Understanding and Preventing Steroid Abuse in Sports

Image of a man in a gym connecting barbell to weight

Steroid use in sports is a concern for coaches, managers, parents, and peers of athletes, as well as the athletes themselves.

Although steroids can enhance one’s ability to perform, they have side effects, and athletes can face complications with dependence and even addiction. Simply put, athletes who abuse steroids are heading down an illegitimate path. While steroids might provide an unfair advantage and short-term performance boost, those who take them also set themselves up for failure in more ways than one.

In this article, you’ll find information on:

  • Steroids and their side effects
  • The prevalence of steroid abuse in sports
  • Signs of steroid abuse
  • Intervention solutions

What Are Steroids?

Steroids are synthetic drugs that imitate hormones that our bodies naturally produce as part of maturation or in response to stress. Anabolic steroids imitate male sex hormones — the proper term for them is anabolic-androgenic steroids. The term anabolic refers to the process of building muscle tissue, while androgenic refers to male sex characteristics. Anabolic steroids are the kind typically abused by athletes.

People often think of anabolic steroids when someone refers to steroids, but the term steroids may also refer to corticosteroids. These steroids imitate cortisone hormones produced by the body’s adrenal glands in response to stress. There are also other performance-enhancing drugs (PEDs) that people sometimes mistakenly refer to as steroids (more on this below).

Legitimate Medical Uses for Steroids

In the 1930s and ‘40s, chemist Percy Lavon Julian and other scientists invented steroids to serve legitimate medical purposes. Prescribed uses of anabolic steroids include:

  • Weight gain for people recovering from serious illness/injury, or for those with an infection
  • Treatment for certain kinds of anemia
  • Treatment for certain kinds of breast cancer
  • Treatment for hereditary angioedema, which causes swelling in parts of the body and can be fatal.

Furthermore, corticosteroids are used to provide relief for inflamed areas of the body. This includes treatment for conditions such as severe allergies, asthma, arthritis, and skin maladies.

Steroids vs. Performance Enhancing Drugs (PEDs)

According to the medical journal Pediatrics in Review, performance enhancing drugs (PEDs) include various “anabolic agents,” such as anabolic steroids and steroid precursors, as well as nutritional supplements, stimulants, and other agonists, including human growth hormone. People sometimes refer to performance enhancing drugs generally as steroids. While it’s true that steroids are PEDs, PEDs are not always steroids.

Pediatrics in Review further notes that PEDs are increasing in popularity. One study found that 3.3% of high school students admitted to anabolic steroid use while, in another study, 8% of girls and 12% of boys reported to have used PEDs to improve muscle mass, appearance, or strength.    

Combined with strength training, anabolic steroids cause muscle growth in their user, leading some athletes to use them improperly to improve performance. Pediatrics in Review noted that users can see strength gains anywhere from 5% to 20%. For this reason, some athletes choose anabolic steroids and give them a preferred status among PEDs. There’s scientific and subjective evidence that anabolic steroids work to increase strength, while other PEDs are less proven.

Unfortunately, athletes may not be aware that anabolic steroids come with several adverse side effects.

Side Effects of Steroids

The side effects of anabolic steroid abuse include:

  • An increase in acne
  • For men: breast growth, shrunken testicles, decrease in sperm count, increased risk of prostate cancer
  • For women: deeper voice, shrunken breasts, facial hair growth, male-pattern baldness
  • For adolescents: stunted growth
  • Hypertension
  • Heart complications, changes in cholesterol levels, increased risk of heart attack and stroke
  • Increased risk of liver disease and liver cancer
  • Kidney damage
  • Increase in aggression, depression, and suicidal ideation

The most severe side effects set in after extended use of steroids. Athletes who abuse them are risking a great deal just to try and win a game or put on a little extra muscle mass.

Are Steroids Illegal?

As per the Anabolic Steroids Control Act of 1990 and the Controlled Substances Act, anabolic steroids are a Schedule III controlled substance in the United States. It’s illegal to possess anabolic steroids without a valid prescription from a doctor.

Although it’s not as rampant, steroid abuse is similar to opioid abuse, insofar as both opioids and steroids have a legitimate medical purpose and are legal if the user has a prescription. Paradoxically, the legal status of opioids and steroids for legitimate medical use has helped lead to illegal, non-medical drug abuse.

Are Steroids Addictive?

Steroid users can sometimes display addictive behaviors, continuing to use steroids despite negative side effects. According to the National Institute of Drug Abuse (NIDA), when it comes to steroid addiction, “About 32% of people who misuse anabolic steroids become dependent.”

