Anabolic-androgenic steroid (AAS) use creates an addictive state, and dependency becomes a motivator for continued use.[6]Thirumalai A, Anawalt BD. Androgenic steroids use and abuse: past, present, and future. Urol Clin North Am. 2022 Nov;49(4):645-63.
http://www.ncbi.nlm.nih.gov/pubmed/36309421?tool=bestpractice.com
[19]Handelsman DJ. Androgen misuse and abuse. Endocr Rev. 2021 Jul 16;42(4):457-501.
https://www.doi.org/10.1210/endrev/bnab001
http://www.ncbi.nlm.nih.gov/pubmed/33484556?tool=bestpractice.com
Despite the cyclical nature of drug dependency due to withdrawal effects upon cessation (e.g., headache, myalgia, fatigue, insomnia, low mood), most people who use AASs will eventually discontinue AAS use.[19]Handelsman DJ. Androgen misuse and abuse. Endocr Rev. 2021 Jul 16;42(4):457-501.
https://www.doi.org/10.1210/endrev/bnab001
http://www.ncbi.nlm.nih.gov/pubmed/33484556?tool=bestpractice.com
[61]Sharma A, Grant B, Islam H, et al. Common symptoms associated with usage and cessation of anabolic androgenic steroids in men. Best Pract Res Clin Endocrinol Metab. 2022 Sep;36(5):101691.
https://www.doi.org/10.1016/j.beem.2022.101691
http://www.ncbi.nlm.nih.gov/pubmed/35999138?tool=bestpractice.com
AAS use increases the risk for hospital admission and death.[62]Horwitz H, Andersen JT, Dalhoff KP. Health consequences of androgenic anabolic steroid use. J Intern Med. 2019 Mar;285(3):333-40.
https://www.doi.org/10.1111/joim.12850
http://www.ncbi.nlm.nih.gov/pubmed/30460728?tool=bestpractice.com
Many people will, however, choose to continue AAS use despite negative consequences.[54]Kanayama G, Brower KJ, Wood RI, et al. Treatment of anabolic-androgenic steroid dependence: emerging evidence and its implications. Drug Alcohol Depend. 2010 Jun 1;109(1-3):6-13.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875348
http://www.ncbi.nlm.nih.gov/pubmed/20188494?tool=bestpractice.com
One review suggests that about one third of people who use AASs seek support from clinicians.[37]Amaral JMX, Kimergård A, Deluca P. Prevalence of anabolic steroid users seeking support from physicians: a systematic review and meta-analysis. BMJ Open. 2022 Jul 4;12(7):e056445.
https://www.doi.org/10.1136/bmjopen-2021-056445
http://www.ncbi.nlm.nih.gov/pubmed/35788077?tool=bestpractice.com
The uptake of support is limited by perceived stigma or embarrassment about AAS use, lack of trust in the knowledge of health professionals, fear of judgmental reactions, and not wanting to be identified as "drug" users or as visiting such support services.[4]Havnes IA, Jørstad ML, Wisløff C. Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires. Subst Abuse Treat Prev Policy. 2019 May 16;14(1):20.
https://www.doi.org/10.1186/s13011-019-0206-5
http://www.ncbi.nlm.nih.gov/pubmed/31096999?tool=bestpractice.com
[55]Harvey O, Keen S, Parrish M, et al. Support for people who use anabolic androgenic steroids: a systematic scoping review into what they want and what they access. BMC Public Health. 2019 Jul 31;19(1):1024.
https://www.doi.org/10.1186/s12889-019-7288-x
http://www.ncbi.nlm.nih.gov/pubmed/31366349?tool=bestpractice.com
Those who started using AAS use due to body dysmorphia and related conditions may find it difficult to stop if the underlying problems are not addressed.[53]Pope HG Jr, Kanayama G. Body image disorders and anabolic steroid withdrawal hypogonadism in men. Endocrinol Metab Clin North Am. 2022 Mar;51(1):205-16.
http://www.ncbi.nlm.nih.gov/pubmed/35216717?tool=bestpractice.com