Steroids: Bigger Is Not Better

Anabolic steroids are synthetically-produced derivatives of testosterone, a natural hormone that, among other things, promotes muscle growth. There are a number of different types of manufactured steroids. The official name for this type of steroid is androgenic anabolic steroid, or in English, "a drug that promotes protein synthesis (anabolic) and leads to masculine secondary sexual characteristics (androgenic)."

To understand how anabolic steroids work, it helps to know how testosterone works. Testosterone is a male sex hormone (although women also produce it) that serves 2 basic purposes. During the first stage of puberty, young men produce an increased amount of testosterone for a number of months. During this stage, the bulk of the male physical maturation process occurs including bone growth, deepening of voice, and development of facial and body hair. Testosterone also maintains the male reproductive system and helps to produce larger body size and muscle mass.

Androgenic steroids are prescribed by doctors for therapeutic treatment of conditions where testosterone (or its effects) need to be added or replaced. Anabolic steroids are designed to copy the muscle-building effects of testosterone, but with fewer of the accompanying "masculinization" effects.

Users of anabolic steroids can be divided into 2 groups:

  • Those who use them for medical purposes
  • Those who use them to enhance their strength and athletic ability, and/or enhance their physical appearance by adding muscle mass

Medical Uses

Anabolic steroids are prescribed for a small number of legitimate medical purposes. These include the treatment of:

  • People with significant weight loss due to extensive surgery, trauma, HIV, cancer, or other conditions
  • Bone pain accompanying osteoporosis

Athletes and Body Enhancers

As far back as the 1950s, athletes have been using anabolic steroids. The reason is simple: the use of these drugs in conjunction with intense physical training increases the body's overall muscle mass, lowers the body's percentage of fat, and thus, enhances body strength. These effects occur in both men and women.

Moreover, some people, including teenagers, use anabolic steroids to help enhance their physical appearance. This is troubling because the potentially dangerous side effects of using anabolic steroids are heightened in adolescents.

Dangerous Side Effects

The potentially dangerous side effects of anabolic steroid use are numerous. Men run the risk of testicular shrinkage, reduced sperm count, erectile dysfunction, baldness, and an enlarged prostate. Women can suffer from masculinization effects, such as deepened voice or the growth of facial hair, cessation of menstruation, enlargement of genitals, and reduction of breast size. Both genders run the risk of serious medical problems, including high blood pressure and liver damage. Both heart attacks and strokes have been described in young persons taking these substances.

Finally, there is the belief held by some that both men and women may be susceptible to so-called "'roid rage"—sudden pronounced outbursts of anger due to their anabolic steroid use. Furthermore, depression and other withdrawal symptoms occur after quitting steroids.

As mentioned, adolescents are at an even greater risk from anabolic steroid use. In addition to the above dangers, young adolescents who use steroids (those who are still growing) run the risk of suffering irreversible stunting of their growth. Indeed, this danger is so significant that steroids are prescribed for children only with great caution and expert medical supervision.

As if the dangers inherent in using anabolic steroids were not enough, the manner in which abusers of these drugs acquire and administer them only serves to increase the dangers. Due to the difficulty in acquiring non-medically prescribed anabolic steroids, a black market for the drugs has developed. As a result, tainted drugs and/or drugs of uncertain potency are sometimes sold to users. In addition to being taken orally, anabolic steroids can also be injected. Since some users reuse or share needles, this creates a danger of transferring blood-born diseases, such as HIV and hepatitis.

The way that some users manage their intake of anabolic steroids is particularly unsafe. Some users "cycle" their intake, taking anabolic steroids on and off for 1-6 month periods. Some who compete in regulated sports do this in the hopes of avoiding detection. Hoping to increase the effect of the drug, many users "megadose," sometimes taking hundreds of milligrams of the drug per day when the medically prescribed dose would be much lower. Others partake in "stacking"—taking many different types of anabolic steroids at the same time, sometimes in combination with other drugs. This may further increase the risks associated with using anabolic steroids.

Some signs of anabolic steroid use include:

  • Puffy face
  • Severe acne (on face, chest, upper back, and thighs)
  • Development of breast tissue in men
  • Joint pain
  • Hyperactivity
  • Increased weight gain over a short period of time
  • Yellowing of skin and/or eyes
  • Male pattern baldness

By themselves, none of these signs indicate that someone is taking anabolic steroids, but they could alert parents and coaches to the possibility that drug abuse is occurring. There are only a few medical conditions in youth for which medical prescription of testosterone is appropriate and indicated. The non-medically authorized use of anabolic steroids poses grave danger. Possession and distribution of anabolic steroids for non-medical purposes is illegal under federal law because steroids are classified as a Schedule III drug under the Controlled Substances Act.

So, the intelligent conclusion is simple: unless anabolic steroids have been medically prescribed for you, do not take them. Consistent hard work with resistance training will provide most of the muscle mass that steroids do.


National Institute on Drug Abuse

Substance Abuse and Mental health Services Administration


Council on Drug Abuse

Canadian Center on Substance Abuse


Casavant MJ, Blake K, Griffith J, Yates A, Copley LM. Consequences of use of anabolic androgenic steroids. Pediatr Clin North Am. 2007;54(4):677-690.

de Souza GL, Hallak J. Anabolic steroids and male infertility: A comprehensive review. BJU Int. 2011;108(11):1860-1865.

Indiana Prevention Resource Center. Anabolic steroids. Indiana Prevention Resource Center website. Available at: Accessed May 31, 2016.

Jenkinson DM, Harbert AJ. Supplements and sports. Am Fam Physician. 2008;78(9):1039-1046.

National Institute for Drug Abuse for Teens. Anabolic steroids. National Institute for Drug Abuse for Teens website. Available at: Updated May 27, 2016. Accessed May 31, 2016.

Oxandrolone. EBSCO DynaMed website. Available at: Updated May 6, 2016. Accessed May 31, 2016.

Rules 2009. US Department of Justice: Drug Enforcement Administration website. Available at: Accessed May 31, 2016.

Signs of steroid abuse. Taylor Hooton Foundation website. Available at: Accessed May 31, 2016.

Testosterone. EBSCO DynaMed website. Available at: Updated May 6, 2016. Accessed May 31, 2016.

Last reviewed May 2016 by Michael Woods, MD  Last Updated: 5/31/2016