What to Know About Anabolic Steroids

Weight Room Steroids
Anabolic Steroids Use in Weight Training. © Getty Images

What is the most important information I should know about anabolic steroids?

  • Anabolic steroids should only be used when prescribed by a doctor to treat specific medical conditions.
  • Steroid misuse can increase the risk of health issues, including liver problems, increased blood pressure, bleeding, and fluid retention.

While anabolic steroids have legitimate medical uses, they are frequently misused due to their muscle-building and performance-enhancing effects.  This misuse can significantly affect physical health, but steroid use can also affect the brain, behavior, and mental health. Steroid dependence and withdrawal can also occur.

Approximately three to four million people between the ages of 13 and 50 are believed to have used anabolic steroids. Of these individuals, an estimated one million have experienced steroid dependence.

Learn more about how anabolic steroids are used, their psychological effects, and treatments that can help.

What Are Anabolic Steroids?

The term "anabolic steroids" is used to refer to a group of synthetic substances that mimic the effects of male sex hormones such as testosterone. The drugs promote in both males and females the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects).

Therefore, the proper term for these substances should be "anabolic-androgenic steroids," throughout this site, they are referred to as the more commonly used term "anabolic steroids."

These are man-made substances; there is nothing "natural" about them. They are supposed to be available by prescription only for specific medical purposes.

Mental Health Effects of Steroid Use

While steroids are generally used for their performance-enhancing and physical effects, it is important to note that they may also have mental health and psychological effects as well.

Some psychological effects of steroid use that have been reported include:

  • Hallucinations and delusions
  • Manic behavior
  • Mood swings

There have been reports of people who misuse steroids experiencing psychotic and manic reactions. However, these have been rare occurrences and researchers believe they have most likely occurred in people with a history of prior mental illness.

A 2021 study noted that high-dose use of anabolic steroids is linked to brain and cognitive abnormalities and that long-term high-dose use can negatively affect brain aging.

Anabolic Steroids and Aggression

While steroid use is often linked to increased aggression, a phenomenon sometimes known as "roid rage," its exact impact on violence and behavioral disorders is not fully known. The prevalence of extreme cases of violence among those who use steroids appears to be low, but as with the health effects, extreme violence could be underreported or underrecognized.

Anger, Hostility, Aggression or Violent Behavior

Anger, irritability, hostility, aggression, and/or violent behavior:

  • Becomes more likely at higher doses
  • Minor provocations evoke exaggerated responses
  • Occurs in some but not all people who use anabolic steroid
  • Presents danger to law enforcement
  • Presents danger to spouse, family, and friends
  • Unpredictable who will respond

Indications are that high doses of anabolic steroids increase irritability and aggression which may be caused by secondary hormonal changes. As with the health effects of steroids, most of the information about the behavioral effects of steroid misuse comes from case reports and small studies.

Some people who misuse anabolic steroid report that when they are taking steroids, they are more likely to engage in aggressive behavior such as fighting, armed robbery, burglary, theft, and vandalism than they are when they are drug-free.

The NIDA reports four studies in which volunteers were given high dosages of anabolic steroids. In three of the studies, the volunteers reported greater feelings of aggression and irritability, although the effects varied widely between individuals.

One study found that anabolic steroid use was associated with changes in inhibitory control and impulsivity, which may be more significant in those who began using steroids as teens.

Anabolic Steroids and Addiction

Some research has found that the use of anabolic steroids may cause people to turn to other drugs to alleviate negative short-term side effects. One study found that 9.3% of men who were being treated for heroin or other opioids use had misused steroids before doing any other drugs.

Of those in treatment, 86% said they initiated opioid use to counteract insomnia and irritability caused by their steroid use.

Are Anabolic Steroids Addictive?

Some individuals who misuse anabolic steroids can develop patterns of behavior that are typical symptoms of addiction. Those behaviors include:

  • Continued use despite negative consequences
  • Spending excessive time and effort in obtaining drugs
  • Experiencing withdrawal symptoms when they stop taking the substance


Some people who use anabolic steroids continue taking the drugs despite experiencing physical problems and problems in their social relationships. The percentage of those who continue to use in spite of negative consequences is not known.

