What are the effects of illicit steroid use and how are they treated?

Effects of Illicit Steroid Use and Their Treatment

Illicit anabolic-androgenic steroid (AAS) use causes significant cardiovascular damage, hormonal disturbances, psychiatric effects, and can lead to dependency, with treatment requiring a multidisciplinary approach focused on discontinuation and management of specific complications. 1

Adverse Health Effects of Anabolic-Androgenic Steroids

Cardiovascular Effects

• Cumulative lifetime AAS exposure is associated with adverse cardiovascular findings and impaired ventricular function in both men and women 1
• Long-term AAS use (>5 years) is linked to more severe coronary artery calcification and higher odds of coronary noncalcified plaques 1
• AAS use causes impaired left and right ventricular function, with decreased global longitudinal strain 1
• Cardiovascular toxicity is one of the most concerning long-term adverse effects of supraphysiologic AAS doses 2

Endocrine and Reproductive Effects

• Common somatic adverse reactions include gynaecomastia, infertility, and testicular dysfunction 3
• Hormonal disturbances occur throughout the body's endocrine system due to disruption of normal testosterone regulation 3
• Sexual dysfunction is a documented side effect of prolonged AAS use 4

Dermatological Effects

• Acne is one of the most common physical manifestations of AAS use 3
• Skin disorders and alopecia can occur with prolonged steroid use 5

Psychiatric and Behavioral Effects

• AAS use is associated with various psychiatric disorders and antisocial behavior 3
• Hypomanic or manic symptoms, sometimes with aggression or violence, can occur during active AAS use 2
• Depressive symptoms commonly occur during AAS withdrawal 2
• These behavioral effects are idiosyncratic and affect only a minority of users 2
• Use of AAS in combination with alcohol significantly increases the risk of violence and aggression 4
• Some users have pre-existing psychological traits including low self-esteem, childhood conduct disorder, and tendency toward high-risk behavior 4

Dependency and Polydrug Use

• AAS can cause a dependence syndrome in a substantial minority of users, though the dependence liability is relatively low compared to other illicit substances 4, 2
• AAS users often ingest other illicit drugs, including both "body image" drugs and classical drugs of abuse 2
• AAS users appear particularly prone to opioid use, possibly due to shared brain mechanisms 2

Treatment Approaches

Discontinuation of AAS

• The primary intervention is cessation of AAS use, as many adverse effects may be reversible with discontinuation 4
• Withdrawal effects from AAS are relatively mild compared to other substances of abuse 4

Management of Steroid-Related Complications

Cardiovascular Monitoring and Treatment

• Patients with history of AAS use should undergo cardiovascular assessment including echocardiography to evaluate ventricular function 1
• For those with >5 years of cumulative use, more thorough evaluation for coronary artery disease is warranted 1

Hormonal Restoration

• Endocrine evaluation and potential hormone replacement therapy may be needed to restore normal hormonal function 3
• Treatment of gynaecomastia may require medical or surgical intervention depending on severity and duration 3

Psychiatric Support

• Assessment and treatment of psychiatric symptoms is essential, particularly during withdrawal periods 2
• Behavioral therapy and counseling should address underlying psychological factors that may have contributed to AAS use 4

Harm Reduction Approaches

• Harm reduction services can provide education about safer injection practices and risks of adulterated products 6
• However, peer influence among established users may sometimes undermine harm reduction goals by promoting risky practices 6
• Education about the dangers of using drugs from the illicit market is crucial, as many users are unaware of potential hazards 6

Special Considerations

Duration of Use and Risk

• Severity of adverse effects appears dose and duration-dependent, with significant cardiovascular damage noted after 5+ years of use 1
• Short-term, low-dose use has fewer documented severe side effects 4

Gender Differences

• While AAS use is more common in men, women who use AAS experience similar cardiovascular complications 1
• Gender-specific effects require tailored assessment and treatment approaches 1

Polydrug Use

• Treatment should address concurrent use of other substances, particularly opioids 2
• Comprehensive substance use assessment is essential for effective treatment planning 2