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Feb 07, 2022
5 min read

Anabolic steroids: what are they and how do they differ from testosterone?

Anabolic steroids are a man-made version of the hormone testosterone. Some athletes and weightlifters abuse them to improve athletic performance and increase muscle mass. Approximately 3–4 million Americans, most of them men, have experience with anabolic steroids. Abuse of anabolic steroids can lead to serious side effects, including heart disease, high blood pressure, mood swings, testicular shrinkage, and decreased libido.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Anabolic steroids are the Jekyll and Hyde of men’s health. Most likely, you’ve heard about their illegal use by athletes and weightlifters and the ensuing scandals in baseball, track and field, and the Olympics. But did you know that medical providers also prescribe anabolic steroids to treat medical issues like low testosterone? 

Read on to learn more about these controversial drugs. 

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What are anabolic steroids?

Anabolic steroids work like testosterone, the main male sex hormone. They may be forms of testosterone, testosterone precursors, or related compounds. You may also see them described by another name: anabolic-androgenic steroids. Because they resemble testosterone, they can cause many of the same effects that testosterone does in your body, like increasing muscle size and strength (Ganesan, 2021).

When people talk about anabolic steroids, they usually refer to drugs that were developed to have more of an anabolic effect (i.e., muscle growth) than an androgenic effect (i.e., male sex characteristics).

Approximately 3-4 million individuals in the United States, mostly males, abuse anabolic steroids at some point in their lives. Those who abuse these drugs typically take doses much higher than recommended, leading to significant side effects (Pope, 2017). 

While abusing them for their performance-enhancing capabilities is illegal, they are legal when a medical provider prescribes them to you to treat an underlying medical condition. Anabolic steroids aren’t the same as corticosteroids (such as prednisone), often prescribed to treat inflammatory conditions like asthma, rheumatoid arthritis, and eczema

How do anabolic steroids work?

Anabolic steroids work by binding to androgen (sex hormone) receptors in the brain, just like natural testosterone. This allows them to affect pathways that determine male characteristics and activate certain cells that produce the proteins that build muscle mass (Ganesan, 2021).

Types of anabolic steroids

Anabolic steroids come in several forms, including pills, injections, implanted pellets, creams, and gels.

There are many different types of anabolic steroids; even those legally used to treat medical conditions can be abused if taken inappropriately.  

Testosterone esters include testosterone enanthate, testosterone cypionate, and testosterone undecanoate―these are often used medically to treat low testosterone levels (hypogonadism). Nandrolone, another ester, was one of the first anabolic steroids to be used as a performance-enhancing drug by athletes (Ganesan, 2021). 

Other types of anabolic steroids include 17-alpha-alkylated androgens, like stanozolol (brand name Winstrol), oxandrolone (brand name Anavar), oxymetholone (brand name Anadrol), and fluoxymesterone (brand name Androxy) (Ganesan, 2021). 

Street names for these drugs include Arnolds, gym candy, pumpers, roids, and stackers.

Are anabolic steroids legal?

Anabolic steroids are not illegal drugs, but anabolic steroid abuse is illegal. 

When not used as performance-enhancing drugs, anabolic steroids have legitimate medical uses and are legal. However, the FDA does classify these medicines as schedule III drugs, similar to opiates, so you will be under close supervision from your healthcare provider when taking them. Anabolic steroids are FDA-approved for several medical uses, including (Ganesan, 2021):

  • Hormone conditions, like hypogonadism (low testosterone): If you’re diagnosed with low testosterone, your healthcare provider may prescribe testosterone replacement therapy (TRT) in the form of injections, a gel rubbed onto the skin, or a patch to wear. 
  • Delayed puberty: Providers may prescribe a course of testosterone injections for boys who haven’t gone through puberty by a certain age, providing a boost in growth and sexual maturity.
  • Conditions that lead to muscle loss, including cancer and HIV: Providers sometimes prescribe steroids to patients experiencing muscle wasting related to their illnesses.

Anabolic steroid abuse

Most sports ban anabolic steroids and other performance-enhancing drug use. 

But professional athletes are not the only ones who abuse anabolic steroids. Some people use them illegally to enhance their athletic performance or physical appearance. Athletes and bodybuilders might use steroids for a competitive advantage, even in high schools; other people may just want to look more muscular. 

