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Last updated October 28, 2019. 4 minute read

Anabolic steroids: like testosterone, but different

While some of these studies are promising, in nearly all cases, the research is preliminary, and more trials are needed before benefits can be definitively stated. More than 4 million Americans, most of them men, have experience with anabolic steroids.

Self Written by Michael Martin
Reviewed by Dr. Mike Bohl, MD, MPH

Anabolic steroids are the Jekyll and Hyde of men’s health. Most likely, you’ve heard about their illegal use by athletes and bodybuilders, and the ensuing scandals in baseball, track and field, and the Olympics. But anabolic steroids are also prescribed by doctors to treat medical issues such as low testosterone. What’s the difference between the two?

What are anabolic steroids?

Vitals

  • Anabolic steroids are a man-made version of the hormone testosterone, its precursors, or other related compounds.
  • Some athletes and weightlifters take them to improve athletic performance and increase muscle mass.
  • Some non-athletes take them too, to improve their gains at the gym or just to look better.
  • More than 4 million Americans, most of them men, have experience with anabolic steroids.
  • Anabolic steroids can have serious side effects, including heart disease, high blood pressure, mood swings, testicular shrinkage, and decreased libido.

Anabolic steroids work in the body like testosterone, the main male sex hormone. Some of them are testosterone, some of them are testosterone precursors, and some of them are related compounds that act similarly in the body. (Their street names include Arnolds, gym candy, pumpers, roids, and stackers.) Anabolic steroids are mostly known in pop culture via sports—some athletes and bodybuilders have taken them to build muscle, increase endurance, or improve their athletic ability, although they’re considered an illegal performance-enhancing drug. But some anabolics also have several medical uses and are legal with a doctor’s prescription. 

Anabolic steroids were developed in the 1930s to treat hypogonadism or low testosterone. The drug’s full name is “anabolic-androgenic steroids”—”anabolic” for muscle building and “androgenic” for male sex characteristics. There are at least 25 types of anabolic steroids; some of the most common include Anadrol-50, Oxandrin, Deca-Durabolin, and Winstrol (generic names oxymetholone, oxandrolone, nandrolone, and stanozolol, respectively) (Drugs.com, n.d.).

Anabolic steroids are frequently abused, with users often taking doses 10 to 100 times higher than the doses approved for medical use, the National Institute on Drug Abuse says (NIH, 2018). 

Medical steroid use is a different thing—it can help treat several conditions. Anabolic steroids aren’t the same as corticosteroids (such as prednisone), which are prescribed to treat inflammatory conditions like asthma, rheumatoid arthritis, and eczema.

How do anabolic steroids work?

Anabolic steroids can be taken as a pill, injection, implanted pellets, or via a cream or gel. 

They work by binding to androgen (sex hormone) receptors in the brain, just as natural testosterone does, which influences how specific cells function and genes are expressed. In particular, they regulate the pathways that determine male characteristics and activate certain cells that produce the proteins that build muscle tissue and fibers. This can increase muscle mass.

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Medical uses for anabolic steroids

Anabolic steroids are prescribed for several medical uses, including:

  • Hormone conditions, like hypogonadism (low testosterone). If you’re diagnosed with low testosterone, your doctor may prescribe testosterone replacement therapy (TRT) in the form of injections, a gel rubbed onto the skin, or a patch to wear. Read more about TRT here.  
  • Delayed puberty. Doctors may prescribe a course of testosterone injections for boys who haven’t gone through puberty by a certain age, providing a boost in growth and sexual maturity.
  • Conditions that lead to muscle loss, including cancer and HIV. Doctors sometimes prescribe steroids to patients who are experiencing muscle wasting related to their illnesses.

Abuse of anabolic steroids

Most sports ban anabolic steroid use. But some people use them illegally to enhance their athletic performance or physical appearance. Athletes and bodybuilders might use steroids for a competitive advantage; other people may just want to look more muscular. 

According to a paper published in the Journal of the American Medical Association, 2.9 to 4 million Americans have used anabolic steroids at some point (nearly all of them men), and about 20% of teenagers have used them (Pope, 2017). Anabolic steroid abuse is not an obscure phenomenon: Nearly 1 million men have become dependent on anabolic steroids, requiring higher and higher doses. 

“Designer” steroids have been developed that concentrate on the anabolic (muscle-building) functions more than the androgenic (masculinizing) ones. These steroids might have the ability to elude drug tests and avoid a positive result. 

People abuse anabolic steroids in three common ways:

  • Stacking involves taking multiple types of steroids at the same time, possibly mixing oral and injectable versions. Some steroid users believe this will boost results. Stacking is also done to cope with the tolerance some people develop to the drug after a while. A typical “stack” may also contain other compounds that are intended to combat the negative side effects of anabolic steroid use.
  • Cycling is a process in which users take steroids for a set time (say, 6 to 12 weeks), then stop for several weeks before resuming steroid use. This is done to encourage the body to make testosterone naturally and to avoid side effects or damage to the body.
  • Pyramiding is when users start a steroid cycle with a low dose, building to a maximum dose partway through, then tapering back to a low dose by the end.

There’s no scientific evidence that these techniques work as they’re intended or spare the body from the side effects of anabolic steroids.

Side effects/dangers of anabolic steroids

The use of anabolic steroids can have negative effects on just about every bodily system, including:

  • Acne
  • Mood swings and aggression (a.k.a. “roid rage”)
  • Shrinkage of the testicles
  • High blood pressure
  • Gynecomastia, or enlarged male breasts
  • Fluid retention
  • Pain while urinating
  • Enlargement of the clitoris
  • Increased red blood cell count
  • Lower levels of good cholesterol
  • Facial hair growth in women; baldness in men
  • Low sperm count
  • Sex drive changes
  • Increased risk of certain medical conditions (including heart attack or cardiovascular issues, liver disease, tendon rupture, and osteoporosis)

Many people who take anabolic steroids illegally order them online from overseas pharmacies, which means there’s no way of truly knowing their purity or strength. 

Anabolic steroids can also interact with alcohol and drugs such as marijuana, cocaine, MDMA, Adderall, and opiates. Steroids reduce the pleasurable effects of those substances, which could lead the user to take more than usual and potentially overdose. 

Withdrawal symptoms are also a risk of illegal anabolic steroid use. They can include mood swings, fatigue, depression, insomnia, low sex drive, and cravings for steroids. 

As you can see, it’s best not to mess with illegal anabolic steroids. Only take them if prescribed by a doctor, and use them as directed.