What is Anabolic Steroid Use Disorder?
“Anabolic” refers to how our body uses energy to grow and manage the building up process in our bodies. Anabolic-androgenic steroids (AAS) are essentially steroids related to male sex hormones like testosterone. These can be naturally occurring hormones or artificial ones designed to act like our body’s own male hormones.
The use of these androgens has grown from being just associated with sports to being used by a much wider slice of the population, which has turned it into a significant public health issue. It’s believed that around 1% to 5% of the global population has used AAS at some point in their lives. Due to the potential for misuse of these substances, the Anabolic Steroid Control Act of 2004 changed the Controlled Substances Act to include any drug or hormone that’s chemically similar to testosterone in its definition of anabolic steroids. This includes substances like tetrahydrogestrinone (THG), androstenedione, and other related chemicals. As a result, testosterone and its similar substances are classified under the Drug Enforcement Administration’s Schedule III.
Androgens are responsible for triggering the development of male sex traits. Anabolic steroids and androgens are prescribed medically either orally or through injections to treat conditions like hormone imbalances, male impotence, delayed puberty in adolescent boys. For women, these can be used as treatments for breast cancer, endometriosis, osteoporosis, and muscle loss in people with cancer or HIV.
Unfortunately, these substances are often misused or abused, especially by athletes who use them to enhance performance and boost endurance. People outside of the athletic world also misuse anabolic steroids to increase their body weight and muscle mass without adding to their body’s fat content.
What Causes Anabolic Steroid Use Disorder?
About 3 to 4 million people in the United States have used a type of drugs known as anabolic-androgenic steroids to bulk up their muscles. They do this either to improve their athletic performance or just to look better. Those who misuse these drugs might be dealing with a condition known as muscle dysmorphia, which influences a person’s behavior around their body image.
These steroids are often used by individuals like fighters, bouncers, or security staff who want to appear physically intimidating for their jobs. Anabolic steroids are commonly referred to as “steroids”, but you might also hear them called by other names like “roids,” “juice,” “andro,” “gear,” and “stackers.”
Risk Factors and Frequency for Anabolic Steroid Use Disorder
Over the past twenty years, the misuse of anabolic androgenic steroids (AAS) has been increasing. Along with this growing trend comes a rise in health problems linked to AAS abuse. Some studies found certain populations, such as athletes, males, and weightlifters in their twenties or thirties, were more likely to misuse AAS. Among high school students, steroid misuse remains a concerning issue. Interestingly, almost half of AAS abusers who frequented fitness centers in Germany got their supply from healthcare providers. Moreover, a survey revealed that the majority of AAS users weren’t athletes or competitive bodybuilders, but rather, people who self-administered injections. However, unsafe practices like sharing and reusing needles were reported by as many as 13% of users.
- Misuse of anabolic androgenic steroids (AAS) has been on the rise for the past two decades.
- This increase has led to a rise in health problems linked to AAS abuse.
- Athletes, males, and weightlifters in their twenties or thirties have been identified as the main groups misusing these substances.
- In high schools, steroid misuse remains an issue.
- Surprisingly, almost half of AAS abusers using fitness centers in Germany received their steroids from healthcare providers.
- Most AAS users aren’t actually athletes or competitive bodybuilders but use the drugs primarily for body aesthetics.
- These users generally self-administer AAS through injections.
- Alarmingly, as many as 13% of users reported unsafe practices like sharing and reusing needles.
Signs and Symptoms of Anabolic Steroid Use Disorder
Diagnosing abuse of Anabolic Androgenic Steroids (AAS) requires a thorough medical history review and physical examination. Doctors become suspicious of AAS abuse when they see certain symptoms in patients. For different sexes and age groups, these signs vary.
- In children or teenagers, signs may include early development of secondary sexual characteristics, reduction in height, and premature closing of areas of bone growth (known as epiphyses).
- In women, symptoms can include receding hairline, excessive hair growth, acne, irregular periods, shrinking of breasts, voice deepening (which is irreversible), enlarged clitoris, reduction in overall body fat, and an increase in muscle mass.
- In men, signs of AAS abuse may show up as rapid increase in muscle mass and strength, changes like breast enlargement, small testes, low sperm count, impotence, and acne.
Testing for Anabolic Steroid Use Disorder
If a patient is involved in competitive sports or activities and shows behavioral changes such as aggression, depression, or irritability, they might be taking additional androgens (a type of hormone that supports male traits). This suspicion can be further supported by changes in their blood tests, such as low levels of luteinizing hormone (a hormone that controls the production of testosterone), high hematocrit (the proportion of red blood cells in the blood), and low sex hormone-binding globulin (a protein that transports sex hormones in the blood).
