Anabolic steroid

that AAS, in the presence of adequate diet, can contribute

to increases in body weight, often as lean mass increases
and that the gains in muscular strength achieved through
high-intensity exercise and proper diet can be additionally
increased by the use of AAS in some individuals.[1]
Health risks can be produced by long-term use or excessive doses of anabolic steroids.[2][3] These eects include
harmful changes in cholesterol levels (increased lowdensity lipoprotein and decreased high-density lipoprotein), acne, high blood pressure, liver damage (mainly
with oral steroids), and dangerous changes in the structure of the left ventricle of the heart.[4] Conditions pertaining to hormonal imbalances such as gynecomastia and
testicular size reduction may also be caused by anabolic
steroids.

Chemical structure of the natural anabolic hormone testosterone,

17-hydroxy-4-androsten-3-one

Ergogenic uses for anabolic steroids in sports, racing,

and bodybuilding as performance-enhancing drugs are
controversial because of their adverse eects and the
potential to gain unfair advantage is considered cheating. Their use is referred to as doping and banned
by all major sporting bodies. For many years, AAS
have been by far the most detected doping substances
in IOC-accredited laboratories.[5][6] In countries where
AAS are controlled substances, there is often a black
market in which smuggled, clandestinely manufactured
or even counterfeit drugs are sold to users.
Chemical structure of the synthetic steroid methandrostenolone
(Dianabol). 17-Methylation (upper-right corner) enhances oral
bioavailability.

1 List of anabolic steroids

Anabolic steroids, technically known as anabolicSee also: List of steroid abbreviations

androgenic steroids (AAS), are drugs that are structurally related to the cyclic steroid ring system and have
similar eects to testosterone in the body. They increase
protein within cells, especially in skeletal muscles. An1.1 Exogenous
anabolic
abolic steroids also have androgenic and virilizing propsteroids
erties, including the development and maintenance of
masculine characteristics such as the growth of the vocal
anabolic
cords, testicles (primary sexual characteristics) and body 1.2 Endogenous
steroids
hair (secondary sexual characteristics). The word anabolic comes from the Greek anabole, that
which is thrown up, mound, and the word androgenic
Androstenediol
from the Greek andros, of a man + - Androstenedione
genes, born.
Anabolic steroids were rst made in the 1930s, and are
now used therapeutically in medicine to stimulate muscle growth and appetite, induce male puberty and treat
chronic wasting conditions, such as cancer and AIDS.
The American College of Sports Medicine acknowledges

androgenic
androgenic

Dihydrotestosterone
Prasterone (dehydroepiandrosterone DHEA)
Testosterone
1

2
1.2.1

2 PHARMACOLOGY

between semi-weekly to once every 12 weeks. A more

frequent schedule may be desirable in order to maintain
Metabolites and isomers of endogenous anabolic andro- a more constant level of hormone in the system.[7] Injectable steroids are typically administered into the musgenic steroids, including, but not limited to:
cle, not into the vein, to avoid sudden changes in the
amount of the drug in the bloodstream. In addition, because estered testosterone is dissolved in oil, intravenous
2 Pharmacology
injection has the potential to cause a dangerous embolism
(clot) in the bloodstream.

2.1

Metabolites and isomers

Routes of administrations

Transdermal patches (adhesive patches placed on the

skin) may also be used to deliver a steady dose through the
skin and into the bloodstream. Testosterone-containing
creams and gels that are applied daily to the skin are
also available, but absorption is inecient (roughly 10%,
varying between individuals) and these treatments tend to
be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed o and may
take up to six hours to be fully absorbed. There is also
the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive
to testosterone and can suer unintended masculinization
and health eects, even from small doses. Injection is the
most common method used by individuals administering
anabolic steroids for non-medical purposes.[8]
The traditional routes of administration do not have differential eects on the ecacy of the drug. Studies indicate that the anabolic properties of anabolic steroids are
relatively similar despite the dierences in pharmacokinetic principles such as rst-pass metabolism. However,
the orally available forms of AAS may cause liver damage
in high doses.[6][9]

2.2 Mechanism of action

A vial of injectable testosterone cypionate

There are four common forms in which anabolic

steroids are administered: oral pills; injectable steroids;
creams/gels for topical application; and skin patches.
Oral administration is the most convenient. Testosterone
administered by mouth is rapidly absorbed, but it is
largely converted to inactive metabolites, and only about
1/6 is available in active form. In order to be suciently
active when given by mouth, testosterone derivatives are
alkylated at the 17 position, e.g. methyltestosterone and
uoxymesterone. This modication reduces the livers
ability to break down these compounds before they reach
the systemic circulation.
Testosterone can be administered parenterally, but it has
more irregular prolonged absorption time and greater activity in muscle in enanthate, undecanoate, or cypionate
ester form. These derivatives are hydrolyzed to release
free testosterone at the site of injection; absorption rate
(and thus injection schedule) varies among dierent esters, but medical injections are normally done anywhere

See also: Steroid hormone

The pharmacodynamics of anabolic steroids are unlike

The human androgen receptor bound to testosterone[10] The protein is shown as a ribbon diagram in red, green, and blue, with
the steroid shown in white.

peptide hormones. Water-soluble peptide hormones can-

2.3

Anabolic and androgenic eects

not penetrate the fatty cell membrane and only indirectly aect the nucleus of target cells through their interaction with the cells surface receptors. However, as
fat-soluble hormones, anabolic steroids are membranepermeable and inuence the nucleus of cells by direct action. The pharmacodynamic action of anabolic steroids
begin when the exogenous hormone penetrates the membrane of the target cell and binds to an androgen receptor located in the cytoplasm of that cell. From there, the
compound hormone-receptor diuses into the nucleus,
where it either alters the expression of genes[11] or activates processes that send signals to other parts of the
cell.[12] Dierent types of anabolic steroids bind to the
androgen receptor with dierent anities, depending on
their chemical structure.[5] Some anabolic steroids such as
methandrostenolone bind weakly to this receptor in vitro,
but still exhibit androgenic eects in vivo. The reason for
this discrepancy is not known.[13]

