Unmasking Steroid Use: Why Doctors Aren't Asking and What You Need to Know
"Are anabolic steroids slipping under the radar in substance abuse treatment? A new study reveals a concerning gap in patient screening and highlights the hidden risks."
Anabolic-androgenic steroids (AAS), synthetic versions of the male hormone testosterone, are known for their muscle-building (anabolic) and male characteristic-enhancing (androgenic) effects. While sometimes prescribed for specific medical conditions, their misuse is a growing concern, particularly among those struggling with substance use disorders (SUD).
AAS misuse carries significant health risks, ranging from cardiovascular and liver problems to psychological effects like aggression and mood swings. What's particularly troubling is that many individuals misusing AAS also struggle with other substance dependencies, creating a complex web of challenges for treatment and recovery.
A recent study sheds light on a concerning gap in how healthcare professionals address AAS misuse among patients in SUD treatment. The research reveals that AAS use is often overlooked, highlighting the need for increased awareness, better screening practices, and integrated treatment approaches.
A Serious but Undermeasured Concern
Anabolic-androgenic steroid use can affect physical and mental health, but the scale of its impact is difficult to summarize without reliable, subsection-specific statistics. The subject warrants careful attention because harms may remain unrecognized when steroid use is not disclosed. Any estimate of prevalence or risk should therefore be interpreted cautiously.
Recognition Remains Incomplete
Clinical approaches generally depend on patients disclosing steroid use and clinicians recognizing possible signs or complications. That process can miss cases when people do not volunteer information or present with problems that appear unrelated to steroid use. As a result, accepted clinical methods may identify consequences without always identifying the underlying use.
An Evolving Field
Understanding of anabolic-steroid use has developed gradually through research into its effects, associated harms, and clinical presentation. The field continues to refine how steroid-related problems should be identified and described. Historical interpretation should remain cautious because the available evidence and terminology have changed over time.
The Hidden World of Steroid Use in Substance Abuse Recovery
A study published in the Journal Brasileiro de Psiquiatria explored the prevalence of AAS use among patients undergoing treatment for substance use disorders. Researchers interviewed ten participants (eight men and two women) receiving treatment for SUD, using scales like ASSIST-WHO and MINI-SUD, alongside semi-structured interviews.
- High Rate of AAS Use: Seven out of the ten participants reported using AAS within the past year.
- Lack of Screening: None of the participants had been previously questioned about their AAS use by mental health professionals.
- Motivations for Use: Common reasons included low self-esteem, desire for weight loss, and wanting to improve physical appearance.
- Adverse Effects and Withdrawal: Participants reported side effects like voice changes, hair growth, acne, and psychological issues. Withdrawal symptoms included muscle loss, weight gain, and depression.
Research Moves Toward Clinical Recognition
A 2025 systematic review examines anabolic-androgenic steroid use through prevalence, motivations, physiological and psychological effects, risks, and remaining knowledge gaps. Recent clinical work also explores the possible pathophysiology, proposed diagnostic criteria, clinical presentation, and comorbidities of anabolic-androgenic steroid use disorder. The National Institute on Drug Abuse notes that these substances do not typically produce a euphoric high, yet users may develop a substance use disorder defined by continued use despite adverse consequences. A 2025 paper further describes AASs as testosterone and synthetic derivatives commonly used to gain muscle and improve strength and performance.
Why Recognition and Treatment Fall Short
AAS use is associated with serious mental and physical health problems, and evidence indicates that use among people who use psychoactive substances is higher than in the general population. Clinical recognition is complicated because some individuals do not identify their behavior as substance misuse and may first present with delayed, organ-specific complications rather than obvious signs of steroid abuse. Although evidence about harms has grown, reviews report little evidence on interventions to support cessation and treat the consequences of use. Recent comparisons of AAS use disorder with substance use disorder also examine overlapping sociodemographic, neuropsychiatric, and withdrawal features.
Different Clinical Pathways
Steroid-related problems may be encountered through substance-use care, general medical care, or treatment of a specific organ complication. These pathways can produce different opportunities for recognition and intervention. Without subsection-specific comparative evidence, the safest conclusion is that no single clinical setting should be assumed to capture every person who uses anabolic steroids.
Why This Matters: The Overlooked Dangers of AAS Misuse
The study's authors suggest that overlooking AAS misuse can complicate SUD treatment. Individuals may turn to escalating doses of other substances to compensate for the adverse effects of AAS or to manage withdrawal symptoms. The combination of AAS and other substances can also exacerbate mental health issues and increase the risk of relapse.
A Need for Coordinated Care
Available evidence connects AAS use with serious mental and physical health problems and indicates that use may be more common among people who use psychoactive substances than in the general population. Clinical guidance emphasizes evaluation and management by an interprofessional team. Together, these findings support coordinated care that addresses both steroid-related health consequences and possible use disorder.
Building Better Evidence
Future progress will likely depend on improving recognition, clarifying diagnostic approaches, and developing better-supported interventions for cessation and recovery. Research should also continue examining the physical and psychological consequences of anabolic-steroid use. Until that evidence grows, conclusions about the most effective clinical strategies should remain appropriately cautious.
The System Beyond the Clinic
The challenge extends beyond individual decisions because recognition, treatment access, and clinical expertise all shape whether steroid-related problems are addressed. Gaps in evidence can make it harder for health systems to establish consistent responses. A broader public-health approach should therefore account for both medical complications and barriers to identifying steroid use.
Visible Goals, Hidden Costs
AAS and other image- and performance-enhancing drugs are described as a growing public-health concern, with reported physical and mental harms that include cardiovascular risks and cognitive deficiencies. Real-world cases also include people using AAS while receiving treatment for a substance use disorder. These examples show why clinicians may need to consider steroid use even when a person enters care for another substance-related concern.
Increased awareness and proactive screening are crucial first steps. Mental health professionals need to be better equipped to identify AAS misuse and address the underlying issues that drive it, such as body image concerns, eating disorders, and low self-esteem.
By integrating AAS screening and treatment into existing SUD programs, healthcare providers can offer more comprehensive care, prevent relapses, and protect patients from the harmful effects of AAS misuse.