Signs such as gynecomastia (breast tissue enlargement in males) and hirsutism (excessive hair growth in women) could also suggest the use of anabolic-androgenic steroids, which are drugs that mimic the effects of testosterone in the body. If these signs are observed, further investigation may be necessary to confirm the use of these steroids.
Treatment Options for Anabolic Steroid Use Disorder
The most effective way to treat Anabolic-Androgenic Steroids (AAS) abuse, according to available research, includes stopping AAS use and dealing with any withdrawal symptoms. This could be coupled with behavioral therapy and treatments aimed at relieving symptoms. The strategy would be based on how long AAS was used, the likelihood of experiencing withdrawal symptoms, the patient’s treatment aims, and weighing the advantages and disadvantages of each treatment method.
Four main approaches to manage AAS abuse are talked about by a researcher named Anawalt. These include: stopping AAS use outright without any additional treatment; stopping AAS use and starting therapy with a drug called clomiphene; stopping AAS use and starting treatment with a drug called hCG; or swapping nonprescription AASs with prescription testosterone.
In individuals who’ve used AAS for less than one year, their testosterone levels usually return to normal within six months after stopping AAS use. But for those who have used AAS for a long time, they might experience a continued period of low testosterone. It’s important to restore hormone balance to prevent a condition called hypogonadism, which is where the body can’t produce enough testosterone.
Athletes who have been using AAS must stop its use immediately, even though they may experience withdrawal symptoms. If testosterone replacement therapy is needed to treat hypogonadism, formal permission should be granted from the relevant authorities before starting such therapies. Doctors may consider using Clomiphene or hCG therapy for men who have used high doses of AAS for an extended period.
Doctors should also consider addressing any additional mental health problems that exist alongside AAS use. Conditions like anxiety and depression could be managed with antidepressant medications and cognitive-behavioral therapy. Patients found to have conduct disorders or who are abusing other substances should also receive behavioral interventions and be referred to specialist services where necessary.
What else can Anabolic Steroid Use Disorder be?
Doctors should look into whether middle-aged men and younger males who show signs of enlarged breasts (gynecomastia), excessive hair growth (hirsutism), heart disease (coronary artery disease), and reduced function of the left side of their heart (left ventricular dysfunction) might be using substances known as anabolic-androgenic steroids.
In addition, healthcare providers should also consider whether these individuals have any other mental health problems or are struggling with substance misuse.
What to expect with Anabolic Steroid Use Disorder
Just like any substance that can become addictive, suddenly stopping the use of Anabolic-Androgenic Steroids (AAS) can lead to withdrawal symptoms. These symptoms can typically include feelings of anxiety and depression.
Other symptoms that a person might experience include tiredness, difficulties with sleeping, loss of appetite, less interest in sex, and strong cravings for steroids. One of the most serious withdrawal symptoms is depression, which could lead to thoughts about suicide and even suicide attempts.
Research has shown that individuals who misuse steroids might even start to use other illegal drugs to help deal with side effects like depression, anxiety, irritability, and sleeplessness.
Possible Complications When Diagnosed with Anabolic Steroid Use Disorder
Using androgens can lead to complications like heart enlargement, lower levels of ‘good’ HDL cholesterol in the blood, hormone imbalance after stopping the use of androgens, and mental health issues. Research shows that when people use androgens not for treatment purposes, they tend to show a rise in risky and illegal behaviors.
A study of 10,000 to 15,000 university students found that those who were using androgens were much more likely to drive under the influence, smoke cigarettes, use illegal drugs, and misuse alcohol.
Anabolic steroids, a type of androgen, are entirely banned in athletic competitions, both in-competition and out-of-competition. This ban is enforced by multiple organizations such as:
- The National Collegiate Athletic Association (NCAA)
- The International Olympic Committee (IOC)
- The U.S. Anti-Doping Agency (USADA)
- The World Anti-Doping Agency (WAD)
Preventing Anabolic Steroid Use Disorder
Using anabolic steroids when they are not medically necessary can lead to serious, long-term side effects. If healthcare professionals think their patients might be misusing these drugs, they should be on alert. It’s also important to educate patients about the potential risks if they are using these steroids for medical treatment. If misuse is identified early, the patient can be referred for treatment. This is extremely important to prevent further damage to the patient’s health.