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#REDIRECT [[Anabolic steroid]]
{{Merge to|Anabolic steroid|discuss=Talk:Anabolic steroid#Proposed merge of Anabolic-androgenic steroids abuse into Anabolic steroid|date=August 2023}}
[[File:Rational harm assessment of drugs radar plot.svg|thumb|Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in [[Delphi method|delphic analysis]] regarding 20 popular recreational drugs. Anabolic steroids were ranked 19th in dependence, 9th in physical harm, and 15th in social harm.<ref>{{cite journal | vauthors = Nutt D, King LA, Saulsbury W, Blakemore C | title = Development of a rational scale to assess the harm of drugs of potential misuse | journal = Lancet | volume = 369 | issue = 9566 | pages = 1047–1053 | date = March 2007 | pmid = 17382831 | doi = 10.1016/s0140-6736(07)60464-4 | s2cid = 5903121 }}</ref>]]
Research data indicates that steroids affect the serotonin and dopamine neurotransmitter systems of the brain.<ref>{{Cite web |url=http://www.dopinglinkki.fi/doping-substances/anabolic-steroids-induce-long-term-changes-in-the-brain |title=Dopinglinkki > Anabolic steroids induce long-term changes in the brain<!-- Bot generated title --> |access-date=2015-07-12 |archive-date=2013-12-03 |archive-url=https://web.archive.org/web/20131203091547/http://www.dopinglinkki.fi/doping-substances/anabolic-steroids-induce-long-term-changes-in-the-brain |url-status=dead }}</ref> In an animal study, male rats developed a [[conditioned place preference]] to testosterone injections into the [[nucleus accumbens]], an effect blocked by [[dopamine antagonist]]s, which suggests that androgen reinforcement is mediated by the brain. Moreover, testosterone appears to act through the [[Mesolimbic pathway|mesolimbic dopamine system]], a common substrate for addictive substances. Nonetheless, androgen reinforcement is not comparable to that of [[cocaine]], [[nicotine]], or [[heroin]]. Instead, [[testosterone]] resembles other mild reinforcers, such as [[caffeine]], or [[benzodiazepine]]s. The potential for androgen addiction remains to be determined.<ref name="pmid15488545">{{cite journal | vauthors = Wood RI | title = Reinforcing aspects of androgens | journal = Physiology & Behavior | volume = 83 | issue = 2 | pages = 279–289 | date = November 2004 | pmid = 15488545 | doi = 10.1016/j.physbeh.2004.08.012 | s2cid = 1027142 }}</ref>

[[Anabolic steroid]]s are not psychoactive{{cite needed|date=December 2021}} and cannot be detected by stimuli devices like a [[pupilometer]] which makes them hard to spot as a source of neuropsychological imbalances in some AAS users.


==Prevalence==

Early studies of illicit use of [[anabolic-androgenic steroids]] conducted in the 1970s-2000's, using questionnaires and police reports, were likely subject to underestimate bias.<ref>1. Prevalence of Doping Use in Elite Sports: A Review of Numbers and Methods. 2015. Sports Med. 45/1, 57-69. O. De Hon, H. Kuipers, M. Van Bottenburg. doi: 10.1007/s40279-014-0247-x.
2. Recreational Athletes' Use of Performance-Enhancing Substances: Results from the First European Randomized Response Technique Survey. 2023. Sports Med-Open. 9/1, 17. A.V. Christiansen, M. Frenger, A. Chirico, W. Pitsch. doi: 10.1186/s40798-022-00548-2.
3. Wastewater-based tracing of doping use by the general population and amateur athletes. 2018. Anal Bioanal Chem. 410/6, 1793-803. A. Causanilles, V. Nordmann, D. Vughs, E. Emke, O. De Hon, F. Hernandez, et al. doi: 10.1007/s00216-017-0835-3.
</ref> Nevertheless, some studies in 2000’s reported, that 5-10 % of male students in USA and Australia took anabolic steroids for athletic and cosmetic reasons.<ref>Consumption of anabolic steroids in sport, physical activity and as a drug of abuse: an analysis of the scientific literature and areas of research. 2008. Br J Sports Med. 42/2, 103-9. V. Agullo-Calatayud, G. Gonzalez-Alcaide, J.C. Valderrama-Zurian, R. Aleixandre-Benavent. doi: 10.1136/bjsm.2007.036228.</ref>

More studies of anabolic steroid use were reported after 2010. Several meta-reviews published in 2014 and 2015 concluded, that overall use (unspecified frequency) of anabolic steroids was ca. 6.4% for men and 1.6% for women.<ref>The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. 2014. Ann Epidemiol. 24/5, 383-98. D. Sagoe, H. Molde, C.S. Andreassen, T. Torsheim, S. Pallesen. doi: 10.1016/j.annepidem.2014.01.009.</ref> The highest rate was reported for men in the Middle East (21.7 %) followed by South America (4.8%), Europe (3.8%), North America (3.0%), Oceania (2.6%), Africa (2.4%) and Asia (0.2%). The three largest categories of men by motivation were recreational sportsmen (18 %), competitive athletes (13 %) and prisoners (12 %).

