-Dec;40(4):352-9.[Abstract][Full Text]
33. National Institute on Drug Abuse. Anabolic steroids and other appearance and performance enhancing drugs (APEDs). May 2023 [internet publication].[Full Text]
34. Goldberg L, Elliot DL, Clarke GN, et al. The Adolescents Training and Learning to Avoid Steroids (ATLAS) prevention program. Background and results of a model intervention. Arch Pediatr Adolesc Med. 1996 Jul;150(7):713-21.[Abstract]
35. Goldberg L, Elliot D, Clarke GN, et al. Effects of a multidimensional anabolic steroid prevention intervention. The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program. JAMA. 1996 Nov 20;276(19):1555-62.[Abstract]
36. Elliot DL, Goldberg L, Moe EL, et al. Long-term outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) program for female high school athletes. J Alcohol Drug Educ. 2008 Aug;52(2):73-92.[Abstract]
37. Amaral JMX, Kimergård A, Deluca P. Prevalence of anabolic steroid users seeking support from physicians: a systematic review and meta-analysis. BMJ Open. 2022 Jul 4;12(7):e056445.[Abstract][Full Text]
38. Brooks JH, Ahmad I, Easton G. Anabolic steroid use. BMJ. 2016 Oct 13;355:i5023.[Abstract]
39. Piacentino D, Sani G, Kotzalidis GD, et al. Anabolic androgenic steroids used as performance and image enhancing drugs in professional and amateur athletes: Toxicological and psychopathological findings. Hum Psychopharmacol. 2022 Jan;37(1):e2815.[Abstract][Full Text]
40. Albano GD, Amico F, Cocimano G, et al. Adverse effects of anabolic-androgenic steroids: a literature review. Healthcare (Basel). 2021 Jan 19;9(1):97.[Abstract][Full Text]
41. Onakomaiya MM, Henderson LP. Mad men, women and steroid cocktails: a review of the impact of sex and other factors on anabolic androgenic steroids effects on affective behaviors. Psychopharmacology (Berl). 2016 Feb;233(4):549-69.[Abstract]
42. Bhasin S, Hatfield DL, Hoffman JR, et al. Anabolic-androgenic steroid use in sports, health, and society. Med Sci Sports Exerc. 2021 Aug 1;53(8):1778-94.[Abstract][Full Text]
43. Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014 Jun;35(3):341-75.[Abstract][Full Text]
44. Christou GA, Christou MA, Žiberna L, et al. Indirect clinical markers for the detection of anabolic steroid abuse beyond the conventional doping control in athletes. Eur J Sport Sci. 2019 Oct;19(9):1276-86.[Abstract]
45. Corona G, Rastrelli G, Marchiani S, et al. Consequences of anabolic-androgenic steroid abuse in males; sexual and reproductive perspective. World J Mens Health. 2022 Apr;40(2):165-78.[Abstract][Full Text]
46. Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017 May 23;135(21):1991-2002.[Abstract][Full Text]
47. Luijkx T, Velthuis BK, Backx FJ, et al. Anabolic androgenic steroid use is associated with ventricular dysfunction on cardiac MRI in strength trained athletes. Int J Cardiol. 2013 Aug 10;167(3):664-8.[Abstract][Full Text]
48. Baumann S, Jabbour C, Huseynov A, et al. Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids. Asian J Sports Med. 2014 Dec;5(4):e24058.[Abstract][Full Text]
49. Golestani R, Slart RH, Dullaart RP, et al. Adverse cardiovascular effects of anabolic steroids: pathophysiology imaging. Eur J Clin Invest. 2012 Jul;42(7):795-803.[Abstract]
50. Brower KJ, Catlin DH, Blow FC, et al. Clinical assessment and urine testing for anabolic-androgenic steroid abuse and dependence. Am J Drug Alcohol Abuse. 1991 Jun;17(2):161-71.[Abstract]