Steroid Addiction Symptoms

Many people who misuse steroids spend large amounts of time and money to obtain the drugs they use. When they stop taking steroids, people can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids.

Other withdrawal symptoms reported in case studies of people coming off anabolic steroids use include:

  • Anorexia
  • Apathy
  • Decreased sex drive
  • Difficulty concentrating
  • Fatigue (extreme tiredness)
  • Feelings of anxiety
  • Headaches
  • Insomnia
  • Muscle and joint pain

One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to a suicide attempt. Research reveals that if untreated, depression associated with anabolic steroid withdrawal can persist for a year or longer after the use of the drug stops.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

History of Anabolic Steroids

Anabolic steroids were originally developed in the 1930s to treat hypogonadism, a medical condition in which the testes do not produce enough testosterone. Currently, they are prescribed to treat steroid hormone deficiency, such as delayed puberty and some types of impotence

Sometimes, steroids are prescribed to counteract the wasting away of the body's muscle mass due to diseases like some cancers and HIV infection.

Misuse by Athletes

When early research with animals in the 1930s found that anabolic steroids could facilitate the growth of skeletal muscle, the drugs began to be misused for that purpose by bodybuilders and weightlifters. They later began to be misused by athletes in other sports because of their performance-enhancing capabilities.

Because their use can affect the outcome of sports competitions, anabolic steroids have been banned by all amateur and professional sports organizations.

Commonly Misused Steroids

According to the National Institute on Drug Abuse, these are some commonly misused steroids:

Oral Steroids

  • Anadrol (oxymetholone)
  • Dianabol (methandrostenolone)
  • Oxandrin (oxandrolone)
  • Winstrol (stanozolol)

Injectable Steroids

  • Deca-Durabolin (nandrolone decanoate)
  • Depo-Testosterone (testosterone cypionate)
  • Durabolin (nandrolone phenpropionate)
  • Equipoise (boldenone undecylenate)
  • Tetrahydrogestrinone (THG)

Steroidal Supplements

Steroidal supplements, promoted as hormone products or alternatives to anabolic steroids, are substances that claim to be converted into testosterone or similar compounds in the body. Many of these products are marketed and labeled as dietary supplements that can purportedly increase muscle mass and strength.

Up until 2004, substances called steroid supplements could be purchased legally at health food stores and other commercial outlets. But, in 2004, Congress passed amendments to the Controlled Substance Act making the sale of supplements like tetrahydrogestrinone (THG) and androstenedione (street name Andro) illegal. The exception to the new laws was dehydroepiandrosterone (DHEA).

The U.S. Food and Drug Administration (FDA) regularly issues public health advisory warnings about bodybuilding products that are represented to contain steroids or steroid-like substances. The warnings state: "These products are marketed as dietary supplements, they are NOT dietary supplements, but instead are unapproved and misbranded drugs."

Because these steroid supplement products could increase testosterone levels in the body like anabolic steroids themselves, it is believed that their side effects could also be the same. Little research has been done on the side effects of these supplements, but the FDA warns they can be harmful.

How Anabolic Steroids Are Used

Steroids may be prescribed to treat certain medical conditions including:

  • Certain types of anemia
  • Some types of breast cancer
  • Calcium deficiency
  • Hereditary angioedema
  • Muscle-wasting conditions
  • Testosterone deficiency
  • To help with weight gain after illness or injury

They may also treat other conditions as determined by a person's doctor. Steroids are categorized as Schedule III substances under the Controlled Substances Act. They are only available by prescription, and their use without a valid prescription is illegal.

Depending on the type, anabolic steroids can be taken orally, injected intramuscularly, or applied through the skin as gels or creams. When used for medical purposes, anabolic steroids can be taken by intramuscular or subcutaneous injection, orally, pellet implantation under the skin, or by application to the skin via patches or gels.

Risks Anabolic Steroids

According to the latest research available regarding anabolic steroids, there are several physical effects of steroid misuse.

