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The generic term steroids refers to a group of substances sharing a common basic chemical structure, many of which function as hormones in the human body. The two best-known classes of human steroid hormones are corticosteroids and anabolic-androgenic steroids. Corticosteroids are hormones secreted by the adrenal gland, such as corti-sol, which modulate a range of physiologic functions, such as inflammatory responses and blood pressure. Many synthetic corticosteroids have been developed, such as hydrocortisone, beclomethasone, and dexamethasone; these synthetic substances have effects similar to those of naturally occurring corticosteroids and are widely prescribed in medicine for a range of conditions. For example, hydrocortisone is often a component of skin creams used to treat poison ivy reactions or other inflammatory skin conditions; beclomethasone is a common component of inhalers used in the treatment of asthma; and high doses of corticosteroids are administered to recipients of organ transplants to prevent rejection of the foreign tissue. In low dosages, corticosteroids have few psychiatric effects, but higher doses may sometimes cause manic symptoms (e.g., euphoria, hyperactivity, increased self-confidence, and impaired judgment) or even psychotic symptoms (e.g., delusions or hallucinations) in some predisposed individuals. Corticosteroids have very little potential for abuse and are rarely ingested by illicit substance abusers.

Anabolic-androgenic steroids represent an entirely different class of hormones. The prototype hormone of this class is the male hormone testosterone, which is secreted primarily by the testes in males. Anabolic-androgenic steroids produce masculinizing (androgenic) effects—such as beard growth, male pattern baldness, and male sexual characteristics—together with muscle-building (anabolic) effects. These latter effects account for the greater muscle mass and lower body fat of men as compared to women. Many synthetic anabolic-androgenic steroids have been developed over the last fifty years. Like testosterone, these synthetic substances produce both anabolic and androgenic effects; there are no purely anabolic or purely androgenic compounds. In medical practice, the principal use of testosterone is in the treatment of hypo-gonadal men—men who do not secrete sufficient testosterone in their own bodies, and who therefore require testosterone supplementation to maintain normal masculine characteristics. Aside from this application, anabolic-androgenic steroids have only very limited medical uses, such as in the treatment of certain forms of anemia.

Unlike corticosteroids, anabolic-androgenic steroids are widely abused by individuals wishing to gain muscle and lose body fat. The great majority of these illicit users are male; women generally do not abuse anabolic-andro-genic steroids because of the drugs’ undesirable masculinizing characteristics, such as beard growth, deepening of the voice, and shrinkage of the breasts. Men generally do not have to worry about these masculinizing effects and therefore may take doses far in excess of the amounts naturally present in the body. Specifically, an average man secretes between 50 and 75 milligrams of testosterone per week in his testes, whereas illicit anabolic-androgenic steroid abusers often ingest the equivalent of 500 to 1,000 milligrams of testosterone per week. When taken in these very high doses, anabolic-androgenic steroids can produce dramatic increases in muscle mass and strength, making it possible for users to far exceed the upper limits of muscularity attainable under natural conditions, without these drugs. Because of these properties, anabolic-androgenic steroids are widely used by athletes in sports requiring strength or muscle mass for feats such as hitting home runs in baseball or playing line positions in American football. In the United States there have been many recent well-publicized cases of prominent professional athletes who were found to be taking anabolic-androgenic steroids, and this issue became a subject of several congressional hearings in 2005. In addition, anabolic-androgenic steroids are increasingly abused by boys and young men who have no particular athletic aspirations, but who simply want to look more muscular. This pattern of abuse is particularly prevalent in North America, Australia, and some European countries—cultures where muscularity is sometimes portrayed as a measure of masculinity. By contrast, anabolic-androgenic steroids are rarely abused for purposes of body image in Asia, probably because Asian cultural traditions do not emphasize muscularity as an index of masculinity. However, anabolic-androgenic steroids are certainly used by some Asian athletes, especially at the elite level because these individuals are seeking a performance advantage, rather than a body-image effect.

In Europe and North America illicit anabolic-androgenic steroid use represents a significant and probably growing public health problem. Taken in massive doses, these hormones may pose long-term medical risks, especially because of their adverse effects on cholesterol levels, which may greatly increase the risk of heart attacks or strokes at an early age (sometimes in the forties or fifties). In addition, high doses of anabolic-androgenic steroids may have psychiatric effects such as irritability, aggressiveness, and even violent behavior (sometimes popularly called “roid rage”) in some individuals. Thus, these drugs may pose a danger not only to users themselves, but even to some nonusers—particularly women—who may become victims of such violence. Men who use anabolic-androgenic steroids for long periods may also suffer depressive symptoms, sometimes accompanied by suicidal thoughts or even successful suicide, if they abruptly stop these drugs. Despite these risks, however, it appears unlikely that illicit anabolic-androgenic steroid use will decline in the near future because these drugs are readily available on the black market and offer a great temptation to men seeking muscle and strength gains.

Bibliography:

Kanayama, Gen, Harrison G. Pope Jr., Geoffrey Cohane, and James I. Hudson. 2003. Risk Factors for Anabolic-Androgenic Steroid Use among Weightlifters: A Case-Control Study. Drug Alcohol Dependence 71 (1): 77–86.
Pope, Harrison G., Jr., and Kirk J. Brower. 2005. Anabolic-Androgenic Steroid Abuse. In Comprehensive Textbook of Psychiatry, vol. 3, eds. Benjamin J. Sadock and Virginia A. Sadock, 1318–1328. Philadelphia: Lippincott Williams and Wilkins.
Yesalis, Charles E., ed. 2000. Anabolic Steroids in Sport and Exercise. 2nd ed. Champaign, IL: Human Kinetics.