Steroid Misuse

Steroid hormones have different physiological effects based on the receptors that they bind to and activate. For example, exogenously-administered corticosteroids such as prednisone or hydrocortisone can be variably used to treat inflammatory conditions such as asthma and allergic skin reactions, as well as autoimmune conditions like rheumatoid arthritis.1

However, within the realm of addiction medicine, the concept of steroids most commonly applies to another group of steroid hormones—the anabolic-androgenic steroids. While there are several therapeutic uses for these types of steroids as well, unlike the corticosteroids, this class of hormone is also associated with sometimes-compulsive, non-medical use.2

Mimicking the effects of male sex hormones—in particular testosterone—anabolic steroids may be misused by athletes in an attempt to “bulk up” or improve performance. As controlled substances, in these instances, they are often obtained illegally.1,2

How Are Steroids Abused?

Various anabolic steroid agents may be ingested orally, via intramuscular injection, or as gels or creams applied to the skin.3,4 Due to more rapid clearance, some people may prefer oral routes when drug testing is a concern, though many ultimately progress to injectable routes due to the potential for relatively less liver toxicity than oral forms.4

Doses when abused are usually much higher than doses given as medical treatments—such supratherapeutic doses are sometimes even 100 times greater than a prescribed dose.Patterns of non-medical steroid misuse include cycling, stacking, pyramiding, and plateauing.2,5

According to the National Institute on Mental Health, practices such as these—which may include combining, overlapping, and substituting different steroids, as well as punctuating periods of gradually increased doses with no steroids at all—are done to maximize the perceived benefits while decreasing the chances for tolerance and certain adverse effects.5

These complicated patterns of use commonly take place over 6- to 12-week cycles, though there is no evidence that any reduction in medical harm is achieved by using steroids in this manner.2,5

Types of Anabolic Steroids

As far back as the 1940s, some weightlifters had already tapped into the muscle building effects of pharmaceutical testosterone. In the years to follow, several different testosterone-related compounds were synthesized, resulting in a long list of substances that, depending on the individual compound, were relatively longer-acting, more potent, more active in oral form, less converted to estrogen, and less detectable compared to testosterone.2

Examples of some of the more commonly used anabolic steroids include:

  • Winstrol (stanozolol) – Widely-counterfeited oral compound with modest anabolic effects and weak androgenic effects. Commonly stacked with other steroids.
  • Anadrol (oxymetholone) – One of the most powerful anabolic and androgenic steroids on the market.
  • Primobolan (methenolone acetate) – Relatively mild anabolic agent available in various formulations for oral, injection, or transdermal use.
  • Deca-Durabolin (nandrolone decanoate).