Joseph G. Oberlander and Leslie P. Henderson of Dartmouth Medical School recently published a paper titled “The Sturm und Drang of anabolic steroid use: angst, anxiety and aggression,” focusing on possible short-term and long-term behavioral effects of using illicit anabolic androgenic steroids (AAS).

While this type of steroids may be used sparingly to treat certain injuries with minimal side effects, athletes who use AAS to improve performance tend to use it more frequently in larger doses.

Aside from the physiological harms associated with abuse of AAS, such as hormonal fluctuations, hair loss, enlarged mammary glands, and fertility issues, studies have also found that AAS use can cause significant changes in behavior.

In their paper, Oberlander and Henderson detail the behavioral effects of AAS on anxiety, stating that although adult men have reported experiencing euphoria early in the course of AAS administration, long-term users may see an increase in irritability, undirected anger, hostility, and overall aggression. This aggression and anger can lead to anxiety and lower self-esteem, causing the athlete to increase AAS usage to counter perceived inability and/or weakness.

“Roid rage” is the term used by the popular press to describe the violent outbursts of athletes known or suspected to abuse steroids. The paper shows that the increased levels of aggression and anxiety can manifest themselves in violent outbursts directed towards other individuals who are perceived as a threat. Studies also show that AAS renders subjects more likely to perceive someone as threatening or intruding.

The paper also states that animal and human subjects who have ceased to take AAS still exhibit signs of aggression and anxiety. The paper suggests that this is due to the prolonged suppression of hormonal glands in the body during steroid abuse. During sustained AAS use, the body reduces its own output of testosterone in an attempt to balance hormonal levels. Because of the high dosages involved in steroid abuse, hormonal imbalance occurs despite the body’s attempts to achieve balance. Even after stopping AAS use, the suppressed hormonal glands do not immediately return to normal, leading to decreased levels of testosterone that can cause heightened anxiety.

The paper concludes that the social dysfunction, depression, anxiety, and aggression caused by the illicit use of AAS are just as harmful as the potential physiological damages. Indeed, while the physiological damage can be repaired following cessation of steroid use, behavioral damage takes much longer to heal. The paper also suggests that the damage caused by AAS is underestimated, because studies do not take into account the likelihood of alcohol and other substance abuse by athletes who have become depressed due to prolonged AAS use.