Anabolic steroid use disorder - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Structures of several common anabolic-androgenic steroids

Citations

Key Articles

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]

Other Online Resources

World Anti-Doping Agency: prohibited list
World Anti-Doping Agency: therapeutic use exemptions

Referenced Articles

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. 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]
43. 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]
44. 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]
45. 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]
46. 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]
47. 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]
48. 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]
49. 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]
50. Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab. 2010 Apr;95(4):1533-43.[Abstract]
51. Department of Health and Social Care. Drug misuse and dependence: UK guidelines on clinical management. December 2017 [internet publication].[Full Text]
52. 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]
53. 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]
54. 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]
55. 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]
56. 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]
57. 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]
58. 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]
59. 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]
60. National Institute for Health and Care Excellence. Needle and syringe programmes. March 2014 [internet publication].[Full Text]
61. 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]
62. 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]
63. 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]
64. 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]
65. 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]
66. Scarth M, Bjørnebekk A. Androgen abuse and the brain. Curr Opin Endocrinol Diabetes Obes. 2021 Dec 1;28(6):604-14.[Abstract][Full Text]
67. 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]
68. 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]