Dependence isn’t necessarily full-blown addiction — the NIDA hasn’t been able to determine how many steroid users develop a substance use disorder. However, in this case, dependence looks similar to addiction. Users often find themselves spending exorbitant amounts of cash on steroids, and have difficulty stopping because of problems like depression and anxiety. For the athlete, this anxiety and depression is compounded because steroid use is directly linked to their competitive performance.

Steroid users can suffer from withdrawal symptoms if they develop a dependency and stop using the drug. Withdrawal symptoms may include fatigue, restlessness, loss of appetite, problems sleeping, decreased libido, and a craving for the drug. In addition to the negative psychological impact of quitting, users may become dependent because they don’t want to go through withdrawal.

As concerned individuals work to intervene on behalf of those who develop steroid dependence, professionals with training in healthcare management are on the forefront at addiction treatment clinics and hospitals that help steroid users combat dependence and adverse side effects.

Steroid Use in Sports

Steroid abuse is prevalent in the sports world because some athletes want to win or rise to the top, no matter the cost. The problem is exacerbated by professional athletes who abuse the drugs. According to Pediatrics in Review, between 1998 and 2000 there was a “sharp decline” in the perception of risk attached to steroid use among adolescents; this decline could have been “related to the use of performance-enhancing substances by professional athletes.”

From 1991 to 2003, adolescent steroid use grew at an alarming rate, from 2.7% to 6.1%. In 2004, the NIDA estimated over half a million 8th and 10th graders were using anabolic steroids. Moreover, 1,084,000 adults, or 0.5% of the population, reported steroid use. Pediatrics in Review also reported that steroid use is especially common among athletes who play football, baseball, and basketball, as well as those who wrestle or take part in gymnastics.

According to the New York State Department of Health, when it comes to steroids and sports, “The number of athletes who abuse anabolic steroids is unknown.” While all of the major professional sports leagues test players for steroids, this doesn’t prevent some athletes from finding a way around the rules. For example, although the NFL tests every player at least once each year, an anonymous survey of 2,552 retired players revealed that 16% of offensive linemen and 15% of defensive linemen had used PEDs (it’s unclear whether they used anabolic steroids).

Competitive Advantage

According to the Drug Enforcement Administration (DEA), athletes who use anabolic steroids do so because of the belief that steroids give them a “competitive advantage and/or improve their physical performance.” While steroids do increase muscle mass when athletes use them in combination with their training regimen, there’s no proof of a competitive advantage due to steroid use.

Many of the world’s greatest athletes have never tested positive for steroids. These athletes, their coaches, and their trainers know that a competitive advantage comes from a competitive psychological standpoint more than it does from muscles. This is in large part because PEDs have no effect on problem solving skills, strategic thought, or game IQ — which are all important intangible factors that help lead to victory.

Body Image

Some athletes have muscle dysmorphic disorder (MDD), which leads them to abuse steroids in an effort to “bulk up.” MDD is a type of body dysmorphic disorder (BDD) that leads to unhealthy behavior. MDD stems from the human inclination to compare ourselves to others. For some athletes, the intensely competitive nature of sports can heighten this inclination.

Athletes with MDD are prone to unusual diets with an emphasis on protein and performance-enhancing supplements, steroid abuse, overexertion in the gym, and other maladaptive psychological tendencies.

Signs of Steroid Use

For anyone close to an athlete in a professional or personal capacity, it’s important to recognize the signs of steroid abuse. Being cognizant of these signs can help concerned parties intervene and aid the athlete in overcoming steroid dependency.

Effective intervention doesn’t just make a difference in the athlete’s life — it makes a difference on the field, on the court, and in the ring. The fewer athletes who use steroids, the fairer the competition, and the more accurate the picture of natural muscle mass. This is about setting a good example for young people.

The signs you’re likely to notice will vary depending on your interactions with someone who may be abusing steroids, whether you’re a coach, family member, or friend.

Signs of Steroid Abuse in the Home

There will always be changes at home when someone engages in prolonged steroid abuse. Look for the signs of steroid abuse and seek help before the abuser’s home life deteriorates.

  • Abrupt mood swings and “roid rage” marked by a tendency toward aggression
  • Increase in acne, especially on shoulders and back
  • Increase in paranoia and hyperactivity
  • Rapid weight gain (especially breast tissue for men) and — if they’re working out — sudden accumulation of muscles

A steroid abuser may be able to hide these telltale signs from you. If you suspect they’re using, look for other signs of steroid abuse that may manifest themselves as time passes:

  • Very greasy hair, oily skin, and bad breath
  • For women, hair loss — look for excessive hair in bed, on comb, or in the shower
  • Jaundiced, yellowing skin as well as other skin problems such as abscesses and cysts
  • A massive increase of appetite or loss of appetite
  • Joint pain and stretch marks on inner joints
  • Disrupted sleep pattern
  • Bloating of the face and body, night sweats, trouble urinating
  • Behavioral shifts: more abusive, disrespectful, secretive, withdrawn; attempts to hide acne and other physical manifestations; noticeable alteration in relationships; loses focus more often, forgets priorities besides sports and working out