The prevalence of steroid use among prison inmates according to questionnaires was 3.7% in Finland in 1998,<ref>Drug abuse of Finnish male prisoners in 1995. 1998. Forensic SciInt. 97/2-3, 171-83. T. Korte, J. Pykalainen, T. Seppala. doi: 10.1016/s0379-0738(98)00159-5.</ref> 25 % in Sweden in 2010,<ref>The significance of anabolic androgenic steroids in a Swedish prison population. 2010. Compr Psychiat. 51/3, 312-8. F. Klotz, A. Petersson, O. Hoffman, I. Thiblin. doi: 10.1016/j.comppsych.2009.05.007.</ref> 7.5% for Norway for current use and 33% for former use in 2021.<ref>A Mixed-Method Evaluation of a Prison Anti-doping Intervention: The Hercules Prison Program. 2021. Front Sports Act Living. 3/14. D. Sagoe, B. Johnsen, B. Lindblad, T.a.J. Normann, V. Skogvoll, M. Heierdal, et al. doi: 10.3389/fspor.2021.779218.</ref> In contrast, a 2021 Belgian study reported, that anabolic steroids comprise “a marginal share in the consumption of all drugs” in country’s prisons.<ref>I push therefore I am: the role of bodybuilding and performance products in prison. 2021. Deviance Soc. 45/2, 231-63. B. Fincoeur, J. Rullo. doi: 10.3917/ds.452.0231.</ref>

Several analyses of news reporting anabolic steroid busts, sales and use in [[Valencia]], Spain published in 2014-2019 concluded, that the use of these substances goes beyond bodybuilders and elite athletes, but also encompasses members of armed forces, security guards, affiliates of extreme right parties and porn actors.<ref>Beyond elite sports: Analysis of the coverage of anabolic steroids in the Spanish press (2007-2011). 2014. Catal J Commun Cultur Studies. 6/2, 197-220. V.A. Calatayud, R.C.I. Cogollos, J.C.V. Zurian. doi: 10.1386/cjcs.6.2.197_1.</ref> More recent questionnaire studies report 2-5 % prevalence rate of occasional steroid use among men in Europe, Australia and Americas.<ref>The epidemiology of anabolic-androgenic steroids use among secondary students (Valencia-Spain). 2019. Health and Addictions/Salud y Drogas. 19/2, 1-7. V.A. Calatayud, T.S. Gras, J.A. Serrano, S.T. Dols. doi: 10.21134/haaj.v19i2.423.</ref> These numbers, however, are lower than those of cannabis ( ca 65%), cocaine (ca. 24%), LSD (14%) and heroin (4%). Notably, ''securing an athletic scholarship in college'' was among motivations for teenage steroid users in the USA.<ref>An Analysis of Steroid Use among High School Athletes. 2008. Department of Public Policy and Administration, School of Business and Public Administration. MASTER OF PUBLIC ADMINISTRATION/. J. Mack.</ref>

