Use of steroids for self-enhancement: an epidemiologic/societal perspective

Humans are basically competitive. For centuries, athletes have used various substances to enhance performance, increase strength, and prolong endurance. In the early 1940s, research indicating that testosterone improved a sense of well-being, appearance, and sexual performance led to the use of anabolic steroid hormones by a select few athletes. Today, even among high school students, the use of androgenic steroid hormones is prevalent, with 1% to 2% of adolescent girls and 4% to 6% of adolescent boys having used an anabolic steroid at least once. An estimated 1 million people in the United States are current of former users of anabolic-androgenic steroid hormones, with men having a higher prevalence of use than women. Androgenic steroid use has been associated with the use of other illicit drugs, cigarette smoking, and alcohol use. Nevertheless, anabolic-androgenic steroid hormones appear to have legitimate uses in certain patients. In HIV-infected, hypogonadal men, anabolic steroid hormones optimize muscle strength and muscle mass when combined with resistance exercise. Although a large number of people have used these drugs for many years, no studies of the long-term health effects have been done. However, when taken in supraphysiologic doses, these drugs are known to cause a wide range of acute adverse effects. When used in less then supraphysiologic doses in eugonadal or hypogonadal HIV-infected patients, these drugs reverse HIV-related hypogonadism, muscle wasting, and perhaps lipodystrophy. Provided that the oral preparations are not used and patients are closely monitored, anabolic-androgenic steroid hormones offer HIV-infected patients a better quality of life and an improved sense of well-being.