3
creased libido, suppression of natural sex hormones, and
impaired production of sperm.[20] Eects on women include deepening of the voice, facial hair growth, and possibly a decrease in breast size. Men may develop an enlargement of breast tissue, known as gynecomastia, testicular atrophy, and a reduced sperm count.[21]

The androgenic:anabolic ratio of an AAS is an important factor when determining the clinical application of these compounds. Compounds with a high ratio of androgenic to an anabolic eects are the drug of
choice in androgen-replacement therapy (e.g., treating
hypogonadism in males), whereas compounds with a reduced androgenic:anabolic ratio are preferred for anemia and osteoporosis, and to reverse protein loss following trauma, surgery, or prolonged immobilization. Determination of androgenic:anabolic ratio is typically performed in animal studies, which has led to the marketing of some compounds claimed to have anabolic activity
The eect of anabolic steroids on muscle mass is caused with weak androgenic eects. This disassociation is less
in at least two ways:[14] rst, they increase the production marked in humans, where all anabolic steroids have sigof proteins; second, they reduce recovery time by block- nicant androgenic eects.[7]
ing the eects of stress hormone cortisol on muscle tissue, A commonly used protocol for determining the
so that catabolism of muscle is greatly reduced. It has androgenic:anabolic ratio, dating back to the 1950s, uses
been hypothesized that this reduction in muscle break- the relative weights of ventral prostate (VP) and levator
down may occur through anabolic steroids inhibiting the ani muscle (LA) of male rats. The VP weight is an indiaction of other steroid hormones called glucocorticoids cator of the androgenic eect, while the LA weight is an
that promote the breakdown of muscles.[15] Anabolic indicator of the anabolic eect. Two or more batches of
steroids also aect the number of cells that develop into rats are castrated and given no treatment and respectively
fat-storage cells, by favouring cellular dierentiation into some AAS of interest. The LA/VP ratio for an AAS is
muscle cells instead.[16] Anabolic steroids can also decalculated as the ratio of LA/VP weight gains produced
crease fat by increasing basal metabolic rate (BMR), since by the treatment with that compound using castrated
an increase in muscle mass increases BMR.
but untreated rats as baseline: (LA , LA )/(VP , VP ).
The LA/VP weight gain ratio from rat experiments
is not unitary for testosterone (typically 0.30.4), but
2.3 Anabolic and androgenic eects
it is normalized for presentation purposes, and used
as basis of comparison for other AAS, which have
As the name suggests, anabolic-androgenic steroids have their androgenic:anabolic ratios scaled accordingly (as
two dierent, but overlapping, types of eects: anabolic, shown in the table above).[13][22] In the early 2000s, this
meaning that they promote anabolism (cell growth), and procedure was standardized and generalized throughout
androgenic (or virilising), meaning that they aect the de- OECD in what is now known as the Hershberger assay.
velopment and maintenance of masculine characteristics.
Some examples of the anabolic eects of these hormones
are increased protein synthesis from amino acids, increased appetite, increased bone remodeling and growth,
and stimulation of bone marrow, which increases the
production of red blood cells. Through a number of
mechanisms anabolic steroids stimulate the formation of
muscle cells and hence cause an increase in the size of
skeletal muscles, leading to increased strength.[17][18][19]

2.3.1 Body composition and strength improvements

Body weight in men may increase by 25 kg as a result of short-term (<10 weeks) AAS use, which may be
attributed mainly to an increase of lean mass. Animal
studies also found that fat mass was reduced, but most
studies in humans failed to elucidate signicant fat mass
decrements. The eects on lean body mass have been
shown to be dose-dependent. Both muscle hypertrophy
and the formation of new muscle bers have been observed. The hydration of lean mass remains unaected
by AAS use, although small increments of blood volume
cannot be ruled out.[5]

The androgenic eects of AAS are numerous. Depending on the length of use, the side eects of the steroid
can be irreversible. Processes aected include pubertal growth, sebaceous gland oil production, and sexuality (especially in fetal development). Some examples of
virilizing eects are growth of the clitoris in females and
the penis in male children (the adult penis size does not The upper region of the body (thorax, neck, shoulders,
change due to steroids ), increased vocal cord size, in- and upper arm) seems to be more susceptible for AAS

3 USAGE

than other body regions because of predominance of androgen receptors in the upper body. The largest dierence in muscle ber size between AAS users and nonusers was observed in type I muscle bers of the vastus
lateralis and the trapezius muscle as a result of long-term
AAS self-administration. After drug withdrawal, the effects fade away slowly, but may persist for more than 612
weeks after cessation of AAS use.[5]
Strength improvements in the range of 520% of baseline strength, depending largely on the drugs and dose
used as well as the administration period. Overall, the
exercise where the most signicant improvements were
observed is the bench press.[5] For almost two decades, it
was assumed that AAS exerted signicant eects only in
experienced strength athletes.[23][24] A randomized controlled trial demonstrated, however, that even in novice
athletes a 10-week strength training program accompanied by testosterone enanthate at 600 mg/week may improve strength more than training alone does.[5][25] This
dose is sucient to signicantly improve lean muscle
mass relative to placebo even in subjects that did not exercise at all.[25] The anabolic eects of testosterone enanthate were highly dose dependent.[5][26]

