“Anabolic Steroids” is the familiar name for synthetic substances related to the male sex hormones (androgens). They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects), and also have some other effects. The term “anabolic steroids” will be used throughout this report because of its familiarity, although the proper term for these compounds is “anabolic-androgenic” steroids (Gallaway, 1997, p. 6).
Anabolic steroids were developed in the late 1930s primarily to treat hypogonadism, a condition in which the testes do not produce sufficient testosterone for normal growth, development, and sexual functioning. The primary medical uses of these compounds are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection of other diseases (Lukas, 2001, p. 11). During the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals, which led to use of the compounds first by bodybuilders and weightlifters and then by athletes in other sports.
Steroid abuse has become so widespread in athletics that it affects the outcome of sports contests. More than one hundred different anabolic steroids have been developed, but they require a prescription to be used legally in the United States. Most steroids that are used illegally are smuggled in from other countries, illegally diverted from U. S. pharmacies, or synthesized in clandestine laboratories (Paris, 2005). What is the scope of steroid use in the United States?
Recent evidence suggests that steroid use among adolescents is on the rise. The 1999 Monitoring the Future study, a National Institute on Drug Abuse funded survey of drug abuse among adolescents in middle and high schools across the United States, estimated that 2. 7 percent of 8th- and 10th-graders and 2. 9 percent of 12th-graders had taken anabolic steroids at least once in their lives. For 10th-graders, that is a significant increase from 1998, when 2. 0 percent of 10th graders said they had taken anabolic steroids at least once.
For all three grades, the 1999 levels represent a significant increase from 1991, the first year that data on steroid abuse were collected from the younger students. In that year, 1. 9 percent of 8th-graders, 1. 8 percent of 10th-graders, and 2. 1 percent of 12th-graders reported that they had taken anabolic steroids at least once. Few data exist on the extent of steroid use by adults. It has been estimated that hundreds of thousands of people aged eighteen and older abuse anabolic steroids at least once a year.
Among both adolescents and adults, steroid use is higher among males than females. However, steroid abuse is growing most rapidly among young women (NIDA, 2005). Steroid use among professional athletes has taken center stage due to the explosion of allegations and suspensions in many of the professional sports leagues. Some former athletes estimate that steroid use in the pros could be somewhere between 20 to 50 percent. To most fans, this is a staggering number that compromises the integrity of the professional sports leagues.
To the athletes who are not using steroids, this creates an unfair disadvantage for those who are actually abiding by the rules. Jose Canseco, former professional baseball superstar and admitted steroid user, believes that the use of steroids in professional sports is a positive thing and he credits steroids for the resurgent popularity of baseball in the new millennium (Canseco, 2005, 148). Why do people use anabolic steroids? One of the main reasons people give for using steroids is to improve their performance in sports. Among competitive bodybuilders, steroid abuse has been estimated to be very high.
Among other athletes the incidence of abuse probably varies depending on the specific sport. Another reason people give for taking steroids is to increase their muscle size and/or reduce their body fat. This group includes some people who have a behavioral syndrome (muscle dysmorphia) in which a person has a distorted image of his of her body. Men with this condition think that they look small and weak, even if they are large and muscular. Similarly, women with the syndrome think that they look fat and flabby, even though they are actually lean and muscular (Ciola, 2004, p. ).
Some people who abuse steroids to boost muscle size have experienced physical or sexual abuse. They are trying to increase their muscle size to protect themselves. In one series of interviews with male weight-lifters given by the NIDA, 25 percent who abused steroids reported memories of childhood physical or sexual abuse, compared with none who did not abuse steroids. In a study of women weightlifters, twice as many of those who had been raped reported using anabolic steroids and/or another purported muscle-building drug, compared to those who had not been raped.
Moreover, almost all of those who had been raped reported that they markedly increased their bodybuilding activities after the attack. They believed that being bigger and stronger would discourage further attacks because men would find them either intimidating or unattractive (NIDA, 2005). Finally, some adolescents use steroids as part of a pattern of high-risk behaviors. These adolescents also take risks such as drinking and driving, carrying a gun, not wearing a helmet on a motorcycle, and abusing other illicit drugs .
While conditions such as muscle dysmorphia, a history of physical or sexual abuse, or a history of engaging in high-risk behaviors may increase the risk of initiating or continuing steroid use, researchers agree that most steroid users are psychologically normal when they start abusing the drugs. How are anabolic steroids used? Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are rubbed on the skin. Doses taken by users can be 10 to 100 times higher than the doses used for medical conditions.
Steroid users typically “stack” the drugs, meaning that they take two or more different anabolic steroids, mixing oral and/or injectable types and sometimes even including compounds that are designed for veterinary use. Users think that the different steroids interact to produce an effect on muscle size that is greater than the effects of each drug individually, a theory that has not been tested scientifically. Often, steroid users also “pyramid” their doses in cycles of six to twelve weeks. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses.
In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Users believe that pyramiding allows the body time to adjust to the high doses and the drug-free cycle allows the body’s hormonal system time to recuperate. As with stacking, the perceived benefits of pyramiding and cycling have not been substantiated scientifically (Kerr, 1982, p. 115). What are the health consequences of steroid use?
Anabolic steroid use has been associated with a wide range of adverse side effects ranging from some that are physically unattractive, such as acne and breast development in men, to others that are life threatening, such as heart attacks and liver cancer. Most are reversible if the abuser stops taking the drugs, but some are permanent. Most data on the long-term effects of anabolic steroids on humans come from case reports rather than formal epidemiological studies. From the case reports, the incidence of life-threatening effects appears to be low, but serious adverse effects may be under-recognized or under-reported.
Data from animal studies seem to support this possibility. One study found that exposing male mice for one-fifth of their lifespan to steroid doses comparable to those taken by human athletes caused a high percentage of premature deaths (Silverstein, 1992, p. 56). Hormonal system Steroid use disrupts the normal production of hormones in the body, causing both reversible and irreversible changes. Changes that can be reversed include reduced sperm production and shrinking of the testicles (testicular atrophy). Irreversible changes include male-pattern baldness and breast development (gynecomastia).
In one study of male bodybuilders, more than half had testicular atrophy, and more than half had gynecomastia. Gynecomastia is thought to occur due to the disruption of normal hormone balance. In the female body, anabolic steroids cause masculinization. Breast size and body fat decrease, the skin becomes coarse, the clitoris enlarges, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects are irreversible. Musculoskeletal system
Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence. Subsequently, when these hormones reach certain levels, they signal the bones to stop growing, locking a person into his or her maximum height. When a child or adolescent takes anabolic steroids, the resulting artificially high sex hormone levels can signal the bones to stop growing sooner than they normally would have done. Cardiovascular system Steroid abuse has been associated with cardiovascular diseases (CVD), including heart attacks and strokes, even in athletes younger than 30.
Steroids contribute to the development of CVD, partly by changing the levels of lipoproteins that carry cholesterol in the blood. Steroids, particularly the oral types, increase the level of low-density lipoprotein (LDL) and decrease the level of high-density lipoprotein (HDL). High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. If blood is prevented from reaching the heart, the result can be a heart attack. If blood is prevented from reaching the brain, the result can be a stroke.