What Are Anabolic Steroids?

Anabolic steroids are synthetic derivatives of the male hormone testosterone, which promote the growth of skeletal muscle and increase lean body mass. They are synthetically produced versions of the naturally occurring male hormone testosterone.

While they may be legally prescribed, illicit use far exceeds legitimate use. This article discusses how anabolic steroids work, how they are used, and their potential short-term and long-term effects.

How Do Anabolic Steroids Work?

Anabolic steroids imitate the actions of naturally occurring hormones. Because they are similar to testosterone, they have an impact on the testosterone receptors in the body. This can then lead to metabolic changes, including:

• Faster recovery from injury
• Muscle growth
• Increased male characteristics such as voice deepening and increased facial hair

The activation of androgen receptors also leads to other changes in the body beyond increased muscle mass. This includes increased calcium levels in the brain, heart, and skeletal muscles. 

Steroids also interact and affect neurotransmitters, including GABA, serotonin, and dopamine. Its effect on GABA receptors may be linked to increased anxiety levels. And while anabolic steroids themselves do not produce a high or cause addiction, they may have an effect on the body's reward system.

Uses

Steroids are often taken as pills, but they are also available as fluids that can be injected or as gels or creams that can be applied to the skin.

Anabolic steroids can increase lean muscle mass, strength, and endurance. Steroids can be prescribed to treat a number of conditions and concerns, including:

• Delayed puberty
• Gender-affirming treatments
• Hormonal problems
• Muscle loss caused by diseases such as AIDS and cancer

Steroids can also be misused, however. For example, athletes sometimes use them to help improve performance and outcomes in sporting events. Because they are used in this way, they are considered a performance-enhancing drug.

Anabolic steroid misuse is most common in male weightlifters who are in their 20s and 30s. The National Institute on Drug Abuse notes, however, that it is hard to determine how prevalent steroid use is because many surveys do not inquire about it. Research does suggest that steroid use appears to be uncommon among teens.

Short-Term Effects

People who misuse steroids can experience a range of potentially serious effects. Those who use steroids often talk about feeling good about themselves and invincible while using steroids. The positive feelings can soon turn to anger, rage, paranoia, and violence.

Other short-term effects include:

• Acne
• Fluid retention
• Headaches
• Increased blood pressure
• Increased heart rate
• Muscle cramps
• Muscle tightness
  
• Nosebleeds
  
• Stomach pain
  
• Tendon problems

Long-Term Effects

Many problems can arise from long-term use. These include:

• Delusions
• Eating disorders
• Elevated cholesterol
• Episodes of rage
• Heart disease
• Hypertension
• Liver cancer
  
• Stunted growth
  
• Violent behavior

People may also experience damage to tendons that are unable to support the increased muscle strength gained from steroid use. Nerve damage due to needle use is also possible.

Individuals who inject anabolic steroids are also at an increased risk for contracting infectious diseases, including HIV/AIDS or hepatitis. People who have these conditions also risk transmitting the disease to others.

Adolescents

Adolescents may experience stunted growth due to premature skeletal maturation and accelerated puberty changes, which is irreversible. According to the National Institute on Drug Abuse, these physical changes may also contribute to some of the mental side effects of steroid use, such as mood disorders.

Women

Women often experience a "masculinization" effect when using steroids. They may have an increase in facial hair, enlarged clitoris, deepened voice, and changes in or cessation of the menstrual cycle.

Men

Men may experience a "feminization" effect when using steroids. They can experience infertility, shrinking testicles, reduced sperm count, impotence, baldness, and development of breasts.

People who are assigned male at birth and who misuse anabolic steroids also have an increased risk for prostate cancer.

Transgender Individuals

Testerone may be used as a gender-affirming therapy for transgender individuals. In transgender men, anabolic steroids can help increase body and facial hair, decrease fat mass, deepen the voice, and halt menstruation. It also contributes to decreased stress, anxiety, depression, and gender dysphoria.