With advancements in [[analytic chemistry]] methods (see [[Liquid chromatography–mass spectrometry]]) by mid-2000’s it became possible to directly measure traces of various drugs and of their metabolites and conjugates in sewage.<ref>13. Temporal variability of pharmaceuticals and illicit drugs in wastewater and the effects of a major sporting event. 2011. Water Res. 45/17, 5399-411. D. Gerrity, R.A. Trenholm, S.A. Snyder. doi: 10.1016/j.watres.2011.07.020.
14. LC-MS-MS Method Development and Analysis of Stimulants, Opiates, Synthetic Opiates, PCP, and Benzodiazepines in Wastewater. Preponderance of these Drugs During Football Games. 2018. Analysis of Drugs of Abuse. 1810/149-82. W. Gul, S.W. Gul, B. Stamper, M. Godfrey, M.A. Elsohly. doi: 10.1007/978-1-4939-8579-1_15.
15. Mass Spectrometry in Wastewater-Based Epidemiology for the Determination of Small and Large Molecules as Biomarkers of Exposure: Toward a Global View of Environment and Human Health under the COVID-19 Outbreak. 2021. ACS Omega. 6/46, 30865-72. Y. Pico, D. Barcelo. doi: 10.1021/acsomega.1c04362.
16. Performance- and image-enhancing drug use in the community: use prevalence, user demographics and the potential role of wastewater-based epidemiology. 2021. J Hazard Mater. 419/12. K.M. Shimko, T. Piatkowski, K.V. Thomas, N. Speers, L. Brooker, B.J. Tscharke, et al. doi: 10.1016/j.jhazmat.2021.126340.
17. Steroid hormones in wastewater: Sources, treatments, environmental risks, and regulations. 2023. Emerging Contaminants. 9/2, 100210-. B. Almazrouei, D. Islayem, F. Alskafi, M.K. Catacutan, R. Amna, S. Nasrat, et al. doi: 10.1016/j.emcon.2023.100210.
18. Detection of emerging patterns of drug misuse in sports via wastewater monitoring: A mini-review and potential strategies. 2023. Environmental pollution (Barking, Essex : 1987). 333/122087-. W.C.-W. Chang, M.-C. Hsu, P.-C. Liao. doi: 10.1016/j.envpol.2023.122087.
</ref> In order to reduce the contributions from naturally present products (e.g. from [[testosterone]]), most reliable data are those for synthetic steroids with unique metabolites, such as [[nandrolone]]. Also, the effects from steroid use in animal farming were reduced by focusing on urban wastewater samples. Nevertheless, the number of such studies remains small as of 2023, and there is still no comprehensive spatio-temporal data in the open literature.<ref>In-Sample Stability of 52 Performance- and Image-Enhancing Drug Biomarkers in Wastewater. 2023. ACS ES&T Wat. 3/3, 669-78. K.M. Shimko, J.W. O'brien, X.L. Lin, B.J. Tscharke, K.V. Thomas. doi: 10.1021/acsestwater.2c00393.</ref> Most published studies are limited to single localities and to samples collected for a period of one month or less. Despite these shortcomings, it has been demonstrated, that certain sporting events result in a temporal increase in performance-enhancing and recreational drugs as well as of their metabolites in sewage.

Examples are:

2010 German study of sewage samples from fitness centers in Aachen found an order of magnitude diurnal variability of [[boldenone]] and a smaller variation in [[methyltestosterone]]. <ref>Anabolic, doping, and lifestyle drugs, and selected metabolites in wastewater-detection, quantification, and behaviour monitored by high-resolution MS and MS (n) before and after sewage treatment. 2010. Anal Bioanal Chem. 398/3, 1207-29. H.F. Schroder, W. Gebhardt, M. Thevis. doi: 10.1007/s00216-010-3958-3.</ref>

A 2018 Dutch-Spanish study<ref>Wastewater-based tracing of doping use by the general population and amateur athletes. 2018. Anal Bioanal Chem. 410/6, 1793-803. A. Causanilles, V. Nordmann, D. Vughs, E. Emke, O. De Hon, F. Hernandez, et al. doi: 10.1007/s00216-017-0835-3.</ref> of small town sewage during two bodybuilding competitions without anti-doping control found substantial rise in [[2,4-dinitrophenol]] (weight loss medication) concentration as well as an occasional appearance of [[methandienone]] and [[nandrolone]].

2018 study by the [[University of Mississippi]] found a substantial increase in [[amphetamine]], [[benzoylecgonine]] (the main metabolite of [[cocaine]]) and [[oxazepam]] in the campus sewage on weekends, when the [[Ole Miss Rebel]] football team held home games.<ref>LC-MS-MS Method Development and Analysis of Stimulants, Opiates, Synthetic Opiates, PCP, and Benzodiazepines in Wastewater. Preponderance of these Drugs During Football Games. 2018. Analysis of Drugs of Abuse. 1810/149-82. W. Gul, S.W. Gul, B. Stamper, M. Godfrey, M.A. Elsohly. doi: 10.1007/978-1-4939-8579-1_15.</ref> Steroids were not investigated in this study.