Usage

3.1

Medical uses

Various anabolic steroids and related compounds

Since the discovery and synthesis of testosterone in the

1930s, anabolic steroids have been used by physicians for
many purposes, with varying degrees of success, for the
treatment of:

growth failure.[28] However, the availability of synthetic growth hormone, which has fewer side eects,
makes this a secondary treatment.
Stimulation of appetite and preservation and increase of muscle mass: Anabolic steroids have been
given to people with chronic wasting conditions such
as cancer and AIDS.[29][30]
Induction of male puberty: Androgens are given to
many boys distressed about extreme delay of puberty. Testosterone is now nearly the only androgen used for this purpose and has been shown to increase height, weight, and fat-free mass in boys with
delayed puberty.[31]
Male contraception, in the form of testosterone
enanthate; potential for use in the nearfuture as a safe, reliable, and reversible male
contraceptive.[32][33]
Stimulation of lean body mass and prevention
of bone loss in elderly men, as some studies indicate.[34][35][36] However, a 2006 placebocontrolled trial of low-dose testosterone supplementation in elderly men with low levels of testosterone
found no benet on body composition, physical performance, insulin sensitivity, or quality of life.[37]
Hormone replacement for men with low levels of
testosterone; also eective in improving libido for
elderly males.[38][39][40][41]
Gender dysphoria, by producing secondary male
characteristics, such as a deeper voice, increased
bone and muscle mass, facial hair, increased levels
of red blood cells, and clitoral enlargement in trans
man patients,[42] among other people designated female at birth or who develop female secondary sexual characteristics but desire to rather be read as
male or look more ambiguous, such as a number of
non-binary transgender people,[43][44][45][46][47] both
intersex and dyadic, and dysphoric non-transgender
intersex men.[48][49]
Increased Maximum Inspiratory Pressure: A study
in Research in Sports Medicine has found that
the combination of resistance training and anabolic
steroid administration produce a signicant increase
in MIP in a cohort of long-term AAS users.[50]

Bone marrow stimulation: For decades, anabolic

steroids were the mainstay of therapy for hypoplastic
3.2 Ergogenic use and abuse
anemias due to leukemia or kidney failure, espe[27]
Anabolic steroids have
cially aplastic anemia.
See also: Ergogenic use of anabolic steroids
largely been replaced in this setting by synthetic proMost steroid users are not athletes.[51] Between 1 miltein hormones (such as epoetin alfa) that selectively
lion and 3 million people (1% of the population) are
stimulate growth of blood cell precursors.
thought to have misused AAS in the United States.[52]
Growth stimulation: Anabolic steroids can be used Studies in the United States have shown that anabolic
by pediatric endocrinologists to treat children with steroid users tend to be mostly middle-class heterosexual

5
that long term AAS users were more likely to have symptoms of muscle dysmorphia and also showed stronger
endorsement of more conventional male roles.[59] A recent study in the Journal of Health Psychology showed
that many users believed that steroids used in moderation
were safe.[60]

Numerous vials of injectable anabolic steroids

men with a median age of about 25 who are noncompetitive bodybuilders and non-athletes and use the drugs for
cosmetic purposes.[53] Among 12- to 17-year-old boys,
use of steroids and similar drugs jumped 25 percent from
1999 to 2000, with 20 percent saying they use them for
looks rather than sports, a study by insurer Blue Cross
Blue Shield found."(Eisenhauer) Another study found
that non-medical use of AAS among college students
was at or less than 1%.[54] According to a recent survey, 78.4% of steroid users were noncompetitive bodybuilders and non-athletes, while about 13% reported unsafe injection practices such as reusing needles, sharing
needles, and sharing multidose vials,[55] though a 2007
study found that sharing of needles was extremely uncommon among individuals using anabolic steroids for nonmedical purposes, less than 1%.[8] Another 2007 study
found that 74% of non-medical anabolic steroid users had
secondary college degrees and more had completed college and fewer had failed to complete high school than is
expected from the general populace.[8] The same study
found that individuals using anabolic steroids for nonmedical purposes had a higher employment rate and a
higher household income than the general population.[8]
Anabolic steroid users tend to research the drugs they are
taking more than other controlled-substance users; however, the major sources consulted by steroid users include
friends, non-medical handbooks, internet-based forums,
blogs, and tness magazines, which can provide questionable or inaccurate information.[56]

Anabolic steroids have been used by men and women

in many dierent kinds of professional sports to attain
a competitive edge or to assist in recovery from injury.
These sports include bodybuilding, weightlifting, shot put
and other track and eld, cycling, baseball, wrestling,
mixed martial arts, boxing, football, and cricket. Such
use is prohibited by the rules of the governing bodies
of most sports. Anabolic steroid use occurs among adolescents, especially by those participating in competitive
sports. It has been suggested that the prevalence of use
among high-school students in the U.S. may be as high as
2.7%.[61] Male students used anabolic steroids more frequently than female students and, on average, those that
participated in sports used steroids more often than those
that did not.

4 Adverse eects
Anabolic steroid use can cause many adverse eects.

4.1 Neuropsychiatric
A 2005 review in CNS Drugs determined that signicant
psychiatric symptoms including aggression and violence,
mania, and less frequently psychosis and suicide have
been associated with steroid abuse. Long-term steroid
abusers may develop symptoms of dependence and
withdrawal on discontinuation of AAS.[62] High concentrations of AAS, comparable to those likely sustained by
many recreational AAS users, produce apoptotic eects
on neurons, raising the specter of possibly irreversible
neuropsychiatric toxicity. Recreational AAS use appears
to be associated with a range of potentially prolonged psychiatric eects, including dependence syndromes, mood
disorders, and progression to other forms of substance
abuse, but the prevalence and severity of these various
eects remains poorly understood.[63] There is no evidence that steroid dependence develops from therapeutic use of anabolic steroids to treat medical disorders, but
instances of AAS dependence have been reported among
weightlifters and bodybuilders who chronically administered supraphysiologic doses.[64] Mood disturbances (e.g.
depression, [hypo-]mania, psychotic features) are likely
to be dose- and drug-dependent, but AAS dependence or
withdrawal eects seem to occur only in a small number
of AAS users.[5]

Anabolic steroid users tend to be disillusioned by the portrayal of anabolic steroids as deadly in the media and
in politics.[57] According to one study, AAS users also
distrust their physicians and in the sample 56% had not
disclosed their AAS use to their physicians.[58] Another
2007 study had similar ndings, showing that, while 66%
of individuals using anabolic steroids for non-medical
purposes were willing to seek medical supervision for
their steroid use, 58% lacked trust in their physicians,
92% felt that the medical communitys knowledge of nonmedical anabolic steroid use was lacking, and 99% felt Large-scale long-term studies of psychiatric eects on
that the public has an exaggerated view of the side-eects AAS users are not currently available.[63] In 2003, the rst
of anabolic steroid use.[8] A recent study has also shown naturalistic long-term study on ten users, seven of which

having completed the study, found a high incidence of

mood disorders and substance abuse, but few clinically
relevant changes in physiological parameters or laboratory measures were noted throughout the study, and these
changes were not clearly related to periods of reported
AAS use.[65] A 13-month study, which was published in
2006 and which involved 320 body builders and athletes
suggests that the wide range of psychiatric side-eects induced by the use of AAS is correlated to the severity of
abuse.[66]
4.1.1

