Steroid misuse or abuse

Steroids are a specific group of hormones that are needed for normal body function. There are different types of steroids that act in different parts of our bodies.  

The steroids that people use for enhancing their physical performance or appearance are versions of testosterone (the main sex hormone in males) and are called ‘androgenic steroids’. They are sometimes also referred to as ‘anabolic steroids’ or ‘anabolic-androgenic steroids’.

The use of testosterone for the enhancement of physical performance or appearance is different to when used as a medical treatment for testosterone deficiency.

Sometimes people refer to ‘steroids’ when using corticosteroids. This is a different type of steroid and has a different function, and can be used in treating asthma, eczema, autoimmune disease and more.

Steroid misuse is when you use steroids (testosterone or other similar hormones or drugs) without a valid medical reason, including:

• Infertility
• Sexual dysfunction without proven androgen deficiency
• A low testosterone level associated with chronic disease (e.g. obesity, diabetes)
• Non-specific symptoms like tiredness or low mood
• Age

Steroid abuse is when you use steroids without any medical need, including:

• Increasing physical performance (e.g. increased strength or endurance)
• Altering your physical appearance (e.g. increased muscle mass)
• Work (e.g. military, police, security)

Steroid misuse usually involves off-label prescription of pharmaceutical products and use of normal clinical dosing, whereas steroid abuse often involves illicitly sourced products of questionable quality taken at excessively high doses and in combination with other substances.

The myth that men’s testosterone levels naturally fall with age has led to the misuse of steroids in the hope of an unproven rejuvenating effect in middle-aged and older men. There is no evidence that steroid misuse is safe and evidence of limited benefits is only available for men aged over 65 years with health problems.

Somewhere between 1% and 5% of people are believed to abuse steroids in their lifetime, with the rate about 50 times higher for males than females. Steroid abuse begins most commonly in males aged in their early 20s, whereas misuse is most predominant in middle-aged males. A large proportion of people who misuse or abuse androgens appear to develop steroid dependence.

Physical signs of steroid abuse in males:

• Rapid weight gain (approx. 10 kg in two to three months)
• Muscular physique (disproportionate muscle growth around chest, neck and shoulders)
• Severe acne (mainly on the back, shoulders and chest)
• Stretch marks (usually between biceps and pectoral muscles, possibly back and thighs)
• Excess body hair and/or accelerated baldness
• High blood pressure
• Injection site swelling, tenderness and/or redness
• Tendon and muscle tears
• Abnormal blood lipids
• Abnormal liver function
• Gynaecomastia
• Erectile dysfunction
• Male infertility
• Testicular atrophy (shrinkage of the testes)

Psychological signs of steroid abuse:

• Aggression
• Impulsivity
• Altered sex drive
• Anxiety
• Dysphoria
• Depression
• Empathy disorder
• Jealousy
• Muscle dysmorphia
• Mood instability
• Panic attack
• Psychosis
• Reduced mentalising capacity (problems with thinking)
• Sleep disorders
• Suicidal ideation
• Suicide attempt
• Violence
• Worry

Brain and behaviour

• Getting annoyed or agitated easily
• Feeling anxious or on edge
• Acting in a confrontational or hostile way
• Behaving without thinking about the consequences
• Self-harm
• Needing steroids to function normally
• Depression
• Suicidal thoughts
• Withdrawal syndrome

Blood and circulation

• Too many red blood cells in the circulation
• Abnormal blood cholesterol levels
• Narrowing or blockage of blood vessels supplying the heart muscle
• Heart attack
• High blood pressure
• Irregular or abnormal heart rhythm
• Abnormal thickening of the heart muscle
• Abnormal enlargement and weakening of the heart chambers
• Reduced ability of the heart to pump blood
• Sudden heart failure

Liver

• Reduced or blocked flow of bile
• High levels of bilirubin (a breakdown product of red blood cells) in the blood
• Buildup of fat in liver cells
• Blood-filled cysts in the liver
• Non-cancerous growths in the liver
• Liver cancer
• Unconsciousness caused by severely poor liver function

Skin

• Acne
• Stretch marks
• Excessive sweating
• Hair loss from the head
• Excessive growth of body hair
• Infection or inflammation of injection sites

Kidneys

• High levels of metabolic waste products (e.g. creatinine) in the blood
• Kidney damage caused by the buildup of bile
• Scarring of small parts of the kidneys where blood is filtered
• Kidney failure

Reproductive system

• Shrinking of the testes
• Low sperm production
• Infertility
• Low sex drive
• Erectile dysfunction
• Growth of breast tissue
• Impaired function of the testes

Misuse or abuse of steroids reduces the body’s own production of testosterone due to its negative feedback system. When you stop steroid misuse or abuse, it takes your body weeks to months to get back to making its own testosterone.

Steroid abusers show signs of addiction, like withdrawal, cravings and loss of control. Psychological dependence on steroids and the effects of withdrawal (headache, tiredness, nausea, muscle pain, restlessness, poor sleep, low mood, low sex drive, body dysmorphia and suicidal thoughts) make it difficult to stop steroid abuse. The same scenario occurs with androgen misuse.

Steroid dependence makes it difficult to stop misusing or abusing steroids, but stopping is necessary if you want to have children or if you develop health problems caused by abuse or misuse.

Methods described online for ‘post-cycle therapy’ or to ‘restart’ testosterone production are not proven to be safe or to work, and are not based on scientific evidence.

You should visit a doctor to discuss the best way for you to stop steroid abuse or misuse.