51. Dickerman RD, Pertusi RM, Zachariah NY, et al. Anabolic steroid-induced hepatotoxicity: is it overstated? Clin J Sport Med. 1999 Jan;9(1):34-9.[Abstract]
52. Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab. 2010 Apr;95(4):1533-43.[Abstract]
53. Department of Health and Social Care. Drug misuse and dependence: UK guidelines on clinical management. December 2017 [internet publication].[Full Text]
54. Bates G, Van Hout MC, Teck JTW, et al. Treatments for people who use anabolic androgenic steroids: a scoping review. Harm Reduct J. 2019 Dec 30;16(1):75.[Abstract][Full Text]
55. Pope HG Jr, Kanayama G. Body image disorders and anabolic steroid withdrawal hypogonadism in men. Endocrinol Metab Clin North Am. 2022 Mar;51(1):205-16.[Abstract]
56. Kanayama G, Brower KJ, Wood RI, et al. Treatment of anabolic-androgenic steroid dependence: emerging evidence and its implications. Drug Alcohol Depend. 2010 Jun 1;109(1-3):6-13.[Abstract][Full Text]
57. Harvey O, Keen S, Parrish M, et al. Support for people who use anabolic androgenic steroids: a systematic scoping review into what they want and what they access. BMC Public Health. 2019 Jul 31;19(1):1024.[Abstract][Full Text]
58. Thomas DT, Erdman KA, Burke LM. American College of Sports Medicine joint position statement. nutrition and athletic performance. Med Sci Sports Exerc. 2016 Mar;48(3):543-68.[Abstract][Full Text]
59. Burke LM, Castell LM, Casa DJ, et al. International Association of Athletics Federations consensus statement 2019: nutrition for athletics. Int J Sport Nutr Exerc Metab. 2019 Mar 1;29(2):73-84.[Abstract][Full Text]
60. Jäger R, Kerksick CM, Campbell BI, et al. International Society of Sports Nutrition position stand: protein and exercise. J Int Soc Sports Nutr. 2017 Jun 20;14:20.[Abstract][Full Text]
61. Aragon AA, Schoenfeld BJ, Wildman R, et al. International Society of Sports Nutrition position stand: diets and body composition. J Int Soc Sports Nutr. 2017 Jun 14;14:16.[Abstract][Full Text]
62. National Institute for Health and Care Excellence. Needle and syringe programmes. March 2014 [internet publication].[Full Text]
63. Sharma A, Grant B, Islam H, et al. Common symptoms associated with usage and cessation of anabolic androgenic steroids in men. Best Pract Res Clin Endocrinol Metab. 2022 Sep;36(5):101691.[Abstract][Full Text]
64. Horwitz H, Andersen JT, Dalhoff KP. Health consequences of androgenic anabolic steroid use. J Intern Med. 2019 Mar;285(3):333-40.[Abstract][Full Text]
65. Piacentino D, Kotzalidis GD, Del Casale A, et al. Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Curr Neuropharmacol. 2015 Jan;13(1):101-21.[Abstract]
66. Dhar R, Stout CW, Link MS, et al. Cardiovascular toxicities of performance-enhancing substances in sports. Mayo Clin Proc. 2005 Oct;80(10):1307-15.[Abstract][Full Text]
67. Far HR, Ågren G, Thiblin I. Cardiac hypertrophy in deceased users of anabolic androgenic steroids: an investigation of autopsy findings. Cardiovasc Pathol. 2012 Jul-Aug;21(4):312-6.[Abstract]
68. Scarth M, Bjørnebekk A. Androgen abuse and the brain. Curr Opin Endocrinol Diabetes Obes. 2021 Dec 1;28(6):604-14.[Abstract][Full Text]
69. Bjørnebekk A, Westlye LT, Walhovd KB, et al. Cognitive performance and structural brain correlates in long-term anabolic-androgenic steroid exposed and nonexposed weightlifters. Neuropsychology. 2019 May;33(4):547-59.[Abstract]
70. Kaufman MJ, Kanayama G, Hudson JI, et al. Supraphysiologic-dose anabolic-androgenic steroid use: a risk factor for dementia? Neurosci Biobehav Rev. 2019 May;100:180-207.[Abstract][Full Text]
