"Anabolic steroids" is the familiar name for synthetic substances related to the male sex hormones (e.g., testosterone). They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects) in both males and females. 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."
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 or other diseases.
During the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals, which led to abuse 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 can affect the outcome of sports contests.
Illicit steroids are often sold at gyms, competitions, and through mail order operations after being smuggled into this country. Most illegal steroids in the United States are smuggled from countries that do not require a prescription for the purchase of steroids. Steroids are also illegally diverted from U.S. pharmacies or synthesized in clandestine laboratories.
Scope of Use
The 2005 Monitoring the Future study, a NIDA-funded survey of drug use among adolescents in middle and high schools across the United States, reported that past year use of steroids decreased significantly among 8th- and 10th-graders since peak use in 2000. Among 12th-graders, there was a different trend—from 2000 to 2004, past year steroid use increased, but in 2005 there was a significant decrease, from 2.5 percent to 1.5 percent.
Steroid abuse affects individuals of various ages. However, it is difficult to estimate the true prevalence of steroid abuse in the United States because many data sources that measure drug abuse do not include steroids. Scientific evidence indicates that anabolic steroid abuse among athletes may range between one and six percent.
Why do people abuse anabolic steroids?
One of the main reasons people give for abusing steroids is to improve their athletic performance. Among athletes, steroid abuse has been estimated to be less that 6 percent according to surveys, but anecdotal information suggests more widespread abuse. Although testing procedures are now in place to deter steroid abuse among professional and Olympic athletes, new designer drugs constantly become available that can escape detection and put athletes willing to cheat one step ahead of testing efforts. This dynamic, however, may be about to shift if the saving of urine and blood samples for retesting at a future date becomes the standard. The high probability of eventual detection of the newer designer steroids, once the technology becomes available, plus the fear of retroactive sanctions, should give athletes pause.
Another reason people give for taking steroids is to increase their muscle size or to reduce their body fat. This group includes people suffering from the behavioral syndrome called muscle dysmorphia, which causes them to have a distorted image of their bodies. Men with muscle dysmorphia think that they look small and weak, even if they are large and muscular. Similarly, women with this condition think that they look fat and flabby, even though they are actually lean and muscular.
Some people who abuse steroids to boost muscle size have experienced physical or sexual abuse. In one series of interviews with male weightlifters, 25 percent who abused steroids reported memories of childhood physical or sexual abuse. Similarly, female weightlifters who had been raped were found to be twice as likely to report use of anabolic steroids or another purported musclebuilding drug, compared with 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.
Finally, some adolescents abuse steroids as part of a pattern of high-risk behaviors. These adolescents also take risks such as drinking and driving, carrying a gun, driving a motorcycle without a helmet, and abusing other illicit drugs. Conditions such as muscle dysmorphia, a history of physical or sexual abuse, or a history of engaging in high-risk behaviors have all been associated with an increased risk of initiating or continuing steroid abuse.
How are anabolic steroids abused?
Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are applied to the skin. Doses taken by abusers can be 10 to 100 times higher than the doses used for medical conditions.
Cycling, stacking, and pyramiding
Steroids are often abused in patterns called "cycling," which involve taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. Users also frequently combine several different types of steroids in a process known as "stacking." Steroid abusers 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.Abusers 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.
Another mode of steroid abuse is referred to as "pyramiding." This is a process in which users slowly escalate steroid abuse (increasing the number of steroids or the dose and frequency of one or more steroids used at one time), reaching a peak amount at mid-cycle and gradually tapering the dose toward the end of the cycle. Often, steroid abusers pyramid their doses in cycles of 6 to 12 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. Abusers 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.