Diagnostic Statistical Manual assertion

ADVERSE EFFECTS

whether AAS use triggers violent behavior have failed,

primarily because of high rates of non-participation.[74]
A 2008 study on a nationally representative sample of
young adult males in the United States found an association between lifetime and past-year self-reported
anabolic-androgenic steroid use and involvement in violent acts. Compared with individuals that did not use
steroids, young adult males that used anabolic-androgenic
steroids reported greater involvement in violent behaviors
even after controlling for the eects of key demographic
variables, previous violent behavior, and polydrug use.[75]
A 1996 review examining the blind studies available at
that time also found that these had demonstrated a link
between aggression and steroid use, but pointed out that
with estimates of over one million past or current steroid
users in the United States at that time, an extremely small
percentage of those using steroids appear to have experienced mental disturbance severe enough to result in clinical treatments or medical case reports.[76]

DSM-IV lists General diagnostic criteria for a personality

disorder guideline that The pattern must not be better accounted for as a manifestation of another mental disorder,
or to the direct physiological eects of a substance (e.g.
drug or medication) or a general medical condition (e.g.
head trauma).. As a result anabolic steroid users may
get misdiagnosed by a psychiatrist not told about their A 1996 randomized controlled trial, which involved 43
men, did not nd an increase in the occurrence of
habit.[67]
angry behavior during 10 weeks of administration of
testosterone enanthate at 600 mg/week, but this study
screened out subjects that had previously abused steroids
4.1.2 Personality proles
or had any psychiatric antecedents.[25][77] A trial conCooper, Noakes, Dunne, Lambert, and Rochford iden- ducted in 2000 using testosterone cypionate at 600
tied that anabolicandrogenic steroid (AAS) using in- mg/week found that treatment signicantly increased
dividuals are more likely to score higher on borderline manic scores on the YMRS, and aggressive responses on
(4.7 times), antisocial (3.8 times), paranoid (3.4 times), several scales. The drug response was highly variable.
schizotypal (3.1 times), histrionic (2.9 times), passive- However: 84% of subjects exhibited minimal psychiaggressive (2.4 times), and narcissistic (1.6 times) person- atric eects, 12% became mildly hypomanic, and 4%
ality proles than non-users.[68] Other studies have sug- (2 subjects) became markedly hypomanic. The mechagested that antisocial personality disorder is slightly more nism of these variable reactions could not be explained by
likely among anabolic steroid users than among non- demographic, psychological, laboratory, or physiological
[78]
users (Pope & Katz, 1994).[67] Bipolar dysfunction,[69] measures.
substance dependency, and conduct disorder have also A 2006 study of two pairs of identical twins, in which one
been associated with AAS use.[70]
twin used anabolic steroids and the other did not, found
that in both cases the steroid-using twin exhibited high
levels of aggressiveness, hostility, anxiety, and paranoid
4.1.3 Mood and anxiety
ideation not found in the control twin.[79] A small-scale
study of 10 AAS users found that cluster B personality
Aective disorders have long been recognised as a comdisorders were confounding factors for aggression.[80]
plication of anabolic steroid use. Case reports describe both hypomania and mania, along with irritabil- Androgenic steroids are known to increase aggression
ity, elation, recklessness, racing thoughts and feelings with greater likelihood when compared to more anabolic
of power and invincibility that did not meet the criteria steroids. Trenbolone is frequently noted for its increases
for mania/hypomania.[71] Of 53 bodybuilders who used in aggression. Equipoise is known to increase anxiety in
anabolic steroids, 27 (51%) reported unspecied mood some users.
disturbance.[72]
Depression and suicide
The relationship between
Aggression and hypomania From the mid-1980s on- AAS use and depression is inconclusive. There have been
ward, the media reported roid rage as a side-eect of anecdotal reports of depression and suicide in teenage
AAS.[73]
steroid users,[81] but little systematic evidence. A 1992
A 2005 review determined that some, but not all, ran- review found that anabolic-androgenic steroids may both
domized controlled studies have found that anabolic relieve and cause depression, and that cessation or diminsteroid use correlates with hypomania and increased ag- ished use of anabolic-androgenic steroids may also result
gressiveness, but pointed out that attempts to determine in depression, but called for additional studies due to dis-

4.2

Physiological

parate data.[82] In the case of suicide, 3.9% of a sample

of 77 those classied as AAS users reported attempting
suicide during withdrawal (Malone, Dime, Lombardo,
& Sample, 1995).[83]

4.2

7
AAS use can cause harmful changes in cholesterol levels:
Some steroids cause an increase in LDL bad cholesterol
and a decrease in HDL good cholesterol.[97] In addition,
steroids provoke a rapid increase in body weight and an
accompanying rise in blood pressure, both of which leave
users more vulnerable to a cardiovascular event.[98]

Physiological

Depending on the length of drug abuse, there is a chance

that the immune system can be damaged. Most of these
side-eects are dose-dependent, the most common being elevated blood pressure, especially in those with preexisting hypertension,[84]

4.2.3 Growth defects

An important side eect to mention for high school athletes because steroids can cause the premature closure of
the growth plate, leading to stunted growth.[98]

