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Steroids Detox Guide: Symptoms, Timeline, and Effects

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steroid-treatment-man-with-counselorAnabolic-androgenic steroids (AAS) or, more simply, anabolic steroids are synthetic versions of the male sex hormone, testosterone. Anabolic steroids are medically indicated for the management of various conditions related to deficiencies in testosterone. Some people, however, take anabolic steroids to enhance their strength, performance, and/or appearance 1. Some users will mix several kinds of steroids or other performance enhancers to maximize effects. This simultaneous use of steroids/performance enhancers is called “stacking” 1.

Use of anabolic steroids without a prescription is not only illegal, but is strongly advised against, as it could be quite harmful to an individual’s health.

Currently, it is estimated that 3 million people use anabolic steroids in the United States 2. Those abusing steroids put their health – both physical and mental – at severe risk. Fortunately, help is available—both detox programs and rehabilitation can ease the process of withdrawal and provide the necessary therapies to help you maintain abstinence from steroids.

Signs and Symptoms of Withdrawal

Though uncommon, anabolic steroids use can lead to dependence 6, 7. Unlike other drugs like cocaine or opiates, steroids do not directly impact the reward pathways in the brain—processes that are more commonly believed to motivate a substance abuser to continue using a drug and further fueling a developing addiction. Rather, anabolic steroid users can get stuck in a pattern of compulsive use due to their perceived benefits (e.g., increased muscle mass), and the apprehension over losing said benefits.

As an anabolic steroid dependency grows, so do the risks of both physical and mental health complications, as well as the likelihood of unpleasant withdrawal symptoms at the point that the steroids aren’t used anymore.7 These symptoms can include:11

  • Depressed mood.
  • Fatigue.
  • Insomnia.
  • Reduced appetite.
  • Lowered sex drive.

If intense enough, symptoms can contribute to relapse and/or continued abuse. Another potential danger of steroid abuse is the possibility of using other drugs, such as opiates, to counteract the negative side effects of steroid use or withdrawals1.

Withdrawal symptoms can vary greatly depending on the person. Heavy, long-term steroid use carries a greater risk of increasing the severity of withdrawal symptoms. Those with an existing, past episode of, or genetic vulnerability to depression may also be at greater risk for depression during the withdrawal period.

There is a growing body of evidence to suggest that some personality traits and psychiatric disorders actually increase the risk of steroid abuse 8,9,10. These pre-existing conditions could also intensify withdrawal symptoms.

Steroid Detox Timeline and Protocol

How long steroids remain in your system depends on a number of factors. These include, but are not limited to, the type of steroid used, dosage, and duration used. Other factors such as age and weight might also have an impact.

Most individuals who abuse anabolic steroids do not seek out treatment 8. One reason for this is for fear of not wanting to lose the performance gains they’ve made as a result of steroid use. Some might also not see treatment as warranted in the absence of obvious psychological or physical symptoms 11.

It is important to remember that even in the absence of obvious symptoms, heavy and long-term anabolic steroid abuse can increase the risk for health complications down the road. If you or someone you know is steroid-dependent, it is important to seek treatment immediately. A number of options are available:

  • Inpatient detoxification
  • Medication
  • Behavioral therapy
Inpatient detoxification
This is an excellent option for those with particularly stubborn, or long-standing, histories of steroid use. Inpatient detoxification involves 24-hour supervised withdrawal in a live-in hospital or residence. Special consideration for this option should be given to those fearing an onset of depression/suicidal ideation during withdrawal. In most cases, inpatient treatment is more costly than other treatment options. Check your insurance policy to see if you are covered, specifically, for steroid detoxification and any accompanying health issues.
Management of Mood Disorders

For some individuals, pre-existing mental illness can potentiate an anabolic steroid abuse problem 8, 9, 10. When people suffer from one or more psychiatric disorders at the same time as a substance use disorder, they are said to be given a dual diagnosis. As mentioned above, depression is commonly associated with steroid abuse and withdrawal. Other common dual diagnoses associated with steroid abuse are anti-social personality disorder and body dysmorphic disorder.

Symptoms of antisocial personality disorder (ASPD) include:

steroid addict man lifting weights

  • Disregard for the feelings and safety of others.
  • Reckless behavior.
  • Impulsivity.
  • Failure to conform to social norms.
  • Irritability or aggressiveness.

Research suggests that conduct disorder, thought to be a potential pediatric precursor to ASPD, may predict future steroid use. The causal reasons for explaining steroid-seeking behavior in those with ASPD is unclear. One theory is that individuals with a history of violence seek substances that increase levels of aggressiveness. Another theory posits that since individuals with ASPD are likely to abuse many substances, they are more likely to also experiment with and potentially abuse steroids.  Exhibiting aggressive behaviors while taking steroids does not mean you have antisocial personality disorder. Oftentimes, aggressive behavior will remit after steroid withdrawal.

