In sports, the use of performance-enhancing drugs is illegal and has led to a fall from grace for some big athletes.
In 2007, the Olympic runner Marion Jones was stripped of five medals won during the 2000 Olympic games after she admitted to using anabolic steroids. The scandal around Major League Baseball’s Barry Bonds’s steroid use lasted years during the early 2000s, and resulted in his being convicted of perjury.
But some social media users may have forgotten these high-profile downfalls, as they boast of the fitness and muscle gains from taking the same illegal drugs.
The bodybuilder and TikToker David Rau (25,600 followers) has been open about his experience. In videos, he’s shared how-tos, comparison photos of physiques attained naturally versus with steroids, and the purported benefits of being on anabolic steroids, according to him (confidence, mental sharpness, and increased muscle mass).
Others, like the TikToker Caroline Mathias (34,000 followers) are calling out steroid drug use by popular social media personal-trainer influencers.
Doctors warn people not to be duped by the attention and praise social media influencers are gathering for these drugs. Anabolic steroids and other performance-enhancing drugs can come with some serious and irreversible health risks and consequences.
What Are Anabolic Steroids?
Anabolic-androgenic steroids (AAS) are man-made versions of testosterone, which is the primary sex hormone in men, according to MedlinePlus. Testosterone is responsible for the appearance of features we associate with masculinity — a deep voice, facial hair, and bulging muscles. The steroids can be taken orally, as injections, or applied topically to the skin.
These hormones are widely misused in high doses because people want large muscles and improved athletic performance, according to a review published in December 2022 in Frontiers in Endocrinology.
“Anabolic steroids greatly enhance muscle mass and increase metabolism and fat breakdown,” says Diederik Smit, an internist specializing in endocrinology and the use of anabolic steroids in Tilburg, Netherlands, and a coauthor of the review. “Besides larger muscles and increased strength, men using AAS usually are leaner. This makes the steroids very suitable for bodybuilding purposes because this is all about muscle size and definition.”
Some anabolic steroid drugs include:
Anabolic steroids have been used in this way since the 1950s, according to research. But since then they’ve been banned by several athletic organizations as performance-enhancing drugs (more on that below).
Anabolic steroids can serve a medical purpose. According to the Department of Justice’s Drug Enforcement Administration (DEA), they’re called on as treatments for:
- Testosterone deficiency
- Delayed puberty
- Breast cancer
- Low red blood cell count
- AIDS-related tissue wasting
They can also be prescribed to help people gain weight after illness, injury, or infection, or to those who have trouble gaining weight for unknown reasons, according to the Mayo Clinic.
A few anabolic steroids are approved for medical use in humans and pets for the aforementioned conditions with a valid prescription, but by and large these are illegal and classified as Schedule 3 substances under the Controlled Substances Act, according to the DEA.
They’ve also been banned by the International Olympic Committee since the mid-1970s, and subsequently by most athletic organizations, per previous research.
It’s when these steroids are used for the wrong reasons (and at doses of 10 to 100 times higher than doses that would be used to treat medical conditions), such as for bodybuilding or enhancing athletic performance, that they become dangerous and illegal, according to MedlinePlus.
Anabolic steroids are different from general steroids, known as corticosteroids, which are anti-inflammatory drugs such as prednisone and cortisone, according to the Cleveland Clinic.
6 Risks of Anabolic Steroids When Used for the Wrong Reasons
Not only are they illegal when taken outside of the care of a medical professional to treat specific medical conditions, but they can be dangerous. Side effects can start after about two or three weeks of use, generally around the same time that the positive effects reveal themselves, Smit says.
Here are six potential side effects of anabolic steroids when they’re taken at high doses and absent a clear medical indication.
1. Heart and Liver Trouble
“The increased risk of cardiovascular disease is one of the most serious consequences of steroid use,” says Sean Byers, MD, a medical adviser in Los Angeles for Health Report Live.
The DEA reports the steroids could heighten cholesterol levels, which may lead to stroke, heart attack, or coronary artery disease.
A study published November 2018 in the International Journal of Sports and Exercise Medicine found that anabolic steroids decrease HDL cholesterol (so-called “good cholesterol”) by more than 90 percent and increase LDL cholesterol (“bad cholesterol”) by about 50 percent. The researchers found levels returned to normal about four months after participants stopped taking them.
“Long-term use [of steroids] predisposes to heart attacks and strokes, much like smoking, hypertension, and bad cholesterol do,” Smit says. “The heart muscle also increases in size, and not particularly in a good manner. This so-called hypertrophy may decrease cardiac function and cause dangerous arrhythmias.”
Oral steroids can also lead to liver trouble, including the development of tumors, according to research published in May 2020 in LiverTox.
2. Stunted Growth in Young People
These steroids could impact adult height if they’re taken in adolescence, according to the DEA. This happens because the bones end up maturing too quickly and then stop growing, according to Nemours KidsHealth.
3. Aggressive Behavior
Ever heard the term “roid rage”? This is the personality change one may experience as a result of taking anabolic steroids. Many people find themselves becoming hostile, experiencing major mood swings, and engaging in aggressive behavior, per the DEA. This can sometimes lead to depression and suicide once the steroids have been stopped.
4. Physical Changes
Many of the side effects are the same for men and women, Smit says. But not all. Men on anabolic steroids may experience baldness, breast growth, and shrinking testicles, according to MedlinePlus.
Women, on the other hand, may find themselves with a deeper voice, more hair on the face and body, male pattern baldness, changes to their menstrual cycle, and a lengthening of the clitoris, according to the DEA. And while many of the side effects for anabolic steroids go away once the drugs are stopped, some of these changes to women can become permanent, Smit says.
5. Male Infertility
Steroids can negatively impact a man’s fertility. Testosterone plays an important role in male reproductive organs and sexual function, according to research, but taking testosterone through steroids can inhibit two other reproductive hormones — FSH and LH.
Steroids can also lead to abnormalities in sperm motility and morphology. It’s possible this can be reversed — the previous study showed sperm can return to normal after four months or so.
Smit adds, though, that other studies haven’t been so promising, so it’s unknown if male fertility always rebounds. “This may have consequences if they still desire to have children later in life,” he says.
Acne tends to appear along the chest, face, neck, back, and arms in response to high doses of steroids, according to the DermNet. The chest is the most common area, and steroid acne tends to be more uniform than usual acne. While not the most serious of side effects, it’s worth noting because it can affect about half of steroid abusers, according to previous research. “Acne can be disfiguring but is manageable,” Smit says.
For men, many of these side effects can be reversed once the steroid is stopped, according to the Cleveland Clinic. But it can be hard to stop, with more than 50 percent of users becoming dependent, per previous research.