Anabolic steroids have been shown to alter fasting

blood sugar and glucose tolerance tests.[85] Anabolic 4.2.4 Feminization
steroids such as testosterone also increase the risk
of cardiovascular disease[2] or coronary artery disease.[86][87] Acne is fairly common among anabolic
steroid users, mostly due to stimulation of the sebaceous
glands by increased testosterone levels.[5][88] Conversion
of testosterone to dihydrotestosterone (DHT) can accelerate the rate of premature baldness for males genetically
predisposed, but testosterone itself can produce baldness
in females.[89]
A number of severe side-eects can occur if adolescents
use anabolic steroids.
For example, the steroids may prematurely stop the
lengthening of bones (premature epiphyseal fusion
through increased levels of estrogen metabolites), resulting in stunted growth. Other eects include, but are not
limited to, accelerated bone maturation, increased frequency and duration of erections, and premature sexual
development. Anabolic steroid use in adolescence is also
correlated with poorer attitudes related to health.[90]

Male with gynecomastia

See also: Feminization (biology)

There are also sex-specic side eects of anabolic

steroids. Development of breast tissue in males, a condition called gynecomastia (which is usually caused by
high levels of circulating estradiol), may arise because of
increased conversion of testosterone to estradiol by the
4.2.1 Cancer
enzyme aromatase.[99] Reduced sexual function and tem[32][100][101]
AnWHO organization International Agency for Research on porary infertility can also occur in males.
other
male-specic
side-eect
that
can
occur
is
testicular
Cancer (IARC) list Androgenic (anabolic) steroids under
atrophy, caused by the suppression of natural testosterone
Group 2A: Probably carcinogenic to humans.[91]
levels, which inhibits production of sperm (most of the
mass of the testes is developing sperm). This side-eect is
temporary: The size of the testicles usually returns to nor4.2.2 Cardiovascular
mal within a few weeks of discontinuing anabolic steroid
[102]
Other side-eects can include alterations in the struc- use as normal production of sperm resumes.
ture of the heart, such as enlargement and thickening
of the left ventricle, which impairs its contraction and
4.2.5 Masculinization
relaxation.[4] Possible eects of these alterations in the
heart are hypertension, cardiac arrhythmias, congestive
heart failure, heart attacks, and sudden cardiac death.[92] See also: Virilization
These changes are also seen in non-drug-using athletes,
but steroid use may accelerate this process.[93][94] How- Female-specic side eects include increases in body
ever, both the connection between changes in the struc- hair, permanent deepening of the voice, enlarged cliture of the left ventricle and decreased cardiac func- toris, and temporary decreases in menstrual cycles. When
tion, as well as the connection to steroid use have been taken during pregnancy, anabolic steroids can aect fetal
development by causing the development of male feadisputed.[95][96]

ANABOLIC-ANDROGENIC STEROIDS ABUSE

tures in the female fetus and female features in the male on the physical result.[109]
fetus.[103]
4.2.6

5.1.1 Diagnostic Statistical Manual

Kidney problems

Kidney tests revealed that nine of the ten steroid users developed a condition called focal segmental glomerulosclerosis, a type of scarring within the kidneys. The kidney
damage in the bodybuilders has similarities to that seen
in morbidly obese patients, but appears to be even more
severe.[104]

For DSM-IV, anabolic-androgenic steroid dependency is

found in the other substance-related disorder (include
inhalants, anabolic steroids, medications) section and can
be coded, depending on which diagnostic criteria are
met.[110]

5.1.2 International Classication of Diseases

4.2.7

Liver problems

ICD10 criteria for dependence include experience of at

High doses of oral anabolic steroid compounds can least three of the following during the past year:[67]
cause liver damage, as the steroids are metabolized
(17-alkylated) in the digestive system to increase their
a strong desire to take steroids
bioavailability and stability.[3] Peliosis hepatis has been
increasingly recognised with the use of anabolic steroids.
diculty in controlling use

Anabolic-androgenic
abuse

steroids

Anabolic steroids are not psychoactive and cannot be detected by stimuli devices like a pupilometer which makes
them hard to spot as a source of neuropsychological imbalaces in some AAS users.

withdrawal syndrome when use is reduced

evidence of tolerance
neglect of other interests and persistent use despite
harmful consequences

However, the following ICD-10-CM Index entries conResearch data indicates that steroids aect the sero- tain back-references to ICD-10-CM F55.3:[111]
tonin and dopamine neurotransmitter systems of the
brain.[105] In an animal study, male rats developed
Abuse
a conditioned place preference to testosterone injections into the nucleus accumbens, an eect blocked by
hormones F55.5
dopamine antagonists, which suggests that androgen reinforcement is mediated by the brain. Moreover, testos steroids F55.5
terone appears to act through the mesolimbic dopamine
system, a common substrate for drugs of abuse. Nonethe drug NEC (non-dependent) F19.10
less, androgen reinforcement is not comparable to that of
hormones F55.5
cocaine, nicotine, or heroin. Instead, testosterone resem steroids F55.5
bles other mild reinforcers, such as caeine, or benzodiazepines. The potential for androgen addiction remains
non-psychoactive substance NEC F55.8
to be determined.[106] However, abuse of steroids is rivalling heroin use in Britain.[107]
hormones F55.5
steroids F55.5

5.1

Abuse potential

The Diagnostic Statistical Manual IV (DSM IV) and the

International Classication of Diseases, Volume 10 (ICD
10) dier in the way they regard Anabolic-Androgenic
Steroids (AAS) potential for producing dependence.

ICD-10 goes on to state that although it is usually clear

that the patient has a strong motivation to take the substance, there is no development of dependence or withdrawal symptoms as in the case of the psychoactive
substances.[110]

DSM IV regards AAS as potentially dependence producing. ICD 10 however regards them as non-dependence
producing.[108] Anabolic steroids are not physically addictive but users can develop a psychological dependence

ICD-9-CM will be replaced by ICD-10-CM beginning

October 1, 2014, therefore, F55.3 and all other ICD-10CM diagnosis codes should only be used for training or
planning purposes until then.

