Adverse effects of anabolic-androgenic steroids: a review

The use of anabolic-androgenic steroids (AS) is banned in most sporting activities. In September 1996, the British Government tightened up the legislation on AS by reclassifying them as class C, under the Misuse of Drugs Act. Generally, those who advocated this change in legislation, putting AS on par with, for example, cannabis and heroin, frequently referred to the dramatic adverse effects of AS. The aim of this review is to consider their side-effects relating to the cardiovascular system, liver and reproductive system, their cosmetic effects, and a selection of other effects reported in the literature. The picture that emerges from this is not necessarily dramatic and some explanations for this are offered. A distinction is made between adverse effects established as a consequence of clinical trials and case reports. Although self-reported side-effects should not be disregarded, the picture produced by these may be biased. When considering the adverse effects of AS use, it is important to bear in mind that the observed effects may be a synergistic action resulting from the use of several AS and other drugs used at the same time (polypharmacy), and the unknown content and quantity of preparations which are commonly obtained on the black market.