Signs of Steroid Abuse in Sports

If you’re a coach, trainer, or manager wondering how to tell if someone is using steroids, look for the following:

  • Unusually fast increase in the size of the lats, trapezius, pectorals, deltoids, and upper arm muscles
  • Testicular shrinkage — abusers may seek to hide this in the locker room
  • A fat-free-mass-index (FFMI) above 25 — a 26 or 27 is the most suspect
  • Aggression level beyond normal
  • Gynecomastia (increase in breast tissue) for men; shrunken breasts for women
  • Hair loss for women

It can often be tough for those involved in sports programs to spot steroid abuse, which is why professional leagues and the NCAA conduct urinalysis tests. In part, drug testing is important for programs so those who are involved in sport business management can do their jobs with the utmost confidence.

Signs of Steroid Abuse at School

The hustle and bustle of school doesn’t make it easy for staff to spot steroid abuse in students. It’s important for friends, peers, teachers, and counselors to look for the following signs:

  • Sudden, unusual irritability and aggression
  • Depression
  • A sudden downward trend in quality of schoolwork
  • Increase in secretiveness and paranoia
  • Sleeping in class
  • Loss of focus and concentration
  • Poor decision-making skills due to “feelings of invincibility” (According to the Taylor Hooton Foundation)

Due to the increase in aggression, a student who abuses steroids may get in more fights at school. Simultaneously, it’s not unusual to see their grades drop because they’re concentrating on physical appearance and/or sports instead of schoolwork.

How to Talk to Someone Who Is Abusing Steroids

After you recognize someone is abusing steroids, the next step is to talk to them. This can take the form of a group intervention, but it doesn’t have to — a one-on-one talk can be very effective. In the end, it’s up to them to quit or face the consequences. However, this discussion could be the catalyst.

You’re already taking the first step, which is to seek to understand why they’re using steroids. Don’t assume anything — begin by telling them what you’ve noticed and express your concern. Let them know you understand. Express how much you care for them regardless of whether they win games or look strong. Let them know you’re there for them, but if they are relying on you for money or anything else that enables their dependency, you can no longer provide it. Be willing to help them find a therapist or trusted individual who can maintain confidentiality and help counsel them off the drug. When it comes down to it, you may have to warn them of the physical problems you’ve learned are the result of steroid abuse.

If it helps, get an inside perspective on anabolic steroid abuse and use it to inform your discussion. The steroid abuser will also benefit from the perspective of someone who abused steroids and discovered why it’s a bad idea.

Steroid Addiction Treatment

In some cases, addiction treatment is necessary to solve a steroid abuse problem. Treatment for steroid abuse may include meetings with a psychologist, endocrine therapies to restore normal hormone levels, and other pharmacological treatments.

Therapy for the steroid addict is multi-dimensional, tackling muscle dysmorphia and drug dependence, but the NIDA reports that around 56% of steroid abusers never tell their physician about their steroid use, possibly because they don’t think the physician is knowledgeable.

When it comes to treating anabolic steroid dependence, the journal Drug and Alcohol Dependence notes that cognitive-behavioral therapy has been shown effective for treating body dysmorphia in multiple studies, and serotonergic antidepressants might be helpful both for muscle dysmorphia and depression from steroid withdrawal.

An inpatient detox program can include synthetic hormones such as human chorionic gonadotropin or clomiphene administered by an endocrinologist, which helps treat hypogonadism (the diminished production of testosterone). Psychiatrists sometimes prescribe clonidine to reduce anxiety, lower blood pressure, and relieve muscle cramps for the recovering addict.

Following steroid abuse, regular meetings with someone who has a expertise in psychology can help a person to overcome the underlying insecurities that may have driven them to abuse steroids in the first place. Behavioral therapists concentrate on helping recovering addicts learn coping skills for when they’re triggered to relapse, to help develop their develop self-esteem, and when shifting from a competitive mindset to one self-care.

Alternatives to Steroids

Steroids are often used by young people who want to gain muscle quickly. However, conventional ways of gaining muscle, such as a well-planned workout and a healthy diet, are much safer. As an alternative to steroids, regular exercise and good nutrition can help build muscle safely.

High-intensity workouts, such as CrossFit or high-intensity interval training for weight lifters, can help young athletes build muscle when combined with a diet rich in protein, carbohydrates, and healthy fats.

Simply put, for the price of steroids an athlete could fill their pantry and refrigerator with healthy foods and develop lean muscle and true health. Steroids may lead to muscle gains in the short-term, but a regular exercise regimen and healthy eating habits will prepare the athlete for lifelong success.