, 13:354 | Cite as

The actions and side effects of Anabolic Steroids in sport and social abuse

  • Alan James George
Open Access
Article de Revue Androgènes et Sports


Anabolic steroids (AS) derived from testosterone have both anabolic (muscle and strength enhancing) and androgenic (primary and secondary sexual) effects. Efforts to limit the androgenic while enhancing the anabolic effects have not been successful. Alterations to the structure of testosterone, so as to improve the pharmacokinetics of AS, have resulted in drugs, which are orally active, have a longer plasma half life and may be administered as depot injections. Therapeutic doses of AS produce statistically significant effects on strength and athletic performance in well-controlled scientific and clinical trials. At low, therapeutic doses, diet and an intensive training regime are equally important in producing a statistically significant increase in strength. Higher doses 6–7000mg per week are regularly administered in sport and produce the greatest increases in muscle strength erythropoiesis and lean body mass. Patterns of steroid abuse can be complex, reflecting a desire to minimise side effects, and avoid detection. AS side effects are of many types. AS increase salt and water retention leading to an expansion of the blood volume, but effects of steroids on blood pressure are equivocal and most cardiovascular side effects appear to be reversible.

Abuse of AS causes an increase in blood triglyceride and cholesterol levels and this is associated with a decline in High Density Lipoproteins (HDLs) and an increase in the Low Density (LDL) type. Though these effects are reversible they are associated with an increased risk of both acute and chronic cardiovascular pathology. The most serious irreversible anabolic steroid side effects are associated with carcinomas-mainly of the liver, prostate and kidney. Hepatic carcinomas are strongly associated with abuse of the orally active 17alpha methyl substituted steroids, which also produce a reversible jaundice. In males, anabolic steroid abuse causes suppression of LH and FSH release leading to inhibition of testosterone production often accompanied by testicular atrophy, and azoospermia. High, chronic doses of the drugs may also cause moderate to severe feminising effects in the form of gynaecomastia. Male secondary sexual characteristics are a side effect of AS abuse in women. Increased insulin resistance and elevated fasting blood glucose levels are the commonest non-gonadal endocrine side effects of AS.

AS abuse leads to contradictory, complex, behavioural, and psychiatric changes. Increased frequency of mental illness, in anabolic steroid abusers including paranoid schizophrenia, mania and depression has been reported. Physical and psychological dependency occur amongst some anabolic steroid abusers and severe psychiatric disorders can appear upon withdrawal, leading in a few cases to criminality and even suicide. We need more studies on the long-term effects of AS. The implications of the past 50 years of AS abuse will be discussed in the review.

Key Words

anabolic steroids androgenic anabolic steroids testosterone side-effects sport athletics abuse pathology dependency review reversible chronic 


