Background

Steroids are considered performance-enhancing drugs/substances (PEDs) due to increases in strength and lean body mass while reducing body fat.

Testosterone, which is produced by the body, is called endogenous testosterone and helps with physical and sexual development, primarily in males. It also has a smaller effect in females. Anabolic-androgenic steroids (AAS) are manmade substances synthesized from testosterone. Similar to testosterone, steroids help with muscle growth (anabolic) and masculine features (androgenic) often observed in puberty.

Symptoms

Symptoms of anabolic-androgenic steroid use may include:

• Psychiatric: aggressive behavior, hallucinations, depression, suicidality

• Severe acne

• Balding

• Facial/chest hair in females

• Elevations in blood pressure, cholesterol

• Increased risk of heart attack

• Increased risk of cancer

• Decreased testicular size

• Menstrual irregularities in females

• Spontaneous tendon rupture

Sports Medicine Evaluation and Treatment

A sports medicine physician will focus on the reasons an athlete is using steroids and the negative health effects associated with their use. Many athletes who use steroids are concerned with their performance or appearance, and the sports medicine physician will need to address realistic expectations for both.

Urine drug testing is often randomly done on athletes to exclude the presence of AAS when participating in sports. Those individuals found to test positive for illegal steroids might be subject to eligibility restrictions including suspension, financial penalty and revocation of medals or awards, as well as being permanently banned from participation.

Injury Prevention

Athletes and those who directly impact their performance, like coaches or parents, should be educated on the short- and long-term risks of anabolic steroid use on an athlete’s body and mind.

Return to Play

An athlete’s eligibility depends on the rules and regulations established by the governing body for that level of sport (e.g. high school, college, Olympic). A decision to return to play should consider the athlete’s current medical and mental health, as well as risks associated with that particular sport and competition level.

AMSSM Member Authors
Vicki Nelson, MD, PhD & Andrew W. Albano, Jr., DO

References
Hoffman, J. & Ratamess, N. Medical Issues Associated with Anabolic Steroid Use:
Are They Exaggerated? J Sports Sci Med. 2006; 5(2): 182–193.
Jenkinson, D. & Harbert, A. Supplements and Sports. Am Fam Physician. 2008;
78(9):1039-1046.