History and exam

Key diagnostic factors

common

increased weight gain and muscular build

Anabolic-androgenic steroid (AAS) use results in significant increases in lean body mass, which contribute to increased muscle mass.​[2]​

Reversible after cessation of AAS use.

increased appetite

Common with chronic use.

Reversible after cessation of AAS use.

consumption of nutritional supplements

Many bodybuilders and cosmetic athletes consume large amounts of nutritional supplements such as protein or creatine.[31]

use of other drugs to counteract adverse effects of AAS use

Many people with AAS use disorder also use other drugs (e.g., aromatase inhibitors, antiestrogens, clomiphene, human chorionic gonadotropin) to alleviate the negative effects associated with AAS use.[2][42]

aggression and mood swings

Psychiatric symptoms in AAS use are common; however, the potential confounding effects of other illicit substance use and prior psychiatric history need to be considered.[6][19]

AASs in supraphysiological concentrations influence several central nervous system functions, such as memory, aggressiveness, anxiety, and depression, particularly in predisposed individuals.[40]​ There seems to be a dose-related effect of AASs on mood disorders, with very high dosages of AASs causing manic symptoms in normal men.[1]​ "Roid rage" is the classic lay term to describe aggressive behavior that is seemingly due to AAS use.[2]

Reversible after cessation of AAS use.

gynecomastia

Common in males with chronic use.

Generally irreversible after cessation of AAS use.

hirsutism

Common in females with chronic use.

Generally irreversible after cessation of AAS use.

voice pitch alterations

Deepening of voice is a potential irreversible masculinizing effect of high-dose chronic AAS use in females.

clitoral hypertrophy

Common in females with chronic use.

Generally irreversible after cessation of AAS use.

testicular atrophy

Common in males with chronic use.

Seems to be reversible initially, and permanent after long-term use.

Other diagnostic factors

common

acne and/or oily skin

Common with chronic use.

Reversible after cessation of AAS use.

temporal hairline recession/male pattern baldness

Common with chronic use.

Male pattern baldness is seen in females and is potentially irreversible after cessation of AAS use.

striae or keloids

Common with chronic use.

Generally irreversible after cessation of AAS use.

menstrual irregularities

Amenorrhea or irregular menstrual cycles are common in females with chronic use.

Generally reversible after cessation of AAS use.

changes in libido

Common in males and females with chronic use.

Generally reversible after cessation of AAS use.

erectile dysfunction

Common in males with chronic use.

Generally reversible after cessation of AAS use.

infertility

Common in males with chronic use.

Both men and women become infertile by several different mechanisms. May be reversible on early cessation of AAS use.

premature masculinization/feminization (adolescents)

May occur in adolescents who use AASs.

cognitive impairment

Includes confusion, forgetfulness, and distractibility.

AASs profoundly affect mood and behavior. Most changes seem to be dose dependent and unpredictable.[1]​​

short stature (adolescents)

May be observed in adolescents, due to closure of epiphyseal plates.

Irreversible after cessation of AAS use.

needle marks

Common with chronic use of injectable AASs.

Generally reversible after cessation of AAS use.

Risk factors

strong

male sex

Use is primarily a problem among male athletes.[1]​ Many feel dissatisfied with weight, body composition, or performance, or feel pressure from team mates or coaches to improve performance.

Nonheterosexual male adolescents are at increased risk for anabolic-androgenic steroid (AAS) use.[26][27]

participation in competitive sports or bodybuilding

Participation in power sports such as bodybuilding, powerlifting, and weightlifting is the most prominent feature of users of AAS prior to initiation of use.[28]​ The practice is also widespread among participants in many other competitive sports.[6][7][28]

history of muscle dysmorphia or other body image disorder

Users often have low self-esteem or are unhappy with their body.[29][30]​ They obsess that they should be more lean and muscular. They may devote significant amounts of time to weight lifting and use dietary supplements.[31]​ Athletes with poor sense of self and body image insecurity can resort to substance abuse very easily.[32]

weak

employment as nightclub security officer, professional male dancer, professional wrestler, or law enforcement officer

Professions where a hypermasculine body image is perceived as being advantageous, such as security-related occupations (e.g., military, police, security) may be associated with androgen abuse.[19]

history of childhood physical or sexual abuse

In a study comparing male users and non-users of anabolic-androgenic steroids (AASs), users were much more likely to report history of sexual abuse.[33]

Women weight lifters who had been raped were twice as likely to report AAS use as those who had not been raped.[33]

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