A recent study showed that approximately 3 to 4 million Americans have used anabolic steroids at some point (nearly all of them men). About 20% of teenagers have also admitted to using anabolic steroids. Unfortunately, anabolic steroid abuse can have long-lasting consequences: nearly 1 million American men have become dependent on anabolic steroids, requiring higher and higher doses (Pope, 2017). 

According to the National Institute on Drug Abuse (NIDA), people abuse anabolic steroids in three common ways (NIDA, 2018):

  • Stacking: People take multiple types of steroids simultaneously, possibly mixing oral and injectable versions; some believe this will boost the steroid effects.
  • Cycling: The user takes steroids for a set time (i.e., 6 to 12 weeks), then stops for several weeks before resuming steroid use.
  • Pyramiding: Steroid users start a steroid cycle with a low dose, building to a maximum dose partway through, then tapering off the drugs by the end.
  • Plateauing: Users try to avoid developing a tolerance to the drugs by alternating, overlapping, or substituting one anabolic steroid with another.

No data supports any of these techniques, and there is no evidence that any of these can prevent you from having negative side effects.

Side effects of anabolic steroids

The use of anabolic steroids can have numerous harmful side effects, including (Ganesan, 2021):

  • Severe acne
  • Mood swings and aggression (a.k.a. “roid rage”)
  • Shrinkage of the testicles
  • High blood pressure
  • Enlarged male breasts (gynecomastia)
  • Urinary problems
  • Enlarged prostate
  • Erectile dysfunction
  • Enlargement of the clitoris
  • Menstrual cycle changes
  • Increased red blood cell count
  • Lower levels of “good” cholesterol (HDL) and higher levels of “bad” cholesterol (LDL)
  • Body hair and facial hair growth and deepening of the voice in women; baldness in men
  • Low sperm count
  • Sex drive changes

Risks of anabolic steroids

Many people who take anabolic steroids illegally order them online from overseas pharmacies, which means there’s no way of truly knowing their purity or strength. 

Additionally, using anabolic steroids can lead to a substance abuse disorder, where you have trouble stopping the drugs even if they are causing harm.

Long-term health problems from using anabolic steroids include serious medical conditions like heart disease, kidney problems, liver disease, and blood clots, potentially leading to heart attacks and strokes.

Anabolic steroid withdrawal

Withdrawal symptoms are also a risk of illegal anabolic steroid use, including depression, fatigue, decreased libido, and sexual dysfunction

Because anabolic steroids can bind to some of the same receptors as testosterone, they can make your body stop producing its own testosterone. If this keeps up long enough, it can cause that pathway to shut down, also called hypogonadism—this can last for weeks to months after stopping the steroids. 

In some people, this withdrawal hypogonadism may lead to the resumption of anabolic steroid use. Others may develop major depression or suicidal thoughts due to withdrawal symptoms (Pope, 2017).

Anabolic steroids vs. testosterone

Testosterone is technically an anabolic steroid since it has muscle-building properties. 

It treats various medical conditions like low testosterone or delayed puberty. However, when people talk about anabolic steroids, they usually mean those used inappropriately or illegally, not those prescribed by a healthcare provider. 

People who use anabolic steroids for non-medical reasons typically take amounts much higher than therapeutic doses. Also, some forms of anabolic steroids, like nandrolone, were created specifically for their performance-enhancing abilities and not to supplement people with low testosterone levels. 

Testosterone requires a prescription from your healthcare provider. So any of those products you see online without a prescription are not usually testosterone.

As you can see, it’s best not to abuse anabolic steroids. Only take them if a medical provider prescribes them and use them as directed.

References

  1. Ganesan, K., & Rahman, S., & Zito, P. M. (2021). Anabolic steroids. [Updated Nov 29, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482418/
  2. National Institute on Drug Abuse (NIDA). (2018). Anabolic steroids drug facts. Retrieved on Jan. 18, 2022 from https://www.drugabuse.gov/publications/drugfacts/anabolic-steroids 
  3. Pope, H. G., Khalsa, J. H., & Bhasin, S. (2017). Body Image Disorders and Abuse of Anabolic-Androgenic Steroids Among Men. JAMA, 317(1), 23–24. doi: 10.1001/jama.2016.17441. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27930760