  1. 1.
    ALDER E.M., COOK A., DAVIDSON D., WEST C. BANCROFT J.: Hormones, mood and sexuality in lactating women. Br. J. Psychiatry, 1986, 148: 74–79.PubMedCrossRefGoogle Scholar
  2. 2.
    ALEN M., RAHKILA P.: Anabolic-androgenic steroid effects on endocrinology and lipid metabolism in athletes. Sports Med., 1988, 6: 327–332.PubMedCrossRefGoogle Scholar
  3. 3.
    ARCHER J.: The influence of testosterone on human aggression. Br. J. Psychol., 1991, 82: 1–28.PubMedGoogle Scholar
  4. 4.
    BAGATELL C.J., BREMNER W.J.: Androgens in men uses and abuses. New Engl J. Med., 1996, 334: 707–714.PubMedCrossRefGoogle Scholar
  5. 5.
    BAGATELL C.J., HEIMANN J.R., RIVIER J.E.: Effects of endogenous testostrone and estradiol on sexual behaviour in normal young men. J. Clin. Endocrinol. Metab., 1994, 78: 713–716.Google Scholar
  6. 6.
    BAHRKE M.S.: Psychological effects of endogenous testosterone and anabolic-androgenic steroids. In: Yesalis C. ed. Anabolic Steroids in sport and exercise. Champaign Il, Human Kinetics Publishers, 2000: 94–106.Google Scholar
  7. 7.
    BHASIN S., STORER T.W., BERMAN N. et al.: The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N. Engl. J. Med., 1996, 335: 1–7.PubMedCrossRefGoogle Scholar
  8. 8.
    BHASIN S., WOODHOUSE L., STORER T.W.: Proof of the effect of testosterone on skeletal muscle. J. Endocrinol., 2001, 170: 27–38.PubMedCrossRefGoogle Scholar
  9. 9.
    BROWER K.J.: Anabolic steroids: potential for physical and psychological dependence. In: Yesalis C. ed. Anabolic steroids in sport and exercise. Champaign Il, Human Kinetics Publishers, 2000: 279–304.Google Scholar
  10. 10.
    BROWER K.J.: Anabolic steroid abuse and dependence. Curr. Psychiatry Reports, 2002, 4: 377–387.CrossRefGoogle Scholar
  11. 11.
    BROWER K.J., BLOW F.C., YOUNG J.P., HILL E.H.: Symptoms and correlates of anabolic steroid dependence. Br. J. Addict., 1991, 86: 759–768.PubMedCrossRefGoogle Scholar
  12. 12.
    CHOI P.Y.L., POPE H.G.: Violence towards women and illicit androgen-anabolic steroid use. Ann. Clin. Psychiatry, 1994, 6: 21–25.PubMedCrossRefGoogle Scholar
  13. 13.
    COHEN J.C., HICKMAN R.: Insulin resistance and diminished glucose tolerance in powerlifters ingesting anabolic steroids. J. Clin. Endocrinol. Metab., 1987, 64: 960–963.PubMedGoogle Scholar
  14. 14.
    COPELAND J., PETERS R., DILLON P.: Anabolic-androgenic steroid dependence in a woman. Austr. N.Z. J. Psychiatry, 1998, 32: 589–591.CrossRefGoogle Scholar
  15. 15.
    COSTILL D.L., PEARSON D.R., FINK W.J.: Anabolic steroid use among athletes. Changes in HDC-C levels. Phys. Sports Med., 1984, 12: 113–117.Google Scholar
  16. 16.
    DALY R.C., SU T-P., SCHMIDT P.J., PICKAR D., MURPHY D.L., RUBINOW D.R.: Cerebrospinal fluid and behavioural changes after methyltestosterone administration. Arch. Gen. Psychiatry, 2001, 58: 172–177.PubMedCrossRefGoogle Scholar
  17. 17.
    DALY R.C., SU T-P., SCHMIDT P.J., PAGLIARO M., PICKAR D., RUBINOW D.R.: Neuroendocrine and behavioural effects of high-dose anabolic steroid administration in male normal volunteers. Psychoneuroendocrinology, 2003, 28: 317–331.PubMedCrossRefGoogle Scholar