Several waste-water epidemiologic studies have been reported by the [[University of Queensland]] (Australia) since 2017.
<ref>Performance- and image-enhancing drug use in the community: use prevalence, user demographics and the potential role of wastewater-based epidemiology. 2021. J Hazard Mater. 419/12. K.M. Shimko, T. Piatkowski, K.V. Thomas, N. Speers, L. Brooker, B.J. Tscharke, et al. doi: 10.1016/j.jhazmat.2021.126340.
In-Sample Stability of 52 Performance- and Image-Enhancing Drug Biomarkers in Wastewater. 2023. ACS ES&T Wat. 3/3, 669-78. K.M. Shimko, J.W. O'brien, X.L. Lin, B.J. Tscharke, K.V. Thomas. doi: 10.1021/acsestwater.2c00393.
21. Can wastewater-based epidemiology be used for the assessment of anabolic steroid use? 2017. 2nd Queensland Mass Spectrometry Symposium 2017. K.M. Shimko, J.W. O'brien, H. Kayalar, P.M. Choi, H. Jiang, B.J. Tscharke, et al.
22. A pilot wastewater-based epidemiology assessment of anabolic steroid use in Queensland, Australia. 2019. Drug Test Anal. 11/7, 937-49. K.M. Shimko, J.W. O'brien, L. Barron, H. Kayalar, J.F. Mueller, B. Tscharke, et al. doi: 10.1002/dta.2591.
23. In-Sewer Stability Assessment of Anabolic Steroids and Selective Androgen Receptor Modulators. 2022. Environ Sci Technol. 56/3, 1627-38. K.M. Shimko, J.W. O'brien, J.Y. Li, B.J. Tscharke, L. Brooker, P.K. Thai, et al. doi: 10.1021/acs.est.1c03047.
24. Prevalence and emergence of steroidal and non-steroidal anabolic agents in the Australian community measured through wastewater analysis. 2022. Toxicol Anal Clin. 34/3, S22-S3. K.M. Shimko, J.W. O'brien, B.J. Tscharke, L. Brooker, C. Goebel, R. Shiels, et al. doi: 10.1016/j.toxac.2022.06.010.
</ref> In their earlier work the researchers did not find an increase in steroid metabolites or in testosterone/epitestosterone ratio in sewage during a bodybuilding competition in town.<ref>A pilot wastewater-based epidemiology assessment of anabolic steroid use in Queensland, Australia. 2019. Drug Test Anal. 11/7, 937-49. K.M. Shimko, J.W. O'brien, L. Barron, H. Kayalar, J.F. Mueller, B. Tscharke, et al. doi: 10.1002/dta.2591.</ref> It is likely, that these results were flawed, because they did not account for [[bioconjugation]] of the metabolites.<ref>In-Sample Stability of 52 Performance- and Image-Enhancing Drug Biomarkers in Wastewater. 2023. ACS ES&T Wat. 3/3, 669-78. K.M. Shimko, J.W. O'brien, X.L. Lin, B.J. Tscharke, K.V. Thomas. doi: 10.1021/acsestwater.2c00393.</ref> <ref>In-Sewer Stability Assessment of Anabolic Steroids and Selective Androgen Receptor Modulators. 2022. Environ Sci Technol. 56/3, 1627-38. K.M. Shimko, J.W. O'brien, J.Y. Li, B.J. Tscharke, L. Brooker, P.K. Thai, et al. doi: 10.1021/acs.est.1c03047.</ref> Interestingly, since 2011 the Australian group has observed increasing levels of [[selective androgen receptor modulators]]- a class of investigational non-steroidal anabolics, which has not been approved for medical use.<ref>Prevalence and emergence of steroidal and non-steroidal anabolic agents in the Australian community measured through wastewater analysis. 2022. Toxicol Anal Clin. 34/3, S22-S3. K.M. Shimko, J.W. O'brien, B.J. Tscharke, L. Brooker, C. Goebel, R. Shiels, et al. doi: 10.1016/j.toxac.2022.06.010.</ref>

A 2023 study from [[Guangzhou University]] (PR China)<ref>Assessment of the excretion of oxidative stress biomarkers and anabolic steroids based on sewage: A case study of college students and the general population. 2023. Sci Total Environ. 878/9. Z.H. Gao, H. Sun, Y.F. Xie, Y. Ren. doi: 10.1016/j.scitotenv.2023.163079.</ref> found a 9±1-fold spike in [[boldenone]] in the university campus sewage during a 2-week athletic event and smaller increases in [[methandienone]], [[testosterone]] and [[androstenedione]].

==Dependence potential==
The [[Diagnostic and Statistical Manual of Mental Disorders|Diagnostic Statistical Manual IV]] (DSM IV) and the [[International Classification of Diseases]], Volume 10 (ICD-10) differ in the way they regard Anabolic-Androgenic Steroids' (AAS) potential for producing dependence.