Short-term adverse effects may include:

  • Abnormal liver function
  • Acne
  • Bleeding (usually nose)
  • Decreased breast size and deepening of the voice in women
  • Decreased HDL cholesterol levels and increased LDL cholesterol levels
  • Decrease in the total height achieved in children and teens
  • Decreased semen volume, sperm production, and sperm motility
  • Elevated blood pressure
  • Enlargement of the breast (gynecomastia) in men
  • Fluid retention leading to swelling
  • Frequent or continuing erections
  • Male pattern baldness
  • Menstrual irregularities (missed or no periods)
  • Precocious sexual development
  • Prostate enlargement
  • Shrinkage of the testicles in men and enlargement of the clitoris in women
  • Skin tissue damage at the site of injection

Long-Term Risks

There is a limited amount of scientific research about the long-term risks of anabolic steroid misuse. The "possible" long-term effects come primarily from case studies and may include:

  • Adverse cardiovascular effects
  • Cancer of the prostate (men only)
  • Hepatitis infections
  • HIV infection (needle sharing)
  • Liver cancer
  • Liver dysfunction
  • Liver tumors
  • Skin infections
  • Violent trauma

The negative effects linked to anabolic steroid misuse can range from those that are mildly annoying to those that can be life-threatening. People who misuse steroids report experiencing health effects that range from developing acne problems to having heart attacks and liver cancer.

Most of the effects of using anabolic steroids are reversible when the person stops using the drugs, but some can be permanent.

According to the National Institute on Drug Abuse, most of the information the agency has gathered about the long-term effects of anabolic steroids has been obtained from case reports and not from formal epidemiological studies. Most of the research conducted on long-term steroid effects thus far has been done with animal studies.

Some Effects Show Up Years Later

The prevalence of life-threatening effects of steroid misuse seems to be very low from case studies, but serious adverse effects may be underreported and underrecognized because they sometimes do not appear until years later.

Treatment for Anabolic Steroid Misuse

Treatment options recommended by the National Institute on Drug Abuse for anabolic steroid misuse are based more on case studies and physician experience rather than controlled studies. There has been very little research into treatment for steroid misuse and dependence.

Treatment for anabolic steroid withdrawal often involves:

  • Supportive care to manage physical symptoms
  • Psychoeducation to help people understand the effects of steroid use
  • Evaluation for depression and suicidal thoughts

If withdrawal symptoms become severe or prolonged, people are given medications to treat the specific withdrawal symptoms. For example, antidepressants for depression or analgesics for headaches and pain.

Some people experiencing steroid withdrawal receive medication to help restore their hormonal systems. Others are treated with behavioral therapies for withdrawal symptoms that go beyond pharmacological treatment.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Preventing Anabolic Steroid Misuse

Because the dangers of anabolic steroid misuse are so great and because there does exist a potential for some people to develop addictive-like behavior related to steroid use, efforts should be concentrated on preventing the use in the first place, especially among young student-athletes.

By far the most prevalent anabolic steroid prevention programs in the U.S. are those aimed at professional, Olympic, and college athletes. Very few local school districts have established steroid prevention programs.

According to NIDA, an estimated 9% of secondary schools have drug testing programs for illicit drugs and less than 4% of high schools in the United States test their athletes for anabolic steroids. Even if such testing was more widespread, research has yet to clearly determine if drug testing is effective in reducing drug use.

Although most secondary schools do not have official anabolic steroids prevention programs in place, programs are available that effectively reduce steroid misuse, other substance use, and other risky behaviors. Some of these programs include:

  • The ATLAS Program: The ATLAS program is designed to show high school football players that they can build powerful bodies and improve their athletic performance without using dangerous anabolic steroids. It incorporates education about the harmful side effects of anabolic steroids and provides nutrition and weight-training alternatives to using steroids. According to NIDA research, the program has successfully reduced the participants' intentions to use steroids while increasing their healthy behaviors.
  • The ATHENA Program: The Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) program was patterned after and similar to the ATLAS program but designed for girls who participate in high school sports programs. The research found that participation in the ATHENA training significantly decreased risky behaviors.

ATLAS-trained athletes had less interest in trying steroids, less desire to misuse them, better knowledge of alternatives to steroid use, improved body image, and increased knowledge of diet supplements.

The ATLAS and ATHENA programs for high school athletes have been endorsed by the United States Congress and the Substance Abuse and Mental Health Services Administration as a model programs for secondary schools across the country.

15 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Buddy T
Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.