5.4
5.1.3

Tragedies involving anabolic-androgenic steroids abuse

National Institute on Drug Abuse

The National Institute on Drug Abuse (NIDA) says that

even though anabolic steroids do not cause the same
high as other drugs, steroids are reinforcing and can lead
to addiction. Studies have shown that animals will selfadminister steroids when given the opportunity, just as
they do with other addictive drugs. People may persist in abusing steroids despite physical problems and
negative eects on social relationships, reecting these
drugs addictive potential. Also, steroid abusers typically spend large amounts of time and money obtaining
the drug; another indication of addiction. Individuals
who abuse steroids can experience withdrawal symptoms
when they stop taking them, including mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex
drive, and steroid cravings, all of which may contribute
to continued abuse. One of the most dangerous withdrawal symptoms is depression. When depression is persistent, it can sometimes lead to suicidal thoughts. Research has found that some steroid abusers turn to other
drugs such as opioid to counteract the negative eects of
steroids.[112]

shouldn't ignore. Its not that we set out to target cops,

but when we're in the middle of an active investigation into steroids, there have been quite a few cases that
have led back to police ocers, says Lawrence Payne,
a spokesman for the United States Drug Enforcement
Administration.[117] The FBI Law Enforcement Bulletin
stated that Anabolic steroid abuse by police ocers is a
serious problem that merits greater awareness by departments across the country.[118] It is also believed that police ocers across the United Kingdom are using criminals to buy steroids and abuse their power for sexual gratication which he claims to be a top risk factor for police
corruption.[119]
5.3.3 Sports
Professional wrestling Main article: WWE Wellness Program

Following the murder-suicide of Chris Benoit in 2007,

the Oversight and Government Reform Committee investigated steroid usage in the wrestling industry.[120]
The Committee investigated WWE and Total Nonstop
Action Wrestling (TNA), asking for documentation of
5.2 Causes and treatment
their companies drug policies. WWE CEO and Chairman, Linda and Vince McMahon respectively, both tesMale anabolic-androgenic steroid abusers often have a tied. The documents stated that 75 wrestlersroughly
troubled social background.[113]
40 percenthad tested positive for drug use since 2006,
most commonly for steroids.[121][122]
5.2.1 Childhood trauma
25% of male weightlifters reported memories of childhood physical or sexual abuse in an interview. Anabolic
steroids are sometimes used by people with muscle dysmorphia (a very specic type of body dysmorphic disorder (BDD)) as a defense mechanism.[114] Interestingly,
yohimbine, while it was originally considered a op of a
supplement, because it did not increase testosterone levels
as rst suspected, have at higher doses been discovered to
be useful to facilitate recall of traumatic memories in the
treatment of post traumatic stress disorder (PTSD).[115]
Also, Tabernanthe iboga and ibogaine have been used to
treat PTSD and/or addiction to anabolic steroids.

5.3

Illicit use by groups

5.4 Tragedies
involving
androgenic steroids abuse

anabolic-

5.4.1 Chris Benoit double-murder and suicide

Main article: Chris Benoit double-murder and suicide
Chris Benoit committed suicide after he killed his wife
Nancy Benoit and strangled their seven-year-old son
Daniel, led to numerous media accounts, and federal investigation into steroid abuse in professional wrestling.
5.4.2 David Jacobs
Main article: David Jacobs (steroid dealer)

5.3.1

Criminals

On June 5, 2008, police discovered Jacobs, along with

Anabolic steroid use has been associated with an antisohis on-again, o-again girlfriend,[123] prominent tness
[116]
cial lifestyle involving various types of criminality.
model Amanda Earhart-Savell, both dead of multiple
gunshot wounds from a .40 caliber Glock handgun.[124]
Police shortly thereafter began characterizing their inves5.3.2 Governments
tigation as consistent with a murder-suicide. Police had
Law enforcement Steroid abuse among law enforce- been alerted to possible foul play after friends of Savell
ment is considered a problem by some. Its a big prob- had reported she had been missing for several days, and
lem, and from the number of cases, its something we ocers were sent to check on their welfare at Jacobs

10

LEGAL AND SPORT RESTRICTIONS

house located in Plano, Texas.[125] Also found in Jacobss 6.1.1 United States
house were 146 vials of steroids, 10 syringes, scales,
bags with steroids and marijuana, a computer, and a .22
semi-automatic gun with ammunition.[126]

Legal and sport restrictions

See also: Legality of anabolic steroids

6.1

Legal status

Steroid pills intercepted by the US Drug Enforcement Administration during the Operation raw deal bust in September 2007.

Various compounds with anabolic and androgenic eects, their

relation with anabolic steroids

The legal status of anabolic steroids varies from country

to country: some have stricter controls on their use or
prescription than others though in many countries they
are not illegal. In the U.S., anabolic steroids are currently listed as Schedule III controlled substances under the Controlled Substances Act, which makes simply possessing of such substances without a prescription, rst oense, a federal crime punishable by up to
one year in prison. Unlawful distribution or possession with intent to distribute anabolic steroids punishable as a rst oense is punished by up to ten years in
prison.[127] In Canada, anabolic steroids and their derivatives are part of the Controlled drugs and substances act
and are Schedule IV substances, meaning that it is illegal to obtain or sell them without a prescription; however, possession is not punishable, a consequence reserved for schedule I, II, or III substances. Those guilty
of buying or selling anabolic steroids in Canada can be
imprisoned for up to 18 months.[128] Import and export also carry similar penalties. In Canada, researchers
have concluded that steroid use among student athletes
is extremely widespread. A study conducted in 1993
by the Canadian Centre for Drug-Free Sport found that
nearly 83,000 Canadians between the ages of 11 and 18
use steroids.[129] Anabolic steroids are also illegal without prescription in Australia,[130] Argentina, Brazil and
Portugal,[131] and are listed as Class C Controlled Drugs
in the United Kingdom. Anabolic steroids are readily
available without a prescription in some countries such
as Mexico and Thailand.