In the case of steroid abuse with co-occurring antisocial personality disorder, behavioral therapy, and sometimes medication, can help alleviate symptoms.

Body Dysmorphic Disorder (BDD) is a disorder where individuals perceive one of their own body features as ugly or deformed when, in reality, it is not 14. This obsessive preoccupation can lead to significant disruption in social and/or occupational functioning. BDD in anabolic steroid abusers is often called muscle dysmorphia. Individuals with muscle dysmorphia may perceive themselves as inadequate and fear having weak or small muscles. Research suggests that muscle dysmorphia is not only a type of BDD, but that it is associated with greater risk of depression and suicide 15. Muscle dysmorphia can be treated with medication and/or behavior therapy 16.

Because mental illness puts steroid abusers at greater risk for continued abuse and relapse, treatment for these disorders is necessary. Medication and/or behavior therapy can address most co-occurring psychiatric disorders. Some facilities, however, are not equipped to treat additional psychiatric issues. If you or someone you know has a dual diagnosis and is seeking inpatient detox/treatment for anabolic steroid abuse, make sure the facility you’ve contacted can address all needs, including treatment for additional psychiatric disorders.

How Does Supervised Detox Help?

Supervised or medically monitored detox provides the safest way to cease anabolic steroid use. Some people may be able to successfully detox from anabolic steroids alone. However, detoxing alone can increase the risk of continued abuse. Additionally, attempting to detox on your own may leave you without a means of safely addressing any depression/suicidal ideation that may arise during the process. Supervised detox not only ensures cessation of anabolic steroid use but provides professional care to properly manage withdrawal symptoms.

Do I Need Steroid Rehab?

Although anabolic steroid abuse doesn’t cause intoxication or feelings of euphoria, chronic users can still develop a maladaptive pattern of use. You may be unsure as to whether you need help for an anabolic steroid addiction or not but there are many signs that can indicate problematic and compulsive use, such as 17:

  • Developing tolerance, requiring that you take increased doses to experience the desired effect (amount of muscle mass).
  • Experiencing withdrawal symptoms with the cessation of or reduction in use.
    Taking steroids in larger amounts or for longer than originally intended, such as taking a shorter “off” period between dosing periods.
  • Attempting to control or cut down on steroid use but failing to do so.
  • Spending an inordinate amount of time getting steroids, using steroids, and recovering from its effects.
  • Sacrificing recreational, occupational, or social activities due to steroid use (and associated activities, such as working out).
  • Continuing to use steroids despite psychological or physical problems caused by steroid use.

If you exhibit any of the aforementioned signs, you may have problematic steroid use and could benefit from detox and formal addiction treatment.

Risks of Use

If you are abusing anabolic steroids, you’re risking your physical and psychological health. Heavy steroid users can take doses up to 100 times higher than what might be prescribed for legitimate steroid deficiency situations. Although steroid abusers sometimes take periodic breaks from steroid use (cycling), giving their body time to recuperate, they are still subject to the side effects and inherent health risks.

Physical Dangers

Among the most common side effects of anabolic steroid abuse are acne and fluid retention. Other side effects are gender- and age-specific and include the following:

Men:

  • Shrinkage of testicles (testicular atrophy).
  • Reduced sperm count or infertility.
  • Increased rate of prostate cancer.
  • Development of breasts (gynecomastia).
  • Baldness.

Women:

steroid-addict-woman-lifting-weights

  • Changes in or stoppage of menstrual cycle.
  • Male-pattern baldness.
  • Deepened voice.
  • Enlargement of the clitoris.
  • Growth of facial hair.

Adolescents:

  • Though debated, some studies point to stunted growth due to early skeletal maturation (closure of growth plates).
  • Early and accelerated changes in puberty.

Long-term physical dangers associated with the prolonged and heavy use of anabolic steroids include:

  • Early heart attacks.
  • Liver tumors, kidney failure, and strokes1.

Psychological Dangers

Abuse of anabolic steroids can also contribute to psychological changes or mental illness. Anabolic steroid users may experience extreme mood states, including manic-like or aggressive states (“roid rage”). Even those without a history of violent behavior are at greater risk for committing violent acts while abusing these drugs 3.

Other psychological side effects include:

man-dealing-with-depression-steroid-withdrawal

  • Delusions.
  • Depression.
  • Paranoia.
  • Irritability.
  • Impaired judgment due to feelings of invincibility.

Long-term steroid use brings wide-ranging risks over time. If you’re unable to stop using, consider getting help.

Drug Detox Facilities

There are a variety of steroid detox programs available for you or a loved one. The level and setting of detox that you choose is largely based on the severity of your addiction and your individual needs. The different detox programs available include:

  • Inpatient: Inpatient detox facilities require that you live at the detox center for the duration of the withdrawal process. Many people benefit from the structure of the program since they are separated from outside triggers or using situations. Trained medical and mental health professionals provide you with around-the-clock care and monitoring while you detox from steroids.
  • Hospital: Hospitals provide intensive detox settings in which patients receive 24-hour detox treatment and supervision. Medical staff are present to intervene if any medical complications arise.
  • Outpatient: Detox is available on an outpatient basis in which the patient lives at home and travels to the detox facility for scheduled visits. This is an appropriate option for someone who doesn’t want to take time off work or away from family in order to quit using steroids.
  • Physician’s office: Another outpatient detox option is to receive detox services through appointments with your physician.