  18. 18.
    EBENBICHLER C.F., STURM W., GANZER H. et al.: Flow-mediated, endothelium dependent vasodilation is impaired in male body builders taking anabolic-androgenic steroids. Atherosclerosis, 2001, 158: 483–490.PubMedCrossRefGoogle Scholar
  19. 19.
    ELASHOFF J.D., JACKNOW A.D., SHAIN S.G., BRAUNSTEIN G.D.: Effects of anabolic-androgenic steroids on muscular strength. Ann. Int. Med., 1991, 115: 387–393.PubMedGoogle Scholar
  20. 20.
    EVANS N.A.: Gym and tonic: a profile of 100 male steroid users. Br. J. Sports Med., 1997, 31: 54–58.PubMedCrossRefGoogle Scholar
  21. 21.
    FORBES G.B.: The effect of anabolic steroids on lean body mass. The dose response curve. Metabolism, 1985, 34: 571–573.PubMedCrossRefGoogle Scholar
  22. 22.
    FREED D.L.J., BANKS A.J., LONGSON D., BURLEY D.M.: Anabolic steroids in athletes: cross-over double blind trial in weightlifters. Br. Med. J., 1975, 2: 471–473.PubMedCrossRefGoogle Scholar
  23. 23.
    FRIEDL K.E., YESALIS C.E.: Self-treatment of gynaecomastia in body builders who use anabolic steroids. Phys. Sports Med., 1989, 17: 67–79.Google Scholar
  24. 24.
    GEORGE A.J.: Drugs in Sport—chemists v cheats-a score draw! Chem. Rev., 4: 10–14.Google Scholar
  25. 25.
    GEORGE A.J.: Anabolic steroids. In: Mottram D.R. ed. Drugs in Sprot 3rd Edition. London, E. & F. Spon, 2003, 138–188.Google Scholar
  26. 26.
    GILL G.V.: Anabolic steroid induced hypogonadism treated with human chorionic gonadotrophins. Postgrad. Med. J., 1998, 74: 45–46.PubMedCrossRefGoogle Scholar
  27. 27.
    GLAZER G.: Arthrogenic effects of anabolic steroids on serum lipid levels. Arch. Int. Med., 1991, 151: 1925–1933.CrossRefGoogle Scholar
  28. 28.
    GOLDMAN B.: Death in the locker room: Steroids and sports. London, Century Publishing, 1984.Google Scholar
  29. 29.
    GUO Z., BENTEN W.P., KRUCKEN J., WUNDERLICH F.: Nongenomic testosterone calcium signalling: genomic actions in androgen receptor-free macrophages. J. Biol. Chem., 2002, 277: 29600–29607.PubMedCrossRefGoogle Scholar
  30. 30.
    GUSTAVSSON G., TRASKMAN-BENDZ L., DEE HIGLEY J., WESTRIN Å.: CSF testosterone in 43 male suicide attempters. Europ. Neuropsychopharmacology, 2003, 13: 105–109.CrossRefGoogle Scholar
  31. 31.
    HARTGENS D., VAN STRAATEN H., FIDELDIJ S., RIETJENS G., KEIZER H.A., KUIPERS H.: Misuse of androgenic-anabolic steroids and human deltoid muscle fibers: differences between polydrug regimens and single drug administration. Europ. J. Appl. Physiol., 2002, 86: 233–239.CrossRefGoogle Scholar
  32. 32.
    HAUPT H.A., ROVERE G.D.: Anabolic steroids: A review of the literature. Am. J. Sports Med., 1984, 12: 469–484.PubMedCrossRefGoogle Scholar
  33. 33.
    HEALD A.H., IVISON F., ANDERSON S.G., CRUICKSHANK K., LAING I., GIBSON J.M.: Significant ethnic variation in total and free testosterone concentration. Clin. Endocrinol., 2003, 58: 262–266.CrossRefGoogle Scholar
  34. 34.
    HERVEY G.R., KNIBBS A.V., BURKINSHAW L. et al.: Effects of methandione on the performance and body composition of man undergoing athletic training. Clin. Sci., 1981, 60: 457–461.PubMedGoogle Scholar
  35. 35.
