Despite its dangers, anabolic steroid abuse continues as athletes and others attempt to gain competitive advantage and to enhance their musculature, NIDA Director Nora D. Volkow said in recent testimony before the Government Reform Committee in the U.S. House of Representatives. "We are now facing a very damaging message that is becoming pervasive in our society—that bigger is better, and being the best is more important than how you get there."

Dr. Volkow's statement is one example of what visitors can find on NIDA's Web site, http://www.steroidabuse.gov, which is devoted to educating the public about the dangers of anabolic steroids. The site provides resources, publications, and links to public service announcements about the consequences of steroid abuse. In the full text of Dr. Volkow's March 17, 2005, testimony before the Government Reform Committee, she discusses the Institute's many efforts to find treatments to mitigate the adverse effects of anabolic steroid abuse and to better understand how these substances affect the body and brain.

Anabolic-androgenic steroids are synthetic substances related to male sex hormones. "Anabolic" refers to muscle-building, and "androgenic" refers to these substances' effect of promoting masculine characteristics such as hair growth or a deepened voice. Steroid drugs are available legally only by prescription to treat conditions that occur when the body produces abnormally low amounts of testosterone, such as delayed puberty and some types of impotence. They are also prescribed to treat body-wasting in patients with AIDS and other diseases that result in loss of lean muscle mass. Abuse of anabolic steroids can lead to serious health problems, some irreversible.

Anabolic steroids differ from other drugs of abuse in that many of their "reinforcing effects" (i.e., those effects that keep a person using a drug) are not experienced immediately or rapidly. The main reasons people abuse steroids are to improve their performance in sports by increasing muscle size and to enhance their appearance by reducing body fat. Although these effects can take months to develop, once they do, they may comprise a strong incentive to continue abuse.

The most recent NIDA-University of Michigan Monitoring the Future survey found that in 2003 and 2004, about 2.5 percent of 12th-graders reported abusing steroids during the past year. This is a peak level among this group, and translates into an estimated 79,000 high school seniors involved with these substances. Meanwhile, the percentage of 12th-graders concerned that steroids might do them harm had fallen to 56 percent from a high of 71 percent in 1992. When students view drugs as less harmful, their levels of abuse often increase. On the positive side, among 8th-graders, steroid abuse in the past year declined from 1.4 percent in 2003 to 1.1 percent in 2004.

Anabolic steroids are taken orally or injected, typically in "cycles" of weeks or months. Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. In addition, users often combine (or "stack") several types of steroids to maximize the substances' effects while—or so abusers believe—minimizing their negative effects.

"Some percentage of steroid abusers become addicted to the drugs, as evidenced by their continuing to take steroids in spite of seriously adverse medical and behavioral problems," Dr. Volkow said. "One of the most dangerous consequences is the severe depression that can occur during withdrawal, which, if not recognized and treated properly, can result in suicide weeks after drug discontinuation. Indeed, untreated, depressive symptoms have been known to persist for a year or more after the abuser stops taking the drugs."

Other consequences of anabolic steroid abuse can include liver and heart disease, stroke, and increased aggression. People who inject anabolic steroids run the added risk of contracting and/or transmitting HIV/AIDS or hepatitis through sharing contaminated needles. In addition, there are some sex-specific side effects:

• For men—shrinking of the testicles, reduced sperm count, infertility, baldness, enlarged breasts, increased risk for prostate cancer.
• For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice.
• For adolescents—permanent short stature due to premature cessation of skeletal growth.

NIDA's Web site also features links to the Institute's "Game Plan" public service announcements, which encourage young men and women to work with what nature has provided and not to "cheat" by using steroids and thereby expose themselves to the negative side effects associated with these drugs. NIDA released its most recent Game Plan in June 2005.

Volume 20, Number 2 (August 2005)