DSM IV regards AAS as potentially dependence producing. ICD-10, however, regards them as non-dependence producing.<ref>{{cite journal |vauthors=Midgley SJ, Heather N, Davies JB | title = Dependence-Producing Potential of Anabolic-Androgenic Steroids | journal = Addiction Research & Theory | year = 1999 | volume = 7 | issue = 6 | pages = 539–550 | doi = 10.3109/16066359909004404 }}</ref> Anabolic steroids are not physically addictive but users can develop a psychological dependence on the physical result.<ref>{{cite web |url=http://www.mensfitness.co.uk/nutrition/supplements/1100/price-steroids |title=The price of steroids &#124; Men's Fitness UK |publisher=Mensfitness.co.uk |date=2008-09-03 |access-date=2013-12-01 |archive-date=2015-09-19 |archive-url=https://web.archive.org/web/20150919174152/http://www.mensfitness.co.uk/nutrition/supplements/1100/price-steroids |url-status=dead }}</ref>

===Diagnostic Statistical Manual===
For DSM-IV, anabolic-androgenic steroid dependency is found in the "other substance-related disorder" (which includes inhalants, anabolic steroids, medications) section and can be coded, depending on which diagnostic criteria are met.<ref name="psychiatryonline.org">{{cite journal | vauthors = Scally MC, Tan RS | title = Complexities in clarifying the diagnostic criteria for anabolic-androgenic steroid dependence | journal = The American Journal of Psychiatry | volume = 166 | issue = 10 | pages = 1187; author reply 1188 | date = October 2009 | pmid = 19797448 | doi = 10.1176/appi.ajp.2009.09060846 | s2cid = 42080262 }}</ref>

=== International Classification of Diseases ===
ICD–10 criteria for dependence include experience of at least three of the following during the past year:<ref name="Rashid et al 2007">{{cite journal |doi=10.1192/apt.bp.105.000935 |title=Anabolic androgenic steroids: What the psychiatrist needs to know |year=2007 |vauthors=Rashid H, Ormerod S, Day E |journal=Advances in Psychiatric Treatment |volume=13 |issue=3 |pages=203–211|doi-access=free }}</ref>
* a strong desire to take steroids
* difficulty in controlling the use
* withdrawal syndrome when use is reduced
* evidence of tolerance
* neglect of other interests and persistent use despite harmful consequences

However, the following ICD-10-CM Index entries contain back-references to ICD-10-CM F55.3:<ref>{{cite web|url=http://www.icd10data.com/ICD10CM/Codes/F01-F99/F50-F59/F55-/F55.3 |title=2014 ICD-10-CM Diagnosis Code F55.3 : Abuse of steroids or hormones |publisher=Icd10data.com |access-date=2013-12-01}}</ref>
*Abuse
**hormones F55.5
**steroids F55.5
**drug NEC (non-dependent) F19.10
***hormones F55.5
***steroids F55.5
**non-psychoactive substance NEC F55.8
***hormones F55.5
***steroids F55.5

ICD-10 goes on to state that "although it is usually clear that the patient has a strong motivation to take the substance, there is no development of dependence or withdrawal symptoms as in the case of the psychoactive substances."<ref name="psychiatryonline.org"/>

===National Institute on Drug Abuse===
The [[National Institute on Drug Abuse]] (NIDA) says that "even though anabolic steroids do not cause the same high as other drugs, steroids are reinforcing and can lead to addiction. Studies have shown that animals will self-administer steroids when given the opportunity, just as they do with other addictive drugs. People may persist in abusing steroids despite physical problems and negative effects on social relationships, reflecting these drugs' addictive potential. Also, people who use anabolic steroids typically spend large amounts of time and money obtaining the drug; another indication of addiction. Individuals who use anabolic steroids can experience withdrawal symptoms when they stop taking them, including mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued use. One of the most dangerous withdrawal symptoms is depression. When depression is persistent, it can sometimes lead to suicidal thoughts. Research has found that some people who use anabolic steroids turn to other substances such as opioids to counteract the negative effects of steroids."<ref>{{cite web|url=http://www.drugabuse.gov/publications/drugfacts/anabolic-steroids |title=DrugFacts: Anabolic Steroids &#124; National Institute on Drug Abuse |publisher=Drugabuse.gov |access-date=2013-12-01}}</ref>