    HOBBS C.J., JONES R.E., PLYMATE S.R.: Nandrolone, a 19-nortestosterone, enhances insulin dependent glucose uptake in normal men. J. Endocrinol. Metab., 1996, 81: 1582–1585.CrossRefGoogle Scholar
  36. 36.
    HOLMA P.K.: Effects of an anabolic steroid (methandienone) on spermatogenesis. Contraception, 1979, 15: 151–162.CrossRefGoogle Scholar
  37. 37.
    JAROW J.P., LIPSCHULTZ L.I.: Anabolic steroid induced hypogonadotrophic hypogonadism. Am. J. Sports Med., 1990, 18: 429–431.PubMedCrossRefGoogle Scholar
  38. 38.
    KADI F., ERIKSSON A., HOLMNER S., BUTLER-BROWNE G., THORNHILL L.E.: Cellullar adaptation of the trapezius muscle in strength trained athletes. Histochem. Cell Biol., 1999, 111: 189–195.PubMedCrossRefGoogle Scholar
  39. 39.
    KADI F., BONNERUND P., ERIKSSON A., THORNELL L.E.: The expression of androgen receptors in human neck and limb muscles: effects of training and self-administration of androgenic-anabolic steroids. Histochem. Cell Biol., 2000, 113: 25–29.PubMedCrossRefGoogle Scholar
  40. 40.
    KASHKLIN K.B., KLEBER H.D.: Hooked on hormones? An anabolic steroid addiction hypothesis. J. Amer. Med. Assoc., 1989, 262: 3166–3170.CrossRefGoogle Scholar
  41. 41.
    KOURI E.M., LUKAS S.E., POPE H.G., OLIVA P.S.: Increased aggressive responding in male volunteers following the administration of gradually increasing doses of testosterone cypionate. Drug Alcohol Depend., 1995, 40: 73–79.PubMedCrossRefGoogle Scholar
  42. 42.
    KUHN C.M.: Anabolic Steroids. Endocrinol. Rev., 2002, 13: 411–434.Google Scholar
  43. 43.
    KUTSCHER E.C., LUND B.C., PERRY P.J.: Anabolic Steroids —A review for the clinician. Sports Med., 2002, 32: 285–296.PubMedCrossRefGoogle Scholar
  44. 44.
    LUBELL A.: Does steroid abuse cause-or excuse-violence? Phys. Sport Med., 1989, 17: 176–185.Google Scholar
  45. 45.
    LUKAS S.E.: Current perspectives on anabolic-androgenic steroid abuse. Trends Pharmacol. Sci., 1993, 14: 61–68.PubMedCrossRefGoogle Scholar
  46. 46.
    LOMBARDO J.A., HICKSON P.C., LAMB D.R.: Anabolic/androgenic steroids and growth hormone. In: Lamb D.R., Williams M.H. eds. Perspectives in Exercise Science and Sports Medicine, Vol. 4: Ergogenics-Enhancement of Performance in Exercise and Sport. New York, Brown and Benchmark, 1991, 249–278.Google Scholar
  47. 47.
    MCINDOE J.H., PERRY P.J., YATES W.R. et al.: Testosterone suppression of the HPT axis. J. Invest. Med., 1997, 45: 441–447.Google Scholar
  48. 48.
    MILLAR A.P.: Licit steroid use—hope for the future. Br. J. Sports Med., 1994, 28: 79–83.PubMedCrossRefGoogle Scholar
  49. 49.
    MOTTRAM D.R., GEORGE A.J.: Anabolic steroids. Clin. Endocrinol. Metab., 2000, 14: 55–69.Google Scholar
  50. 50.
    NELSON K.A., WHITE J.S.: Androgen receptor CAG repeats and prostate cancer. Am. J. Epidemiol., 2002, 155: 883–890.PubMedCrossRefGoogle Scholar
  51. 51.
    NIEMINEN M.S., RAMO M.P., VIITASALO M. et al.: Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters. Europ. Heart J., 1996, 17: 1576–1583.Google Scholar
  52. 52.
    OLIVARDIA R., POPE H.G., HUDSON J.L.: Muscle dysmorphia in male weightlifters: a case control study. Am. J. Psychiatry, 2000, 157: 1291–1296.PubMedCrossRefGoogle Scholar
