NATIONAL INSTITUTE ON DRUG ABUSE Research Report SERIES Persistent reports of anabolic steroid abuse by professional athletes, many of whom are regarded as role models by young people, highlight the fact that we are now facing a very damaging message in our society— that bigger is better, and being the best is more important than how you get there. Abuse of anabolic steroids differs from the abuse of other illicit sub- stances because the initial abuse of anabolic steroids is not driven by the immediate euphoria that accompanies most drugs of abuse, such as cocaine, heroin, and marijuana, but by the What are Anabolic steroids were devel- desire of abusers to change their oped in the late 1930s primarily appearance and performance, characteristics of great importance anabolic steroids? to treat hypogonadism, a condi- to adolescents. The effects of steroids nabolic steroids” is the tion in which the testes do not can boost confidence and strength, “ familiar name for synthetic produce sufficient testosterone leading abusers to overlook the poten- tial serious and long-term damage Asubstances related to the for normal growth, development, that these substances can cause. male sex hormones (e.g., testos- and sexual functioning. The r While anabolic steroids can terone). They promote the growth primary medical uses of these enhance certain types of performance of skeletal muscle (anabolic compounds are to treat delayed o or appearance, they are dangerous drugs, and when used inappropriately effects) and the development puberty, some types of impo- t they can cause a host of severe, of male sexual characteristics tence, and wasting of the body long-lasting, and in some cases, c irreversible negative health conse- (androgenic effects) in both males caused by HIV infection or other quences. Anabolic steroids can lead and females. The term “anabolic diseases. to early heart attacks, strokes, liver e steroids” will be used through- During the 1930s, scientists tumors, kidney failure, and serious out this report because of its discovered that anabolic steroids r psychiatric problems. In addition, familiarity, although the proper could facilitate the growth of i because steroids are often injected, users who share needles or use non- term for these compounds is skeletal muscle in laboratory sterile techniques when they inject “anabolic-androgenic steroids.” animals, which led to abuse of d steroids are at risk for contracting dangerous infections, such as HIV/AIDS and hepatitis B and C. I hope that students, parents, 12th-Graders’ Perceived Harmfulness of Steroid Use e teachers, coaches, and others will take advantage of the information 80% about anabolic steroids found on h the NIDA Web site (www.steroid- 68.1% t 60 abuse.gov) and join us in our 62.1% prevention and education efforts. 57.9% 58.9% 57.1% 55.0% 55.7% 56.8% Participating in sports offers many 40 benefits, but young people and adults should not take unnecessary health m risks in an effort to win. 20 Nora D.Volkow,M.D. o 0 Director 1998 1999 2000 2001 2002 2003 2004 2005 r National Institute on Drug Abuse Source: 2005 Monitoring the Future Survey. f U.S. Department of Health and Human Services • National Institutes of Health 2NIDA RESEARCH REPORT SERIES the compounds first by body- builders and weightlifters and What is the scope Why do people then by athletes in other sports. of steroid use in abuse anabolic Steroid abuse has become so widespread in athletics that it the United States? steroids? can affect the outcome of sports he 2005 Monitoring the ne of the main reasons contests. Future study, a NIDA-funded people give for abusing Illicit steroids are often sold at Tsurvey of drug use among steroids is to improve their adolescents in middle and high O gyms, competitions, and through athletic performance. Among mail order operations after being schools across the United States, athletes, steroid abuse has been smuggled into this country. Most reported that past year use of estimated to be less that 6 per- illegal steroids in the United States steroids decreased significantly cent according to surveys, but are smuggled from countries that among 8th- and 10th-graders anecdotal information suggests do not require a prescription for since peak use in 2000. Among more widespread abuse. the purchase of steroids. Steroids 12th-graders, there was a differ- Although testing procedures are are also illegally diverted from ent trend—from 2000 to 2004, now in place to deter steroid U.S. pharmacies or synthesized in past year steroid use increased, abuse among professional and but in 2005 there was a signifi- clandestine laboratories. Olympic athletes, new designer cant decrease, from 2.5 percent drugs constantly become avail- to 1.5 percent. Steroid abuse affects individu- able that can escape detection What are steroidal als of various ages. However, it and put athletes willing to cheat supplements? is difficult to estimate the true one step ahead of testing efforts. This dynamic, however, may