==Causes and treatment==
Males who use anabolic androgenic steroids often have a troubled social background.<ref name="pmid17615062">{{cite journal | vauthors = Skarberg K, Engstrom I | title = Troubled social background of male anabolic-androgenic steroid abusers in treatment | journal = Substance Abuse Treatment, Prevention, and Policy | volume = 2 | pages = 20 | date = July 2007 | pmid = 17615062 | pmc = 1995193 | doi = 10.1186/1747-597X-2-20 }}</ref>

===Childhood trauma===
25% of male weightlifters reported memories of childhood physical or sexual abuse in an interview.{{Citation needed|date=May 2020}} Anabolic steroids are sometimes used by people with [[muscle dysmorphia]] (a specific type of [[body dysmorphic disorder]] (BDD)) as a defense mechanism.<ref>{{cite web |url=http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse/why-do-people-abuse-anabolic-steroids |title=Why do people abuse anabolic steroids? &#124; National Institute on Drug Abuse |publisher=Drugabuse.gov |access-date=2013-12-01 |archive-date=2015-04-15 |archive-url=https://web.archive.org/web/20150415205916/http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse/why-do-people-abuse-anabolic-steroids |url-status=dead }}</ref> [[Yohimbine]] (a common [[Pre-workout#Ingredients|pre-workout ingredient]]), although it fails to increase testosterone levels as had at first been suspected, has at higher doses been discovered to be useful in facilitating recall of traumatic memories during [[post traumatic stress disorder]] (PTSD) treatment that can be used in conjunction with [[exposure therapy]].<ref>{{cite journal | vauthors = Singewald N, Schmuckermair C, Whittle N, Holmes A, Ressler KJ | title = Pharmacology of cognitive enhancers for exposure-based therapy of fear, anxiety and trauma-related disorders | journal = Pharmacology & Therapeutics | volume = 149 | pages = 150–190 | date = May 2015 | pmid = 25550231 | pmc = 4380664 | doi = 10.1016/j.pharmthera.2014.12.004 | department = Review }}</ref><ref>{{cite journal | vauthors = McGuire JF, Lewin AB, Storch EA | title = Enhancing exposure therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder | journal = Expert Review of Neurotherapeutics | volume = 14 | issue = 8 | pages = 893–910 | date = August 2014 | pmid = 24972729 | pmc = 4125602 | doi = 10.1586/14737175.2014.934677 | department = Review }}</ref><ref>{{cite book | vauthors = van der Kolk BA |author-link= Bessel van der Kolk |chapter=The Treatment of Post Traumatic Stress Disorder |chapter-url=https://books.google.com/books?id=sVuMSVEY83UC&pg=PA421 | veditors = Hobfoll SE, De Vries MW |title=Extreme stress and communities: impact and intervention |publisher=Kluwer Academic Publishers |location=Boston |year=1995 |pages=421–44 |isbn=978-0-7923-3468-2}}</ref>

==Illicit use by groups==

===Criminals===
Anabolic steroid use has been associated with an antisocial lifestyle involving various types of criminality.<ref name="pmid17088508">{{cite journal | vauthors = Klötz F, Garle M, Granath F, Thiblin I | title = Criminality among individuals testing positive for the presence of anabolic androgenic steroids | journal = Archives of General Psychiatry | volume = 63 | issue = 11 | pages = 1274–1279 | date = November 2006 | pmid = 17088508 | doi = 10.1001/archpsyc.63.11.1274 | doi-access = }}</ref>

===Governments===

====Law enforcement====
Steroid abuse among law enforcement is considered a problem by some. "It's a big problem, and from the number of cases, it's something we shouldn't ignore. It's not that we set out to target cops, but when we're in the middle of an active investigation into steroids, there have been quite a few cases that have led back to police officers," says Lawrence Payne, a spokesman for the United States [[Drug Enforcement Administration]].<ref>{{Cite news|url=http://www.annarbor.com/health/steroid-abuse-among-law-enforcement-a-problem-nationwide/|title=Steroid abuse among law enforcement a problem nationwide| vauthors = Keeping J |work=The Ann Arbor News|date=27 December 2010|access-date=1 December 2013}}</ref> The FBI Law Enforcement Bulletin stated that "Anabolic steroid abuse by police officers is a serious problem that merits greater awareness by departments across the country".<ref>{{Cite news|url=http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=1512&issue_id=62008|title=Anabolic Steroid Use and Abuse by Police Officers: Policy & Prevention|work=The Police Chief|date=June 2008|access-date=1 December 2013}}</ref> It is also believed that police officers across the United Kingdom "are using criminals to buy steroids and [[Abuse of power|abuse their power]] for sexual gratification" which he claims to be a top risk factor for [[police corruption]].