  53. 53.
    PARSINNEN M., KINJALA U., VARTIAINEN E., SARNA S., SEPPALA T.: Increased premature mortality of competitive powerlifters suspected to have used anabolic agents. Int. J. Sports Med., 2000, 21: 225–227.CrossRefGoogle Scholar
  54. 54.
    PARSSINEN M., SEPPALA T.: Steroid use and long-term health risks in former athletes. Sports Med., 2002, 32: 83–94.PubMedCrossRefGoogle Scholar
  55. 55.
    POPE H.G., KATZ D.L.: Psychiatric and medical effects of anabolic-androgenic steroid use. Arch. Gen. Psychiat., 1994, 51: 375–382.PubMedGoogle Scholar
  56. 56.
    POPE H.G., GRUBER A.J., CHOI P., OLIVARDIA R., PHILLIPS K.A.: Muscle dysmorphia. Psychosomatics, 1997, 38: 548–557.PubMedGoogle Scholar
  57. 57.
    POPE H.G., KOURI E.M., HUDSON J.I.: Effects of supraphysiological doses of testosterone on mood and aggressionin normal men. Arch. Gen. Psychiatry, 2000, 57: 133–140.PubMedCrossRefGoogle Scholar
  58. 58.
    POPE H.G., COHANE G.H., KANAYAMA G., SIEGEL A.J., HUDSON J.I.: Testosterone gel supplementation for men with refractory depression: a randomised placebo-controlled trial. Am. J. Psychiatry (in press).Google Scholar
  59. 59.
    PORCERELLI J.H., SANDLER B.A.: Narcissism and empathy in steroid users Ann. J. Psychiatry, 1995, 152: 1672–1674.Google Scholar
  60. 60.
    RABKIN J.G., WAGNER G.J., RABKIN R.: A double blind, placebo controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Arch. Gen. Psychiatry, 2000, 57: 141–147.PubMedCrossRefGoogle Scholar
  61. 61.
    RAGLIN J.S.: Psychological factors in sport performance. Sports Med., 2001, 31: 875–890.PubMedCrossRefGoogle Scholar
  62. 62.
    ROCKHOLD R.W.: Cardiovascular toxicity of anabolic steroids. Ann. Rev. Pharmac. Tox., 1993, 33: 497–520.CrossRefGoogle Scholar
  63. 63.
    ROGOL A.D., YESALIS C.E.: Anabolic-androgenic steroids and athletes: What are the issues? J. Endocrinol. Metab., 1992, 74: 465–469.CrossRefGoogle Scholar
  64. 64.
    RUBINOW D.R., SCHMIDT P.J.: Androgens, brain and behaviour. Am. J. Psychiatry, 1996, 153: 974–984.PubMedGoogle Scholar
  65. 65.
    RYAN A.J.: Anabolic steroids are fool’s gold. Fed. Proc., 1981, 40: 2682–2688.PubMedGoogle Scholar
  66. 66.
    SACHS B.D., LEIPHEIMER R.E.: Rapid effect of testosterone on striated muscle activity in rats. Neuroendocrinology, 1988, 48: 453–458.PubMedCrossRefGoogle Scholar
  67. 67.
    SEIDMANN S.N., RABKIN J.G.: Testosterone replacement therapy for hypogonadal men with SSRI-refractory depression. J. Affect. Disord., 1998, 48: 157–161.CrossRefGoogle Scholar
  68. 68.
    SHEFFIELD-MOORE M., URBAN R.J., WOLF S.E. et al.: Short-term oxandrolone administration stimulates net muscle protein synthesis in young men. J. Clin. Endocrinol. Metab., 1999, 84: 2705–2711.PubMedCrossRefGoogle Scholar
  69. 69.
    STIMAC D., MILLI S., DINTINJANA R.D., KOVAC D., RISTI S.: Androgenic/Anabolic steroid induced toxic hepatitis. J. Clin. Gastroenterol., 2002, 35: 350–352.PubMedCrossRefGoogle Scholar
  70. 70.
    STORER T.W., MAGLIANO L., WOODHOUSE L. et al.: Testosterone dose-dependently increases maximal voluntary strength and leg-power, but does not affect fatigability or specific tension. J. Endocrinol. Metab., 2003, 88: 1478–1485.CrossRefGoogle Scholar
