Identifying Steroid Use: Physical, Behavioral, and Health Indicators

Steroids, both natural and synthetic, serve diverse biological functions, from medical treatment (e.g., prednisone for skin conditions) to enhancing physical performance (e.g., testosterone in sports). This article focuses on anabolic-androgenic steroids (AAS), known for muscle growth and athletic enhancement, prevalent in sports, bodybuilding, and fitness. While offering rapid results, their usage poses health risks and ethical concerns. Keep reading to learn exactly what these steroids are, the signs and symptoms of using them, and common misconceptions about their usage.

What are steroids?

The scientific definition of a steroid is an organic compound containing 4 carbon rings. Steroids naturally occur in plants, animals, and people. They have very specific actions depending on their designated role.

Corticosteroids are steroids produced by the adrenal glands in humans and include glucocorticoids (e.g., cortisol), mineralocorticoids (e.g., aldosterone), and in small amounts, androgens which are sex hormones (e.g., estrogen, progesterone, and testosterone, which are produced in higher amounts by ovaries and testes). These are all naturally occurring, but there can be synthetic derivatives used as medical treatments, such as prednisone for asthma or estrogen in birth control.

Testosterone develops male reproductive tissues, increasing hair growth, muscle mass, and bone density. There are synthetic forms of testosterone, known as anabolic-androgenic steroids (or AAS). These steroids can be used medically when hormonal deficiencies are present; however, when used strictly for athletic performance (when no deficiency is present), problems can and often do arise. These are the substances most commonly thought of when we hear someone is 'on steroids.'

Use of anabolic steroids

There are a handful of specific reasons people use anabolic steroids, and most have to do with physical performance. The most common reasons include:

  • Increased muscle mass
  • Better athletic performance
  • Improved endurance
  • Faster recovery between workouts

In addition, there are many different delivery systems for anabolic steroids, the most common include:

  • Oral medications
  • Intramuscular injection
  • Topical gels or creams

Doses taken outside of medical supervision can often exceed 10–100 times higher than doses used to treat medical conditions. This is clearly a cause for concern in terms of safety and health risks. Although anabolic steroids can increase muscle mass and improve athletic performance, they don’t come without their negative effects.

Signs and symptoms of AAS use

Anabolic steroids affect many areas of the body. Outside of muscles, hair growth, and bone density, they can also impact the central nervous system, reproductive system, liver, and kidneys, causing a multitude of issues. Let’s explore what physical, psychological, behavioral, and health issues can arise while taking AAS.

The Journal of Clinical Endocrinology Metabolism reviewed nearly 30 years of research (1990–2018) and found consistencies in many signs, symptoms, and adverse effects of taking anabolic steroids when not medically necessary. In addition, the National Institute of Drug Abuse has a very detailed review of common signs, symptoms, and side effects associated with AAS use. The next few sections summarize all of these findings.

Physical signs

The physical signs of taking AAS come on relatively quickly and can include:

  • Rapid muscle growth. Unusually quick muscle gains, surpassing natural size and limits, which can often increase the chances of tendon injuries.
  • Acne and skin changes. Increased acne (face, back, chest), oily skin, and potential development of stretch marks.
  • Hair changes. Both excessive body hair growth and baldness can occur in both females and males.
  • Physical feature changes. Males: development of breasts known as gynecomastia and testicular shrinkage. Females: deepening of voice, changes in facial structure (e.g., stronger jawline, broader brow bone), and decreased breast size.

Many of these physical changes are not reversible (e.g., voice changes and bone changes); however, some do resolve after getting off AAS (e.g., muscle gains and skin changes).