The history of the U.S. legislation on anabolic steroids

goes back to the late 1980s, when the U.S. Congress
considered placing anabolic steroids under the Controlled
Substances Act following the controversy over Ben Johnsons victory at the 1988 Summer Olympics in Seoul.
During deliberations, the American Medical Association
(AMA), Drug Enforcement Administration (DEA), Food
and Drug Administration (FDA) as well as the National
Institute on Drug Abuse (NIDA) all opposed listing anabolic steroids as controlled substances, citing the fact
that use of these hormones does not lead to the physical
or psychological dependence required for such scheduling under the Controlled Substance Act. Nevertheless,
anabolic steroids were added to Schedule III of the Controlled Substances Act in the Anabolic Steroids Control
Act of 1990.[132]
The same act also introduced more stringent controls with
higher criminal penalties for oenses involving the illegal distribution of anabolic steroids and human growth
hormone. By the early 1990s, after anabolic steroids
were scheduled in the U.S., several pharmaceutical companies stopped manufacturing or marketing the products
in the U.S., including Ciba, Searle, Syntex, and others.
In the Controlled Substances Act, anabolic steroids are
dened to be any drug or hormonal substance chemically
and pharmacologically related to testosterone (other than
estrogens, progestins, and corticosteroids) that promote
muscle growth. The act was amended by the Anabolic
Steroid Control Act of 2004, which added prohormones
to the list of controlled substances, with eect from January 20, 2005.[133]
6.1.2 United Kingdom
In the United Kingdom, anabolic steroids are classied
as class C drugs for their illegal abuse potential, which

6.3

Detection of use

11

puts them in the same class as benzodiazepines. Anabolic 6.3 Detection of use
steroids are in Schedule 4, which is divided in 2 parts;
Part 1 contains most of the benzodiazepines and Part 2 The most commonly employed human physiological
specimen for detecting anabolic steroid usage is urine,
contains the anabolic and androgenic steroids.
although both blood and hair have been investigated for
Part 1 drugs are subject to full import and export conthis purpose. The anabolic steroids, whether of endogetrols with possession being an oence without an appronous or exogenous origin, are subject to extensive heppriate prescription. There is no restriction on the possesatic biotransformation by a variety of enzymatic pathsion when it is part of a medicinal product. Part 2 drugs
ways. The primary urinary metabolites may be derequire a Home Oce licence for importation and export
tectable for up to 30 days after the last use, depending
unless the substance is in the form of a medicinal product
on the specic agent, dose and route of administration.
[134]
and is for self-administration by a person.
A number of the drugs have common metabolic pathways, and their excretion proles may overlap those of
the endogenous steroids, making interpretation of testing results a very signicant challenge to the analyti6.2 Status in sports
cal chemist. Methods for detection of the substances or
their excretion products in urine specimens usually inSee also: Use of performance-enhancing drugs in sport
volve gas chromatographymass spectrometry or liquid
Anabolic steroids are banned by all major sports bod- chromatography-mass spectrometry.[148][149][150][151]

7 Illegal trade
Main article: Illegal trade in anabolic steroids
Anabolic steroids are frequently produced in pharmaceu-

Legal status of anabolic steroids and other compounds with anabolic eects in Western countries

ies including Association of Tennis Professionals, Major

League Baseball, Fdration Internationale de Football
Association[135] the Olympics,[136] the National Basketball Association,[137] the National Hockey League,[138]
and the National Football League.[139] The World
Anti-Doping Agency (WADA) maintains the list of
performance-enhancing substances used by many major sports bodies and includes all anabolic agents, which
includes all anabolic steroids and precursors as well as
all hormones and related substances.[140][141] Spain has
passed an anti-doping law creating a national anti-doping
agency.[142] Italy passed a law in 2000 where penalties range up to three years in prison if an athlete has
tested positive for banned substances.[143] In 2006, Russian President Vladimir Putin signed into law ratication of the International Convention Against Doping in
Sport which would encourage cooperation with WADA.
Many other countries have similar legislation prohibiting anabolic steroids in sports including Denmark,[144]
France,[145] the Netherlands[146] and Sweden.[147]

Several large buckets containing tens of thousands of anabolic

steroid vials conscated by the DEA during Operation Raw
Deal in 2007.

tical laboratories, but, in nations where stricter laws are

present, they are also produced in small home-made underground laboratories, usually from raw substances imported from abroad.[152] In these countries, the majority of steroids are obtained illegally through black market
trade.[153][154] These steroids are usually manufactured in
other countries, and therefore must be smuggled across
international borders. As with most signicant smuggling
operations, organized crime is involved.[155]
In the late 2000s, the worldwide trade in illicit AAS increased signicantly, and authorities announced record
captures on three continents. In 2006, Finnish authorities
announced a record seizure of 11.8 million AAS tablets.
A year later, the DEA seized 11.4 million units of AAS
in the largest U.S seizure ever. In the rst three months of
2008, Australian customs reported a record 300 seizures
of AAS shipments.[156]
In the U.S., Canada, and Europe, illegal steroids are

12

9 SEE ALSO

sometimes purchased just as any other illegal drug,

through dealers who are able to obtain the drugs from a
number of sources. Illegal anabolic steroids are sometimes sold at gyms and competitions, and through the
mail, but may also be obtained through pharmacists,
veterinarians, and physicians.[157] In addition, a signicant number of counterfeit products are sold as anabolic
steroids, in particular via mail order from websites posing as overseas pharmacies. In the U.S., black-market
importation continues from Mexico, Thailand, and other
countries where steroids are more easily available, as they
are legal.[158]

bodybuilding magazine.[159] There are often reported rumors that German soldiers were administered anabolic
steroids during the Second World War, the aim being
to increase their aggression and stamina, but these are,
as yet, unproven.[164] Adolf Hitler himself, according to
his physician, was injected with testosterone derivatives
to treat various ailments.[165] AAS were used in experiments conducted by the Nazis on concentration camp
inmates,[165] and later by the allies attempting to treat
the malnourished victims that survived Nazi camps.[164]
President John F. Kennedy was administered steroids
both before and during his presidency.[166]