n the United States, supple- prevalence of steroid abuse in be about to shift if the saving ments such as tetrahydro- the United States because many of urine and blood samples gestrinone (THG) and data sources that measure drug I abuse do not include steroids. for retesting at a future date androstenedione (street name becomes the standard. The high “Andro”) previously could be Scientific evidence indicates that anabolic steroid abuse among probability of eventual detection purchased legally without a athletes may range between one of the newer designer steroids, prescription through many and six percent. once the technology becomes commercial sources, including health food stores. Steroidal supplements can be converted Commonly Abused Steroids into testosterone or a similar compound in the body. Less is known about the side effects of Oral Steroids Injectable Steroids steroidal supplements, but if I Anadrol I Deca-Durabolin large quantities of these com- (oxymetholone) (nandrolone decanoate) pounds substantially increase I I Durabolin testosterone levels in the body, Oxandrin (nandrolone phenpropionate) then they also are likely to pro- (oxandrolone) I duce the same side effects as I Dianabol Depo-Testosterone anabolic steroids themselves. The (methandrostenolone) (testosterone cypionate) purchase of these supplements, I Equipoise with the notable exception of I Winstrol (boldenone undecylenate) dehydroepiandrosterone (DHEA), (stanozolol) became illegal after the passage I Tetrahydrogestrinone (THG) in 2004 of amendments to the Controlled Substances Act. NIDA RESEARCH REPORT SERIES 3 Annual Prevalence of Steroid Use Among Males Cycling, stacking, and pyramiding Grades 8, 10, 12 Steroids are often abused in 3.5% patterns called “cycling,” which 3.0 involve taking multiple doses of 2.5 steroids over a specific period of time, stopping for a period, 2.0 and starting again. Users also fre- 1.5 quently combine several different 1.0 types of steroids in a process 0.5 known as “stacking.” Steroid 0.0 abusers typically “stack” the 8th Grade 10th Grade 12th Grade drugs, meaning that they take Source: 2005 Monitoring the Future Survey. two or more different anabolic steroids, mixing oral and/or available, plus the fear of who had been raped reported injectable types, and sometimes retroactive sanctions, should give that they markedly increased even including compounds that athletes pause. their bodybuilding activities are designed for veterinary use. Another reason people give after the attack. They believed Abusers think that the different for taking steroids is to increase that being bigger and stronger steroids interact to produce an their muscle size or to reduce would discourage further attacks effect on muscle size that is their body fat. This group because men would find them greater than the effects of each either intimidating or unattractive. includes people suffering from drug individually, a theory that Finally, some adolescents the behavioral syndrome called has not been tested scientifically. abuse steroids as part of a pattern muscle dysmorphia, which causes Another mode of steroid abuse them to have a distorted image of high-risk behaviors. These is referred to as “pyramiding.” of their bodies. Men with muscle adolescents also take risks such This is a process in which users dysmorphia think that they look as drinking and driving, carrying slowly escalate steroid abuse small and weak, even if they are a gun, driving a motorcycle with- (increasing the number of ste- large and muscular. Similarly, out a helmet, and abusing other roids or the dose and frequency women with this condition think illicit drugs. Conditions such as that they look fat and flabby, muscle dysmorphia, a history of of one or more steroids used at even though they are actually physical or sexual abuse, or a one time), reaching a peak lean and muscular. history of engaging in high-risk amount at mid-cycle and gradu- Some people who abuse behaviors have all been associat- ally tapering the dose toward the steroids to boost muscle size ed with an increased risk of initi- end of the cycle. Often, steroid have experienced physical or ating or continuing steroid abuse. abusers pyramid their doses in sexual abuse. In one series of cycles of 6 to 12 weeks. At the interviews with male weight- beginning of a cycle, the person lifters, 25 percent who abused How are anabolic starts with low doses of the steroids reported memories of steroids abused? drugs being stacked and then childhood physical or sexual ome anabolic steroids are slowly increases the doses. In abuse. Similarly, female weight- taken orally, others are the second half of the cycle, the lifters who had been raped were injected intramuscularly, doses are slowly decreased to S zero. This is sometimes followed found to be twice as likely to and still others are provided in report use of anabolic steroids gels or creams that are applied to by a second cycle in which the or another purported muscle- the skin.