  71. 71.
    STREET C., ANTONIO J., CUDLIPP D.: Androgen use by athletes: A re-evaluation of the health risks. Canad. J. Appl. Physiol., 1996, 21: 421–440.Google Scholar
  72. 72.
    SULLIVAN M.L., MARTINEZ C.M., GENNIS C. et al.: The cardiac toxicity of anabolic steroids. Prog. Cardiovasc. Dis., 1998, 41: 1–15.PubMedCrossRefGoogle Scholar
  73. 73.
    THIBLIN I., LINDQUIST O., RAJS J.: Cause and manner of death among abusers of anabolic androgenic steroids. J. Forensic Sci., 2000, 45: 16–23.PubMedGoogle Scholar
  74. 74.
    TUREK P.J., WILLIAMS R.H., GILLBRAUCH J.H. et al.: The reversibility of anabolic steroid induced azoospermia. J. Urol., 1995, 153: 1628–1630.PubMedCrossRefGoogle Scholar
  75. 75.
    UEKI M., OKANA M.: Doping with naturally occurring steroids. J. Toxicol. Toxin. Rev., 1999, 18: 177–195.Google Scholar
  76. 76.
    VAN BREDA E., KEIZER H.A., KUIPERS H., WOLFFEN-BUTTEL B.H.R.: Androgenic anabolic steroid use and severe hypothalamic-pituitary dysfunction: a case study. Int. J. Sports Med., 2003, 24: 195–196.PubMedCrossRefGoogle Scholar
  77. 77.
    WILLIAMSON P.J., YOUNG A.H.: Psychiatric effects of androgenic and anabolic-androgenic steroid abuse in men: a brief review of the literature. J. Psychopharmac., 1992, 6: 20–26.CrossRefGoogle Scholar
  78. 78.
    WILSON J.D.: Androgen abuse by athletes. Endocrinol. Rev., 1988, 9: 181–199.CrossRefGoogle Scholar
  79. 79.
    WOODHOUSE L.J., REISZ-PORSZASZ S., JAVANBAKHT M. et al.: Development of models to predict anabolic response to testosterone administration in healthy young men. Am. J. Physiol., 2003, 284: 1009–1017.Google Scholar
  80. 80.
    WRIGHT J.E.: Anabolic steroids and athletics. Exerc. Sport Sci. Rev., 1980, 8: 149–202.PubMedCrossRefGoogle Scholar
  81. 81.
    WRIGHT F., BRICOUT V., DOUKANI A., BONGINI M.: Nandrolone et nor-stéroïdes: substances endogènes ou xénobiotiques? Sci. Sports, 2000, 15: 111–124.CrossRefGoogle Scholar
  82. 82.
    WROBLEWSKA A.M.: Androgenic-anabolic steroids and body dysmorphia in young men. J. Psychosom. Res., 1997, 42: 225–234.PubMedCrossRefGoogle Scholar
  83. 83.
    WU F.C.W.: Endocrine agents of anabolic steroids. Clin. Chem., 1997, 43: 1289–1292.PubMedGoogle Scholar
  84. 84.
    YANG P., JONES B.L., HENDERSON L.P.: Mechanisms of anabolic androgenic steroid modulation of alpha(1)beta(3)gamma(2L) GABAa receptors. Neuropharmacology, 2002, 43: 619–633.PubMedCrossRefGoogle Scholar
  85. 85.
    YATES W.R., PERRY P.J., MACINDOE J., HOLMAN T. ELLINGRAD V.: Psychosexual effects of 3 doses of testosterone cycling in normal men. Biol. Psychiatry, 1999, 45: 254–260.PubMedCrossRefGoogle Scholar
  86. 86.
    YESALIS C., COURSON S., WRIGHT J.: History of anabolic steroid use in sport and exercise. In: Yesalis C. ed. Anabolic Steroids in sport and exercise. Champaign Il, Human Kinetics Publishers, 2000: 54–56.Google Scholar

Copyright information

© Société d’Andrologie de Langue Française 2003

Authors and Affiliations

  • Alan James George
    • 1
  1. 1.Liverpool John Moores UniversityLondon

Personalised recommendations