The pressure to have a muscular body for men can be a driving force in misusing anabolic steroids. Learn more about why individuals may misuse steroids, and what the effects on the body and overall health can be.
Why Do People Misuse Steroids?
Anabolic steroids can increase muscle mass and decrease fat. Weightlifters, bodybuilders, and some athletes take them regularly to improve their performance and appearance. Up to half of all people who misuse steroids have muscle dysmorphia. and distorted perceptions of their physical appearance.
Who Misuses Anabolic Steroids?
About 1 million people in the United States are current or recovering anabolic steroid misusers. Every year, more than 300,000 people take these drugs. Most people who misuse anabolic steroids are men, but women can also misuse these drugs, particularly women who are athletes and under pressure to compete and maintain certain degrees of physical fitness  People who misuse steroids may also use other drugs: In one study, about half of all people who misuse steroids also took ecstasy, amphetamines, cocaine, and/or cannabis.
Only about 3% of people who misuse anabolic steroids take drugs to become more physically attractive, according to one study. Other motivating factors seem to be physical fitness or achieving performance enhancement. On the other hand, other studies suggest that up to half of people who use steroids do so to change their physical appearance that they are somehow dissatisfied with .
One study found that more than 90% of people who misuse steroids know their habits could harm their health. The majority of them don’t perform routine lab work to check on their health, and few look for signs of heart or organ problems.
Short-Term Side Effects of Steroid Misuse
Any dose of a steroid can have negative side effects. People who misuse steroids may take doses up to 100 times higher than those used in medical settings.
Hormones like testosterone are associated with secondary sex characteristics, such as breast growth. People who start misusing anabolic steroids can see the impact right away. For others, changes may take longer to develop.
Several common short-term side effects include: 
1. Skin Changes
Testosterone tends to cause worsening of acne and some other inflammatory skin conditions.
2. Sexual Characteristics Change
Taking testosterone can impact fertility. Women may stop having their periods, and men may notice their testicles shrink. Their sperm count may decrease as well.
3. Mental Health/Mood Challenges
Aggression and combativeness are common in people who misuse testosterone steroids. Some people experience an estrogen rebound between steroid cycles. Estrogen that is repressed during active steroid misuse surges, which can result in depression or anxiety or even psychosis.
Long-Term Side Effects of Steroid Misuse
Other side effects of steroid misuse over time include:
Testosterone supplementation can cause elevations in blood pressure and cardiac stress that can cause or worsen cardiovascular disease. Depending on the degree and severity of misuse, damage can potentially last even years after discontinuing steroids
Your liver processes steroids and excess doses can be toxic to these critical tissues. Long-term misuse can lead to liver injury over time. 
Some changes in sexual characteristics can be permanent with long standing use of steroids: Breast development and baldness in men, voice changes, coarse skin, and hair loss in women may be permanent.
Some steroid users use needles to inject, and they may share them with other drug users. Steroid users also tend to take other drugs and engage in risky sexual behaviors. This can put users at risk of infections and blood borne pathogens such as HIV, hepatitis B and hepatitis C.  These conditions, once contracted, may be permanent.
Individuals that use steroids at a young age prior to achieving their adult height are at risk for short stature, which can be permanent. 
Signs of Anabolic Steroid Use Disorder
People who misuse steroids present in a variety of ways, but some characteristics they might have include:
- Labile emotions: steroid use can cause mood changes and emotional lability
- Rapid gain of muscle: Muscles on the shoulders and back grow quickly with steroids, leading to quick changes in physical muscle mass
- Preoccupation with body and working out: They may spend long hours at the gym lifting weights, and they may change their eating patterns to ensure muscle gain.
Some individuals using steroids may talk openly about it, while others may keep it a secret. If you are concerned that someone you know may be using steroids, talk to them about the risks and suggest they seek help from a professional.
How Do We Treat Steroid Misuse?
It may take time and persistence to encourage a person to discontinue illicit steroid use, but it is worth it. Research on steroid addiction recovery is thin, and experts haven’t reached a consensus on what plans work best. Because steroids do not tend to cause a traditional physical dependence, there are no medications that are used to treat a use disorder. Treatments at this time are largely behavioral, and include therapy and body image counseling.
Anabolic Steroid Addiction FAQs
What are long-term side effects of steroids?
Heart problems, liver damage, sexual changes, infection, and loss of height are five long-term problems linked to steroid misuse.
Can steroids cause personality changes?
Some people who misuse steroids develop a short temper and a willingness to use violence to solve problems. Steroids can also cause depression, anxiety, and even psychosis.
How do you get rid of a steroid addiction?
Treatment programs that combine therapy and medications can help stop misusing steroids. The mainstay of treatment for steroid misuse is behavioral therapy. There are no medications used for steroid misuse at this time, however medications may be used to treat other related problems such as body dysmorphia, depression or anxiety.
How do I stop using steroids?
It’s best not to stop using steroids suddenly. Consult a physician so they can supervise a taper off the drugs if appropriate. You’ll also want to have behavioral support, and a strong social support system to encourage you as you recover.
By: Elena Hill, MD, MPH
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