A | B | C | D | E | F | G | H | CH | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9
| Anabolic–androgenic steroids | |
|---|---|
| Drug class | |
 Chemical structure of the natural AAS testosterone (androst-4-en-17β-ol-3-one). | |
| Class identifiers | |
| Synonyms | Anabolic steroids; Androgens |
| Use | Various |
| ATC code | A14A |
| Biological target | Androgen receptor |
| Chemical class | Steroids; Androstanes; Estranes |
| Clinical data | |
| Drugs.com | Drug Classes |
| External links | |
| MeSH | D045165 |
| Legal status | |
| Legal status |
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| In Wikidata | |
Anabolic steroids, also known as anabolic-androgenic steroids (AAS), are a class of drugs that are structurally related to testosterone, the main male sex hormone, and produce effects by binding to the androgen receptor. Anabolic steroids have a number of medical uses,[1] but are also used by athletes to increase muscle size, strength, and performance.
Health risks can be produced by long-term use or excessive doses of AAS.[2][3] These effects include harmful changes in cholesterol levels (increased low-density lipoprotein and decreased high-density lipoprotein), acne, high blood pressure, liver damage (mainly with most oral AAS), and left ventricular hypertrophy.[4] These risks are further increased when athletes take steroids alongside other drugs, causing significantly more damage to their bodies.[5] The effect of anabolic steroids on the heart can cause myocardial infarction and strokes.[5] Conditions pertaining to hormonal imbalances such as gynecomastia and testicular size reduction may also be caused by AAS.[6] In women and children, AAS can cause irreversible masculinization.[6]
Ergogenic uses for AAS in sports, racing, and bodybuilding as performance-enhancing drugs are controversial because of their adverse effects and the potential to gain advantage in physical competitions. Their use is referred to as doping and banned by most major sporting bodies. Athletes have been looking for drugs to enhance their athletic abilities since the Olympics started in Ancient Greece.[5] For many years, AAS have been by far the most detected doping substances in IOC-accredited laboratories.[7][8] Anabolic steroids are classified as Schedule III controlled substances in many countries,[9] meaing that AAS have recognized medical use but are also recognized as having a potential for abuse and dependence, leading to their regulation and control. In countries where AAS are controlled substances, there is often a black market in which smuggled, clandestinely manufactured or even counterfeit drugs are sold to users.
Uses
Medical
Since the discovery and synthesis of testosterone in the 1930s, AAS have been used by physicians for many purposes, with varying degrees of success. These can broadly be grouped into anabolic, androgenic, and other uses.
Anabolic
- Bone marrow stimulation: For decades, AAS were the mainstay of therapy for hypoplastic anemias due to leukemia, kidney failure or aplastic anemia.[10]
- Growth stimulation: AAS can be used by pediatric endocrinologists to treat children with growth failure.[11] However, the availability of synthetic growth hormone, which has fewer side effects, makes this a secondary treatment.[medical citation needed]
- Stimulation of appetite and preservation and increase of muscle mass: AAS have been given to people with chronic wasting conditions such as cancer and AIDS.[12][13]
- Stimulation of lean body mass and prevention of bone loss in elderly men, as some studies indicate.[14][15][16] However, a 2006 placebo-controlled trial of low-dose testosterone supplementation in elderly men with low levels of testosterone found no benefit on body composition, physical performance, insulin sensitivity, or quality of life.[17]
- Prevention or treatment of osteoporosis in postmenopausal women.[18][19] Nandrolone decanoate is approved for this use.[20] Although they have been indicated for this indication, AAS saw very little use for this purpose due to their virilizing side effects.[18][21]
- Aiding weight gain following surgery or physical trauma, during chronic infection, or in the context of unexplained weight loss.[22][23]
- Counteracting the catabolic effect of long-term corticosteroid therapy.[22][23]
- Oxandrolone improves both short-term and long-term outcomes in people recovering from severe burns, and is well-established as a safe treatment for this indication.[24][25]
- Treatment of idiopathic short stature, hereditary angioedema, alcoholic hepatitis, and hypogonadism.[26][27]
- Methyltestosterone is used in the treatment of delayed puberty, hypogonadism, cryptorchidism, and erectile dysfunction in males, and in low doses to treat menopausal symptoms (specifically for osteoporosis, hot flashes, and to increase libido and energy), postpartum breast pain and engorgement, and breast cancer in women.[28][29][30]
- Growth hormones used in Veterinary Medicine (e.g. Trenbolone Acetate) are also used in intensive animal farming for faster gains in muscle mass for higher yields of meat from livestock and higher milk production in the Dairy industry.[31][32]