Once you’ve completed a detox program, it’s important that you attend a steroid addiction treatment program. Detox helps your body to withdraw safely and comfortably from the drug but doesn’t equip you with the relapse prevention skills necessary to promote long-lasting recovery.

Finding a Treatment Program

You should be able to access necessary care through most drug treatment centers. When looking for a rehab center, make sure to ask about the features that are important to you. This may include:

  • Supervised detoxification.
  • Medication.
  • Behavioral therapy.
  • Dual diagnosis treatment.

If inpatient care is not an option, you may be able to address withdrawal symptoms and co-occurring psychiatric disorders on an outpatient basis. This means visiting a hospital, clinic or therapist to receive treatment a few times a week.


References:

  1. National Institute On Drug Abuse. (2006). Anabolic steroid abuse.
  2. de Souza, G. L., & Hallak, J. (2011). Anabolic steroids and male infertility: A comprehensive review. BJU International, 108(11), 1860-1865.
  3. Beaver, K. M., Vaughn, M. G., Delisi, M., & Wright, J. P. (2008). Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the united states. American Journal of Public Health, 98(12), 2185-2187. doi:10.2105/AJPH.2008.137018 [doi]
  4. Pope, H. G., & Katz, D. L. (1994). Psychiatric and medical effects of anabolic-androgenic steroid use: A controlled study of 160 athletes. Archives of General Psychiatry, 51(5), 375-382.
  5. Hall, R. C. W., Hall, R. C. W., & Chapman, M. J. (2005). Psychiatric complications of anabolic steroid abuse. Psychosomatics, 46(4), 285-290. doi:http://dx.doi.org.ezproxy.bu.edu/10.1176/appi.psy.46.4.285
  6. Substance Abuse and Mental Health Services Administration (US). (2006). Anabolic steroid abuse. Substance Abuse Treatment Advisory, 5(3)
  7. Talih, F., Fattal, O., & Malone, D. (2007). Anabolic steroid abuse: Psychiatric and physical costs. Cleveland Clinic Journal of Medicine, 74(5), 341.
  8. Kanayama, G., Brower, K. J., Wood, R. I., Hudson, J. I., & Pope Jr., H. G. (2010). Treatment of anabolic–androgenic steroid dependence: Emerging evidence and its implications. Drug and Alcohol Dependence, 109(1–3), 6-13. doi:http://dx.doi.org/10.1016/j.drugalcdep.2010.01.011
  9. Perry, P. J., Kutscher, E. C., Lund, B. C., Yates, W. R., Holman, T. L., & Demers, L. (2003). Measures of aggression and mood changes in male weightlifters with and without androgenic anabolic steroid use. Journal of Forensic Sciences, 48(3), 646-651.
  10. Handelsman, D., & Gupta, L. (1997). Prevalence and risk factors for anabolic‐androgenic steroid abuse in australian high school students. International Journal of Andrology, 20(3), 159-164.
  11. Cohen, J., Collins, R., Darkes, J., & Gwartney, D. (2007). A league of their own: Demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the united states. Journal of the International Society of Sports Nutrition, 4(1), 1-14.
  12. Medras, M., & Tworowska, U. (2001). Treatment strategies of withdrawal from long-term use of anabolic-androgenic steroids. [Postepowanie przy odstawianiu dlugotrwale stosowanych preparatow androgenno-anabolicznych] Polski Merkuriusz Lekarski : Organ Polskiego Towarzystwa Lekarskiego, 11(66), 535-538.
  13. Rahnema, C. D., Lipshultz, L. I., Crosnoe, L. E., Kovac, J. R., & Kim, E. D. (2014). Anabolic steroid–induced hypogonadism: Diagnosis and treatment. Fertility and Sterility, 101(5), 1271-1279. doi:http://dx.doi.org/10.1016/j.fertnstert.2014.02.002
  14. Phillips, K. A. (2004). Body dysmorphic disorder: Recognizing and treating imagined ugliness. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 3(1), 12-17.
  15. Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips, K. A. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image, 2(4), 395-400. doi:10.1016/j.bodyim.2005.09.001
  16. Substance Abuse and Mental Health Services Administration (US). (2006). Detoxification and substance abuse treatment.
  17. Kanayama, G., Brower, K.J., Wood, R.I., Hudson, J.I., Pope, H.G. (2009). Issues for DSM-V: Clarifying the Diagnostic Criteria for Anabolic-Androgenic Steroid Dependence. The American Journal of Psychiatry, 166 (6), 642-645.

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