National Athletic Trainers’ Association Position Statement: Anabolic Androgenic Steroids


This manuscript summarizes the best available scholarly evidence related to anabolic-androgenic steroids (AAS) as a reference for health care professionals, including athletic trainers, educators, and interested others.


Health care professionals associated with sports or exercise should understand and be prepared to educate others about AAS. These synthetic, testosterone-based derivatives are widely abused by athletes and nonathletes to gain athletic performance advantages, develop their physiques, and improve their body image. Although AAS can be ergogenic, their abuse may lead to numerous negative health effects.


Abusers of AAS often rely on questionable information sources. Sports medicine professionals can therefore serve an important role by providing accurate, reliable information. The recommendations provide health care professionals with a current and accurate synopsis of the AAS-related research.


  • Steroid hormones are a class of chemical messengers that affect body tissues and have anti-inflammatory, salt-retaining and feminizing or masculinizing properties depending on the substance
  • In males, testosterone levels peak during puberty and level off as they grow older
  • USA classifies the many available AAS as Schedule III controlled substances
  • AAS are available as oral, injectable, buccal, subcutaneous pellets, and transdermal patches, creams and gels
  • AAS appear to promote protein synthesis through increased transcription while also acting as glucocorticoid antagonists, limiting catabolism
  • AAS induce various potentially ergogenic psychotropic actions and alter the neurochemistry
  • ATs should recognize the possible therapeutic uses for AAS and the potential for abuse
  • Abuse of AAS is used to gain performance improvement, physique development, and body-image enhancement
  • Males abuse AAS more frequently than females
  • AAS abuse can start as early as middle school
  • Counterfeit AAS are common, leading to product quality concerns with impurities, and contaminants
  • People who abuse AAS usually take them in much higher doses than therapeutic replacement levels
  • AAS abuse is often cyclical in cycles of 6 to 12 weeks of use
  • The efficacy for AAS generally measure with strength or power-related performances
  • AAS usage may be associated with hypomanic or manic syndromes that are characterized by irritable or aggressive behavior
  • Major depression may be associated with AAS withdrawal
  • Cardiovascular effects of AAS abuse indicate conditions such as HCM and an increase in risk for coronary artery disease due to the lipid changes
  • Exogenous AAS abuse can alter thyroid function, glucose tolerance, luteinizing hormones, and follicle-stimulating hormones
  • Abuse of AAS directly affects the male reproductive system, although many of this side effects are reversible once AAS stops
  • Females who abuse AAS see reproductive changes that generally involve virilization and many of these side effects are permanent
  • Skeletally immature AAS abusers may have premature epiphyseal closure of the long bones
  • Tendinopathies, including tendon rupture, are common in AAS abusers
  • Dermatological conditions are also common side effects of AAS abuse
  • Due to the small number of high quality studies it is undeterminable whether drug testing deters the abuse of AAS
  • ATs should be aware of the dynamic, social processes for AAS abuse


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