Author
Department of Psychology, Faculty of Ethics and Education, Institute for Humanities and Cultural Studies (IHCS).
Abstract
Background and Aim: Anabolic-androgenic steroids (AAS) are a family of drugs that include the naturally occurring male hormone testosterone, which exhibit varying degrees of anabolic (muscle-building) and androgenic (masculinizing) effects. When taken in supraphysiological doses, AAS allow individuals to gain large amounts of muscle mass and lose body fat, often beyond the limits that can be achieved naturally. Because of these properties, AAS use has become a major substance use disorder worldwide. AAS use has become a relatively common substance use disorder in many countries, particularly Scandinavia, the United Kingdom, and Brazil. Other countries in continental Europe are also now showing increasing rates of AAS use, while AAS use is very rare in East Asian countries, such as China, Korea, and Japan. The uneven distribution of AAS use worldwide appears to be related to cultural factors. Since AAS use is arguably the newest substance use disorder in the world, many aspects of AAS are still poorly understood by both clinicians and researchers. Recent research findings indicate a high rate of steroid use among Iranian athletes, as well as a low level of awareness among users about these drugs. Low awareness, coupled with misconceptions, accessibility, and ease of obtaining these drugs, can lead to increased use of these drugs in athletes and various populations, which highlights the need for greater attention from authorities and the design of prevention programs. The aim of this study is to review the most fundamental issues related to the diagnosis and treatment of AAS abuse.
Research Method: This study used a narrative review method. Literature review articles or narrative review articles provide abstracts and narrative evaluations of findings or theories in a literature database. Literature databases may include qualitative, quantitative, or mixed methods studies. To collect data, relevant articles between 1990 and 2025 were searched in Google Scholar, PubMed, NOORMAGS, SID, and irandoc databases using the keywords anabolic-androgenic steroids, toxicity, dependence, withdrawal syndrome, and treatment. Articles that were not written in English or Persian or were book chapters, conference papers, extended abstracts, or preprints were excluded. A list of articles was obtained and the abstracts were read to assess relevance. Using this method, 105 articles were identified and accessed. Then, each article was read and analyzed, and finally, 26 articles were selected for data extraction.
Findings: It is difficult to accurately estimate the number of people who use AAS in different countries. Surveys have led to several widespread misconceptions about the prevalence of AAS use, including that AAS use is not uncommon in adolescent girls, that AAS use is a common phenomenon in adolescents, and that AAS use occurs mainly among athletes. In fact, the majority of AAS users are men over 18 years of age who do not participate in any competitive sports. The number of AAS users in different countries has been estimated to be 0.5–2% among men and approximately 30% of Iranian professional athletes and bodybuilders. The most concerning consequence of long-term exposure to AAS is its effect on the cardiovascular system, especially premature death from myocardial infarction in young men. Exogenous AAS suppress the function of the hypothalamic-pituitary-testicular axis in men, leading to decreased gonadotropin production from the hypothalamus, decreased luteinizing hormone and follicle-stimulating hormone from the pituitary, and consequently reduced testicular production of testosterone and sperm, and discontinuation of AAS, especially after a long period of use, is likely to result in AAS-induced hypogonadism, which is defined as decreased functional activity of the gonads. AAS use and withdrawal may precipitate major mood disorders, including hypomania and depression, in some susceptible individuals. These mood effects appear to be highly individual-specific, and the mechanisms underlying these specific responses are not well understood. AAS have also been associated with a variety of other less serious or less common adverse effects on other organs, including severe body acne, gynecomastia, hepatotoxicity, cases of renal failure, apoptosis, delayed sleep onset, impaired daytime functioning, and use of hypnotic drugs in AAS-using athletes. AAS can cause a dependence syndrome characterized by chronic AAS use that may be continued despite adverse effects. AAS users rarely seek treatment, and the available research literature on treatment is therefore sparse.
Discussion and Conclusion: Since widespread AAS use is very new, psychiatric research findings on the epidemiology, characteristics, and treatment of this disorder are limited compared to the volume of research on other forms of substance use, and many findings in this area remain tentative, and misconceptions about AAS use are still prevalent among both the general public and mental health professionals. This situation is likely to change over the next decade or two, as more older AAS users experience side effects that require clinical attention and treatment. AAS use in Iranian athletes appears to be a challenge facing the health system. The lack of sufficient knowledge among Iranian coaches and athletes about the side effects and consequences of steroid use has dramatically facilitated the use of these substances, and therefore the development of comprehensive educational programs to raise the awareness of athletes and coaches seems essential. Studies show an increase in awareness, perceived severity, and behavioral intention to abstain from using anabolic steroids after completing a training program among Iranian athletes, and demonstrate the usefulness of organizing educational classes for them. The epidemiology of AAS users in different Iranian communities, especially competitive athletes, and the subsequent investigation of the consequences of chronic use of these substances is an important step in shaping indigenous knowledge in this area.
Keywords
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