8.2 Development of synthetic anabolicandrogenic steroids

8.1

History
Isolation of gonadal
androgenic steroids

anabolic- The development of muscle-building properties of testos-

The use of gonadal steroids pre-dates their identication

and isolation. Medical use of testicle extract began in
the late 19th century while its eects on strength were
still being studied.[20] The isolation of gonadal steroids
can be traced back to 1931, when Adolf Butenandt, a
chemist in Marburg, puried 15 milligrams of the male
hormone androstenone from tens of thousands of litres of
urine. This steroid was subsequently synthesized in 1934
by Leopold Ruzicka, a chemist in Zurich.[159]
In the 1930s, it was already known that the testes contain
a more powerful androgen than androstenone, and three
groups of scientists, funded by competing pharmaceutical
companies in the Netherlands, Germany, and Switzerland, raced to isolate it.[159][160] This hormone was rst
identied by Karoly Gyula David, E. Dingemanse, J.
Freud and Ernst Laqueur in a May 1935 paper On Crystalline Male Hormone from Testicles (Testosterone).[161]
They named the hormone testosterone, from the stems of
testicle and sterol, and the sux of ketone. The chemical
synthesis of testosterone was achieved in August that
year, when Butenandt and G. Hanisch published a paper describing A Method for Preparing Testosterone
from Cholesterol.[162] Only a week later, the third group,
Ruzicka and A. Wettstein, announced a patent application in a paper On the Articial Preparation of the
Testicular Hormone Testosterone (Androsten-3-one-17ol).[163] Ruzicka and Butenandt were oered the 1939
Nobel Prize in Chemistry for their work, but the Nazi
government forced Butenandt to decline the honor, although he accepted the prize after the end of World War
II.[159][160]
Clinical trials on humans, involving either oral doses of
methyltestosterone or injections of testosterone propionate, began as early as 1937.[159] Testosterone propionate is mentioned in a letter to the editor of Strength and
Health magazine in 1938; this is the earliest known reference to an anabolic steroid in a U.S. weightlifting or

terone was pursued in the 1940s, in the Soviet Union

and in Eastern Bloc countries such as East Germany,
where steroid programs were used to enhance the performance of Olympic and other amateur weight lifters.
In response to the success of Russian weightlifters, the
U.S. Olympic Team physician John Ziegler worked with
synthetic chemists to develop an anabolic steroid with reduced androgenic eects.[167] Zieglers work resulted in
the production of methandrostenolone, which Ciba Pharmaceuticals marketed as Dianabol. The new steroid was
approved for use in the U.S. by the Food and Drug Administration (FDA) in 1958. It was most commonly administered to burn victims and the elderly. The drugs olabel users were mostly bodybuilders and weight lifters.
Although Ziegler prescribed only small doses to athletes,
he soon discovered that those having abused Dianabol
suered from enlarged prostates and atrophied testes.[168]
AAS were placed on the list of banned substances of
the IOC in 1976, and a decade later the committee introduced 'out-of-competition' doping tests because many
athletes used AAS in their training period rather than during competition.[5]
Three major ideas governed modications of testosterone
into a multitude of AAS: Alkylation at 17-alpha position with methyl or ethyl group created orally active compounds because it slows the degradation of the drug by the
liver; esterication of testosterone and nortestosterone at
the 17-beta position allows the substance to be administered parenterally and increases the duration of eectiveness because agents soluble in oily liquids may be present
in the body for several months; and alterations of the ring
structure were applied for both oral and parenteral agents
to seeking to obtain dierent anabolic to androgenic effect ratios.[5]

9 See also
Antiandrogen

13
Androgen insensitivity syndrome
Steroid rosacea
Steroid use in Bollywood
Bigger, Stronger, Faster*
Juiced: Wild Times, Rampant 'Roids, Smash Hits
& How Baseball Got Big
Selective androgen receptor modulator

10

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Further reading

Yesalis CE (2000). Anabolic Steroids in Sport and

Exercise. Human Kinetics. ISBN 0-88011-786-9.
Daniels RC (February 1, 2003). The Anabolic
Steroid Handbook. RCD Books. p. 80. ISBN 09548227-0-6.

Tygart TT (December 2009). Steroids, the Media,

and Youth. Prevention Researcher Integrated Research Services, Inc., (SIRS Researcher) 16 (79).
Eisenhauer L (Nov 7, 2005). Do I Look OK?". St.
Louis Post-Dispatch (St. Louis, MO). Retrieved 25
Oct 2010.

12 External links
Dmoz Directory of websites on anabolic steroids
National Institute on Drug Abuse: "NIDA for Teens:
Anabolic Steroids".

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13

13
13.1

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Anabolic steroid Source: http://en.wikipedia.org/wiki/Anabolic%20steroid?oldid=643626809 Contributors: The Anome, Codeczero,

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Esquivalience, Marcoshul, Fred11212, Creative1230, Y8o8o, Yamarr and Anonymous: 1407

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Images

File:Anabolic_substances_and_their_legal_status_in_most_Western_countries.png
Source:
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wikipedia/en/f/f2/Anabolic_substances_and_their_legal_status_in_most_Western_countries.png License: CC-BY-SA-3.0 Contributors:
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Original artist:
Polyhister
File:Anabolicsteroids41.jpg Source: http://upload.wikimedia.org/wikipedia/commons/d/dc/Anabolicsteroids41.jpg License: Public domain Contributors: Originally from en.wikipedia; description page is/was here. Original artist: Original uploader was Wikidudeman at
en.wikipedia
File:Compounds_showing_anabolic_and_androgenic_effects.png
Source:
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Compounds_showing_anabolic_and_androgenic_effects.png License: CC-BY-SA-3.0 Contributors:
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Original artist:
Polyhister
File:Depo-testosterone_200_mg_ml.jpg Source: http://upload.wikimedia.org/wikipedia/commons/c/c2/Depo-testosterone_200_mg_
ml.jpg License: Public domain Contributors: ? Original artist: ?
File:GynecomastiaFrontalAsymSevere.jpg
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GynecomastiaFrontalAsymSevere.jpg License: CC BY-SA 3.0 Contributors: Own work Original artist: JMZ1122 Dr. Mordcai
Blau www.gynecomastia-md.com
File:Metandienone.svg Source: http://upload.wikimedia.org/wikipedia/commons/1/16/Metandienone.svg License: Public domain Contributors: Own work Original artist: Fvasconcellos
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Contributors: Transferred from en.wikipedia Original artist: Original uploader was TimVickers at en.wikipedia
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