Psychological and behavioral issues

In addition to the reports reviewed by The Journal of Clinical Endocrinology Metabolism and the National Institute of Drug Abuse, a study was conducted by The Substance Abuse Treatment, Prevention, and Policy Journal. They surveyed 232 AAS users and 60 of their family members over 4 years and found consistent and sometimes severe psychological and behavioral side effects. These included:

  • Mental health issues. Anxiety, depression, suicidal ideations, paranoia, and psychotic episodes, especially aggression, rage, jealousy, and mania. Mood swings and irritability were also reported.
  • Energy levels changes. Sudden bursts of energy followed by fatigue or lethargy; these swings in energy were also associated with mood swings. Insomnia and sleep disturbance were also reported.
  • Dependency and addiction. Psychological dependence leading to cravings and withdrawal symptoms was noted. A correlation was also found between people using AAS and an increased use of drugs like marijuana, cocaine, and opioids. It’s believed that AAS users turn to these other drugs to manage the side effects of the steroids.
  • Impact on relationships. Mood swings and mental health issues can often lead to strained interpersonal relationships or even violence. Not only does steroid use affect the user directly, it indirectly impacts their friends, family, and loved ones.

Health symptoms and concerns

Misuse of steroids can result in many potential health problems. These can range from mild to more severe and even life-threatening. Some issues can resolve once the steroids are stopped, but some issues may become permanent. Here are some of the most prevalent health issues associated with AAS use:

  • Cardiovascular issues. High blood pressure, heart attack, blood clots, stroke, arrhythmia, and atherosclerosis.
  • Liver damage. Elevated liver enzymes, jaundice, and liver tumors.
  • Kidney problems. Decreased kidney function, fluid retention, and high blood pressure.
  • Cholesterol. Increased LDL cholesterol, decreased HDL cholesterol, and higher risk of cardiovascular and liver diseases associated with hyperlipidemia and hypercholesterolemia.
  • Sexual health/reproductive system. Decrease or increase in libido, erectile dysfunction, infertility, impotence.
  • Nervous system disturbance. Insomnia and sleep disturbance, increased nerve and/or body pain, headaches, and migraines.
  • Musculoskeletal problems. Tendon rupture, muscle aches and pains, increase in injury, abnormal bone growth.
  • Injection site issues. Sometimes illicit users don’t practice safe/sterile needle use which can result in infections, abscesses at the injection site, and even viral spread (like HIV and hepatitis).

Again, some of these health concerns may or may not be reversible once the steroid use is stopped; this depends on how long they’ve been used, the doses used, and the age and health status of the person using them.

Confirming steroid use

It can be difficult to know for sure if someone is using anabolic steroids. Signs of AAS use can include the previously mentioned physical and behavioral changes. It’s also important to observe sudden changes in workout routines, dietary habits, and secrecy about medication use. If these are all happening, there could be a high likelihood someone is using steroids; however, the best way to know for sure is lab testing.

Blood tests, urine tests, and imaging studies can detect abnormal hormone levels and organ damage in those using anabolic steroids. These are the objective measures that can confirm AAS use.

Laws around steroids vary depending on the type and purpose of use. In many countries, certain steroids are legal when prescribed by a healthcare professional to treat medical conditions such as hormone deficiencies, autoimmune disorders, and inflammatory conditions.

The non-medical use of anabolic steroids for performance enhancement or bodybuilding purposes is often illegal without a prescription; this is the case in the United States, where steroids are a Schedule III substance.

It's important to know the laws and regulations regarding steroid use in specific jurisdictions to ensure compliance and avoid legal consequences.

Prevention of steroid use

Preventing steroid use and promoting healthy alternatives and lifestyles involves a multifaceted approach that addresses education, support, and access to resources. Here are some strategies studies have shown can help:

  1. Education and awareness. Educate on the risks and consequences of steroid use. Provide accurate information about the short-term and long-term effects of steroids on physical and mental health, emphasizing the importance of natural, sustainable approaches to fitness and performance enhancement.
  2. Promote body positivity. Implement positive body image and self-esteem initiatives by promoting acceptance of diverse body shapes and sizes, potentially lowering motivation to go to extreme measures to make body changes.
  3. Access to mental health support. Recognize and address underlying psychological factors that may contribute to steroid use, such as body dysmorphia, low self-esteem, and pressure (both from peers and sports teams). Offer access to mental health resources, including counseling, therapy, and support groups to help people (especially teens) cope with body image issues and develop healthy coping strategies.
  4. Focus on natural training methods. Educate people on natural training methods like strength training, cardio exercise, flexibility training, and functional movements to improve fitness and performance. Highlight the benefits of natural training in reaching goals with sustainable results and overall well-being.
  5. Provide nutrition education. Offer nutrition education and resources to promote healthy eating habits and balanced diets rich in whole foods, lean proteins, fruits, vegetables, and whole grains to support energy levels, muscle growth, recovery, and overall health.
  6. Promote positive role models. Highlight the achievements of athletes and fitness enthusiasts who prioritize natural training methods, healthy lifestyles, and positive body image. Showcase individuals who embody strength, resilience, and authenticity without resorting to performance-enhancing substances.
  7. Implement drug-free policies. Enforce drug-free policies in sports organizations, schools, and fitness facilities to discourage the use of steroids and other performance-enhancing drugs. Provide support for athletes to compete clean by promoting anti-doping regulations, fair play, integrity, and sportsmanship.
  8. Healthcare professionals' support. Collaborate with healthcare professionals (like physicians, nutritionists, and mental health professionals) to provide comprehensive support and guidance for those seeking improved health and fitness. Tools like medical assessments, nutritional counseling, and personalized training programs can help optimize health and performance safely and sustainably.

Implementing these strategies can empower people to make informed choices, prioritize their health and well-being, and pursue fitness goals in a safe, sustainable, and drug-free way.

Impact of steroid use in sports

Steroid use in sports can lead to unfair advantages, compromising the integrity of the game. Steroid use violates the principles of fair play and sportsmanship, undermining the spirit of competition. It creates an uneven playing field, creating disadvantages for athletes who choose to compete clean and follow 'anti-doping' regulations.

Athletes who use steroids risk a range of adverse health effects, including liver damage, cardiovascular complications, hormonal imbalances, and psychiatric disorders, which can actually hinder their performance in the long run and jeopardize their athletic career.

Sports organizations implement anti-doping policies and testing protocols to detect and deter steroid use among athletes. Random drug testing, strict sanctions, and educational programs aim to promote fair play, protect athlete health, and uphold the integrity of sport.

Debunking steroid myths and understanding realities

Here are some common myths and misconceptions about anabolic steroids and the realities to debunk these myths.

Myth #1: AAS guarantee instant muscle growth

Reality: Steroids aren’t magic, their effects are not instantaneous nor sustainable without proper diet, training, and lifestyle habits. They work by increasing protein synthesis and nitrogen retention in muscles (like naturally occurring testosterone does) which can help increase strength and muscle size. However, how effective they are depends on several factors, including dosage, duration of use, genetic predisposition, and training program regimen.

Myth #2: Steroids are safe when used in moderation

Reality: While medical supervision can mitigate some risks associated with steroid use, it does not eliminate them entirely. Steroids are potent substances that can disrupt your body's hormonal balance, leading to a cascade of physical and psychological effects, some of which are very severe and even irreversible.

Myth #3: You can’t get addicted to steroids, they are easy to stop

Reality: Steroid abuse has been on the rise for the last 2 decades, with an estimated 3–4 million users. Males engaging in athletics/sports are at the highest risk for addiction and misuse. It’s estimated that about 30% of AAS users will develop dependency, even when they experience negative side effects.

Discontinuing steroid use often results in withdrawal symptoms like increased anxiety and depression. The National Institute of Medicine reported associations between anabolic steroid use and illicit drug use, furthering risk factors for addiction and withdrawal-related health concerns, as well as long-term health effects. If you or someone you know may be struggling with anabolic steroid misuse, please visit or call the Substance Abuse and Mental Health Services Administration.

In the fight against steroid abuse, accurate information is our most valuable weapon. By debunking myths, dispelling misconceptions, and sharing evidence-based knowledge, people can be empowered to make informed decisions about their health and well-being.

Anabolic steroids are not the magic solution they're often portrayed to be. Short-term aesthetic and performance gains may sound appealing; however, they may not be worth the negative long-term health consequences. Working towards promoting healthier alternatives, sharing accurate information, and having access to quality resources can all help identify and potentially prevent steroid misuse and abuse for millions of Americans.

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