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What are anabolic steroids? 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 estosterone 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. What are steroidal supplements? In the United States, supplements such as tetrahydrogestrinone (THG) and androstenedione (street name Andro) previously could be purchased legally without a prescription through many commercial sources, including health ood stores. Steroidal supplements can be converted into testosterone or a similar compound in the body. Less is known about the side effects of steroidal supplements, but if large quantities of these compounds Index Letter from the Director What are anabolic steroids? What are steroidal supplements? What is the scope of steroid abuse in the United States? Why do people use anabolic steroids? How are anabolic steroids abused? What are the health consequences of steroid abuse? What effects do anabolic steroids have on behavior? Are anabolic steroids addictive? What can be done to prevent steroid abuse? NIDA-funded prevention research helps reduce steroid abuse. What treatments are effective for anabolic steroid abuse? Where can I get further scientific information about steroid abuse? Glossary and References substantially increase testosterone levels in the body, then they also are likely to produce the same side effects as anabolic steroids themselves. The purchase of these supplements, with the notable exception of dehydroepiandrosterone (DHEA), became illegal after the passage in 2004 of amendments to the Controlled Substances Act. Commonly Abused Steroids Oral Steroids †¢Anadrol (oxymetholone) †¢Oxandrin oxandrolone) †¢Dianabol (methandrostenolone) †¢Winstrol (stanozolol) Injectable Steroids †¢Deca-Durabolin (nandrolone decanoate) †¢Durabolin (nandrolone phenpropionate) †¢Depo-Testosterone (testosterone cypionate) †¢Equipoise (boldenone undecylenate) †¢Tetrahydrogestrinone (THG) What is the scope of steroid use in the United States? 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 ifferent 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 prevalenc e 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. What are the health consequences of steroid abuse? Index Letter from the Director Anabolic steroid abuse has been associated ith 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, such as voice deepening in females. Most data on the long-term effects of anabolic steroids in humans come from case reports rather than formal epidemiological studies. From the case reports, the incidence of lifethreatening effects appears to be low, but serious adverse effects may be underrecognized or underreported, especially ince they may occ ur many years later. 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 frequency of early deaths. Hormonal system Steroid abuse 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 men. In one study of male bodybuilders, more than half had testicular atrophy and/or gynecomastia. 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 ef fects become irreversible. Musculoskeletal system Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence and provide the signals to stop growth as well. When a child or adolescent takes anabolic steroids, the resulting artificially high sex hormone levels can prematurely signal the bones to stop growing. Cardiovascular system Steroid abuse has been associated with What are anabolic steroids? What are steroidal supplements? What is the scope of steroid abuse in the United States? Why do people use anabolic steroids? How are anabolic steroids abused? What are the health consequences of steroid abuse? What effects do anabolic steroids have on behavior? Are anabolic steroids addictive? What can be done to prevent steroid abuse? NIDA-funded prevention esearch helps reduce steroid abuse. What treatments are effective for anabolic steroid abuse? Where can I get further scientific information about steroid abuse? Glossary and References Possible Health Consequences of Anabolic Steroid Abuse Hormonal system Men †¢infertility †¢breast development †¢shrinking of the testicles †¢male-pattern baldness Women †¢enlargement of the clitoris †¢excessive growth of body hair †¢male-pattern baldness Musculoskeletal system †¢short stature (if taken by adolescents) †¢tendon rupture Cardiovascular system †¢increases in LDL; †¢decreases in HDL †¢high blood pressure †¢heart attacks enlargement of the hearts left ventricle Liver †¢cancer †¢peliosis hepatis †¢tumors Skin †¢severe acne and cysts †¢oily scalp †¢jaundice †¢fluid retention Infection †¢HIV/AIDS †¢hepatitis Psychiatric effects †¢rage, aggression †¢mania †¢delusions cardiovascular diseases (CVD), including heart attacks and strokes, even in athletes younger than 30. Steroids contribute to the development of CVD, partly by changi ng the levels of lipoproteins that carry cholesterol in the blood. Steroids, particularly oral steroids, 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. Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle so that it does not pump blood effectively. Liver Steroid abuse has been associated with liver tumors and a rare condition called peliosis hepatis, in which blood-filled cysts form in the liver. Both the tumors and the cysts can rupture, causing internal bleeding. Skin Steroid abuse can cause acne, cysts, and oily hair and skin. Infections Many abusers who inject anabolic steroids may use nonsterile injection techniques or share contaminated needles with other abusers. In addition, some steroid preparations are manufactured illegally under nonsterile conditions. These factors put abusers at risk for acquiring lifethreatening viral infections, such as HIV and hepatitis B and C. Abusers also can develop endocarditis, a bacterial infection that causes a potentially fatal inflammation f the inner lining of the heart. Bacterial infections also can cause pain and abscess formation at injection sites. What effects do anabolic steroids have on behavior? Case reports and small studies indicate that anabolic steroids, when used in high doses, increase irritability and aggression. Some steroid abusers report that they have committed aggressive acts, such as physical fighting or armed robbery, theft, vandalism, or burglary. Abusers who have committed aggressive acts or property crimes generally report that th ey engage in these behaviors more often when they take steroids than when they are drug free. A recent study suggests that the mood and behavioral effects seen during anabolic-androgenic steroid abuse may result from secondary hormonal changes. Scientists have attempted to test the association between anabolic steroids and aggression by administering high steroid doses or placebo for days or weeks to human volunteers and then asking the people to report on their behavioral symptoms. To date, four such studies have been conducted. In three, high steroid doses did produce greater feelings of irritability and aggression than did placebo, although the effects appear to be highly variable across individuals. In one study, the drugs did not have that effect. One possible explanation, according to the researchers, is that some but not all anabolic steroids increase irritability and aggression. Recent animal studies show an increase in aggression after steroid administration. In a few controlled studies, aggression or adverse, overt behaviors resulting from the administration of anabolic steroid use have been reported by a minority of volunteers. In summary, the extent to which steroid abuse contributes to violence and behavioral disorders is unknown. As with the health complications of steroid buse, the prevalence of extreme cases of violence and behavioral disorders seems to be low, but it may be underreported or underrecognized. Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for addiction to heroin or other opioids found that 9. 3 percent had abused anabolic steroids before trying any other illicit drug. Of these 9. 3 percent, 86 percent first used opioids to counteract insomnia and irritability resulting from anabolic steroids.