Androgenic
- Androgen replacement therapy for men with low levels of testosterone, such as those associated with late-onset hypogonadism;[33] also effective in improving libido for elderly males.[34][35][36][37]
- Induction of male puberty: Androgens are given to many boys distressed about extreme delay of puberty. Testosterone is now nearly the only androgen used for this purpose and has been shown to increase height, weight, and fat-free mass in boys with delayed puberty.[38]
- Masculinizing hormone therapy for transgender men, other transmasculine people, and intersex people, by producing masculine secondary sexual characteristics such as a voice deepening, increased bone and muscle mass, masculine fat distribution, facial and body hair, and clitoral enlargement, as well as mental changes such as alleviation of gender dysphoria and increased sex drive.[39][40][41][42][43]
Other
- Treatment of breast cancer in women, although they are now very rarely used for this purpose due to their marked virilizing side effects.[44][18][45]
- In low doses as a component of hormone therapy for postmenopausal and transgender women, for instance to increase energy, well-being, libido, and quality of life, as well as to reduce hot flashes.[46][47][48][49] Testosterone is usually used for this purpose, although methyltestosterone is also used.[49][50]
- Male hormonal contraception; currently experimental, but potential for use as effective, safe, reliable, and reversible male contraceptives.[51]
- Assistant in the treatment of Raynaud's Phenomenon and peripheral acrocyanosis. Testosterone and other anabolics tend to be potent vasodilators, which can significantly improve bloodflow in individuals prone to vasoconstriction.[52]
Enhancing performance
Most steroid users are not athletes.[53] In the United States, between 1 million and 3 million people (1% of the population) are thought to have used AAS.[54] Studies in the United States have shown that AAS users tend to be mostly middle-class men with a median age of about 25 who are noncompetitive bodybuilders and non-athletes and use the drugs for cosmetic purposes.[55] "Among 12- to 17-year-old boys, use of steroids and similar drugs jumped 25 percent from 1999 to 2000, with 20 percent saying they use them for looks rather than sports, a study by insurer Blue Cross Blue Shield found."[56] Another study found that non-medical use of AAS among college students was at or less than 1%.[57] According to a recent survey, 78.4% of steroid users were noncompetitive bodybuilders and non-athletes, while about 13% reported unsafe injection practices such as reusing needles, sharing needles, and sharing multidose vials,[58] though a 2007 study found that sharing of needles was extremely uncommon among individuals using AAS for non-medical purposes, less than 1%.[59] Another 2007 study found that 74% of non-medical AAS users had post-secondary degrees and more had completed college and fewer had failed to complete high school than is expected from the general populace.[59] The same study found that individuals using AAS for non-medical purposes had a higher employment rate and a higher household income than the general population.[59] AAS users tend to research the drugs they are taking more than other controlled-substance users;[citation needed] however, the major sources consulted by steroid users include friends, non-medical handbooks, internet-based forums, blogs, and fitness magazines, which can provide questionable or inaccurate information.[60]
AAS users tend to be unhappy with the portrayal of AAS as deadly in the media and in politics.[61] According to one study, AAS users also distrust their physicians and in the sample 56% had not disclosed their AAS use to their physicians.[62] Another 2007 study had similar findings, showing that, while 66% of individuals using AAS for non-medical purposes were willing to seek medical supervision for their steroid use, 58% lacked trust in their physicians, 92% felt that the medical community's knowledge of non-medical AAS use was lacking, and 99% felt that the public has an exaggerated view of the side-effects of AAS use.[59] A recent study has also shown that long term AAS users were more likely to have symptoms of muscle dysmorphia and also showed stronger endorsement of more conventional male roles.[63] A recent study in the Journal of Health Psychology showed that many users believed that steroids used in moderation were safe.[64]
AAS have been used by men and women in many different kinds of professional sports to attain a competitive edge or to assist in recovery from injury. These sports include bodybuilding, weightlifting, shot put and other track and field, cycling, baseball, wrestling, mixed martial arts, boxing, football, and cricket. Such use is prohibited by the rules of the governing bodies of most sports. AAS use occurs among adolescents, especially by those participating in competitive sports. It has been suggested that the prevalence of use among high-school students in the U.S. may be as high as 2.7%.[65]