===Sports===

====Professional wrestling====
{{main|WWE#Wellness Program}}

Following the resurgence of Bill Graham, the [[United States House Committee on Oversight and Government Reform|Oversight and Government Reform Committee]] investigated steroid usage in the wrestling industry.<ref name="greenwichtimecontroversy">{{cite web|url= http://www.greenwichtime.com/news/article/Sunday-subscriber-advantage-WWE-steroid-385857.php#page-1|title=WWE steroid investigation: A controversy McMahon 'doesn't need'|author=Brian Lockhart|publisher=Greenwich Time|date=2010-03-01|access-date=2010-03-01}}</ref> The Committee investigated [[WWE]] and [[Total Nonstop Action Wrestling]] (TNA), asking for documentation of their companies' drug policies. WWE CEO and Chairman, [[Linda McMahon|Linda]] and [[Vince McMahon]] respectively, both testified. The documents stated that 75 wrestlers—roughly 40 percent—had tested positive for drug use since 2006, most commonly for steroids.<ref>{{cite web | url = http://oversight.house.gov/images/stories/documents/20081231141129.pdf | title = documents | work = World Wrestling Entertainment, Inc. | archive-url = https://web.archive.org/web/20101224020122/http://oversight.house.gov/images/stories/documents/20081231141129.pdf | archive-date=December 24, 2010 }}</ref><ref>{{cite web |url=http://www.theday.com/article/20100609/NWS12/306099933/1019%26town%3D |title=Deposition details McMahon steroid testimony &#124; News from southeastern Connecticut |publisher=The Day |date=2007-12-13 |access-date=2010-08-14 |archive-date=2010-06-12 |archive-url=https://web.archive.org/web/20100612182249/http://theday.com/article/20100609/NWS12/306099933/1019%26town%3D |url-status=dead }}</ref>

==== Students ====
===== Middle school =====
According to a 1998 study, 2.7% of middle school students (between 9 and 13 years of age) from four public middle schools in Massachusetts admitted to taking steroids, with similar numbers for boys and girls. 2% of non-users indicated they would use steroids in the future.<ref name="pmid9565439">{{cite journal | vauthors = Faigenbaum AD, Zaichkowsky LD, Gardner DE, Micheli LJ | title = Anabolic steroid use by male and female middle school students | journal = Pediatrics | volume = 101 | issue = 5 | pages = E6 | date = May 1998 | pmid = 9565439 | doi = 10.1542/peds.101.5.e6 | s2cid = 14152460 | doi-access = free }}</ref> This study was critisized on the grounds, that the students probably did not understand the questions, and thought that they were asked about over-the-counter supplements.<ref>Anabolic steroid abuse among teenage girls: An illusory problem? 2007. Drug Alcohol Depend. 88/2-3, 156-62. G. Kanayama, M. Boynes, J.I. Hudson, A.E. Field, H.G. Pope Jr. doi: 10.1016/j.drugalcdep.2006.10.013.</ref>

A similar study conducted in 2005-2006 (with the majority of students coming from New Jersey) found a low AAS's use among middle schoolers, although the numbers over 6% were reported for middle school male football players.<ref>Nutritional supplementation and anabolic steroid use in adolescents. 2008. Med Sci Sports Exerc. 40/1, 15-24. J.R. Hoffman, A.D. Faigenbaum, N.A. Ratamess, R. Ross, J. Kang, G. Tenenbaum. doi: 10.1249/mss.0b013e31815a5181.</ref>
In a questionaire study conducted in 2013-2015 1 % of [[Massachusetts]] high school male students reported using anabolic steroids without a prescription at least once. The numbers were somewhat higher for black (2.9%) and gay (8%) students.<ref>Exploring Anabolic-Androgenic Steroid Use and Teen Dating Violence Among Adolescent Males. 2019. Subst Use Misuse. 54/5, 779-86. K.T. Ganson, T.J. Cadet. doi: 10.1080/10826084.2018.1536723.</ref>

=== Recreational users ===
A high-profile 2007 study<ref>A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. 2007. J Int Soc Sport Nutr. 4/14. J. Cohen, R. Collins, J. Darkes, D. Gwartney. doi: 10.1186/1550-2783-4-12.</ref> by the [[University of South Florida]] based on an anonymous internet survey concluded, that median anabolic steroid user in the USA is a 29-years old single white male, who started "juicing" after the age of 25. Most users have a bachelor degree or higher, are employed [[White-collar worker|white collar]] professionals with an above average income, and not active in competitive sports. This user profile is quite different from those of typical substance abusers.

== Side effects ==
There are heavy physiological side effects that affect the human body upon using anabolic steroids. Both men and women can use androgenic (testosterone) hormones and experience the repercussions. There are "Male Specific",<ref name="Turvey_2015">{{cite book | vauthors = Turvey BE, Crowder S | title = Anabolic steroid abuse in public safety personnel: a forensic manual. | location = London, England | publisher = Academic Press | date = January 2015 }}</ref> "Female Specific",<ref name="Turvey_2015" /> Universal,<ref name="Turvey_2015" /> Physical,<ref name="Turvey_2015" /> Injection related,<ref name="Turvey_2015" /> and Psychological<ref name="Turvey_2015" /> side effects that occur from anabolic steroid use.

=== Male specific side effects ===
These side effects pertain to males which include:<ref name="Turvey_2015" />

* [[Gynecomastia|Male breast enlargement]]
* [[Testicular atrophy|Shrunken testicles]]
* Decreased [[sperm count]] to the point of sterility or [[infertility]]
* [[Impotence]]
* [[Benign prostatic hyperplasia|An enlarged prostate]]
* Low back pain

=== Female specific side effects ===
These side effects pertain to females which include:<ref name="Turvey_2015" />

* Breast shrinkage
* [[Hirsutism|Facial hair growth]]
* Extreme clitoral enlargement
* Menstrual irregularity (such as late periods, or lack thereof)

=== Universal side effects ===
These side effects can happen to any people of any sex. They are broken down into three categories which are the Physical,<ref name="Makin_2010"></ref> Injection related,<ref name="Turvey_2015" /> and Psychological<ref name="Turvey_2015" /> side effects.

==== Physical side effects ====
Side effects that men and women experience physically include:<ref name="Turvey_2015" />

* [[Edema|Water retention]]
* Increased [[libido]] during cycle
* Decreased [[libido]] after cycle
* Deepened voice
* [[Headache|Headaches]]
* Kidney pain
* General [[Skin and skin structure infection|skin infections]] and skin tearing
* [[Stretch marks|Striae]]
* [[Hair loss|Alopecia]]
* Severe [[acne]] on the face and back
* [[Hives|Urticaria]]
* [[Liver disease]]
* [[Kidney disease|Kidney damage]]
* [[Gastrointestinal disease|Gastrointestinal distress]]
* [[Dermatitis|Eczema]]
* Increased heart size

==== Injection side effects ====
Common side effects of anabolic steroid use via injection include:<ref name="Turvey_2015" />

* Neurovascular injury (damage to blood vessels and nerve clusters)
* [[Hematoma]]
* [[Fibrosis]]
* Bacterial infection
* [[Hepatitis B]] or [[Hepatitis C|C]]
* [[HIV/AIDS|HIV infection]].

==== Psychological side effects ====
Anabolic steroid abuse can affect one's psyche, regardless of gender. Psychological damages from abuse include:<ref name="Turvey_2015" />

* Psychological dependence and addiction
* [[Mood swing|Mood swings]]
* Short-term personality changes during periods of increased use
* Increased [[aggression]]
* [[Paranoia]]
* [[Mania]]
* [[Grandiose delusions|Delusions of grandeur]]
* [[Psychosis]]
* Irrational thoughts and behavior
* Memory loss
* [[Panic attack]]s

Note that all of these side effects of anabolic steroid use may or may not occur. Side effects occur because of hormonal imbalances. Non-direct reasonings for steroid use for sports can also stem from the low positive dope tests that occur before an event.<ref>{{cite book | vauthors = Kicman AT, Houghton E, Gower DB | chapter = Anabolic Steroids: Metabolism, Doping and Detection in Human and Equestrian Sports. | title = Steroid Analysis | date = 2010 | pages = 743–836 | publisher = Springer | location = Dordrecht }}</ref> When competition is at an all-time high, the incentive to use steroids becomes that much easier as sports events do not have a just way to provide fool-proof drug tests.<ref name="Makin_2010">{{cite book | vauthors = Makin HL, Gower DB | title = Steroid Analysis | edition = 2nd | location = Dordrecht, Netherlands | publisher = Springer | date = 2010 }}</ref>

== References ==
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{{Androgens and antiandrogens}}
{{Androgen receptor modulators}}

[[Category:Androgens and anabolic steroids]]
[[Category:Substance-related disorders]]

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