In recent decades, the use of anabolic-androgenic steroids (AAS) has surged, particularly among athletes, bodybuilders, and fitness enthusiasts seeking increased muscle mass, endurance, and physical performance. While much attention has been given to the physiological effects and ethical controversies of steroid use, a growing body of research has begun to explore an equally important aspect: the psychological impact of AAS, particularly its relationship with anxiety and antianxiety treatments.
Understanding Anabolic Steroids
Anabolic steroids are synthetic derivatives of testosterone, the primary male sex hormone. They are designed to mimic its muscle-building (anabolic) effects while minimizing the masculinizing (androgenic) traits. Medically, they may be prescribed for conditions like delayed puberty, muscle loss from diseases such as cancer or AIDS, or hormonal imbalances. However, their non-medical use — especially at doses far exceeding therapeutic recommendations — is where health complications often arise.
These substances can be taken orally, injected intramuscularly, or applied through gels or patches. AAS users often cycle (use for a period, stop, then resume) or stack (combine several types of steroids) to maximize benefits and minimize side effects — though evidence suggests these strategies are not particularly effective at reducing harm.
The Psychological Toll of Steroid Use
While the physical side effects of steroid use are well documented — including liver damage, cardiovascular disease, and reproductive issues — the psychological consequences are less often discussed. Research shows that AAS use can significantly impact mental health, leading to mood swings, aggression (“roid rage”), irritability, depression, and anxiety.
Anxiety, in particular, emerges as a complex and paradoxical side effect. For some users, anabolic steroids initially produce a sense of confidence, energy, and reduced social anxiety due to increased testosterone and the accompanying physical changes. However, as use continues or during withdrawal phases, many individuals experience heightened anxiety, restlessness, and even panic attacks.
Steroid Withdrawal and Anxiety
When users cease AAS intake, their bodies often struggle to restart natural testosterone production, leading to a hormonal crash. This crash can precipitate symptoms of both depression and anxiety. Many users report intense psychological distress during this phase, characterized by low mood, irritability, and a pervasive sense of unease.
This withdrawal-related anxiety is sometimes severe enough to lead individuals to seek medical help or self-medicate, often with antianxiety medications such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs). However, these medications come with their own risks and potential for dependence, particularly when used without professional guidance.
Antianxiety Medications: A Double-Edged Sword?
Benzodiazepines (e.g., diazepam, lorazepam) and SSRIs (e.g., sertraline, fluoxetine) are commonly prescribed for anxiety disorders. While they can be effective, their interaction with anabolic steroids is not thoroughly studied. Anecdotal evidence and some clinical reports suggest that the use of both substances can lead to unpredictable mood effects, blunted emotional responses, or paradoxical increases in anxiety.
Moreover, individuals who use AAS often do so outside of a supervised medical setting. When they experience psychological distress, they may turn to antianxiety medications without understanding the underlying hormonal imbalances contributing to their symptoms. This self-medicating behavior increases the risk of drug interactions, misuse, and potential dependency.
The Role of Body Image and Performance Pressure
A key driver behind both steroid use and anxiety is body image dissatisfaction and performance pressure — particularly in competitive environments like bodybuilding, sports, or even social media spaces where physical appearance is scrutinized.
Conditions like muscle dysmorphia — sometimes referred to as “bigorexia” — are especially relevant. This disorder involves a distorted body image in which individuals believe they are never muscular or lean enough. Those affected are more likely to use steroids and also more prone to anxiety, depression, and compulsive behaviors.
This creates a vicious cycle: individuals turn to steroids to enhance their physique, experience short-term improvements, then face withdrawal or mental health issues, which in turn may lead to further substance use, including antianxiety medications.
Toward a Holistic Understanding
Understanding the intersection between anabolic steroid use and anxiety requires a multifaceted approach. It’s not merely a matter of substance abuse, but a broader issue of mental health, societal pressures, and individual vulnerability. Addressing this complex relationship means expanding our focus beyond physical outcomes to include emotional and psychological well-being.
Healthcare professionals need to be aware of the signs of AAS use and its psychological side effects, especially when patients present with unexplained anxiety or mood disturbances. Education and prevention efforts should highlight not only the physical risks of steroids but also the mental health implications. Moreover, athletes and young people — especially males — should be encouraged to seek healthy, sustainable ways to manage body image concerns and performance anxiety.
Conclusion
The relationship between anabolic steroids and anxiety is both significant and often overlooked. While steroids may initially seem to offer benefits in terms of confidence and performance, the long-term psychological consequences — particularly the emergence or worsening of anxiety — can be profound. Antianxiety medications may offer short-term relief, but without addressing the root causes, they can become part of a broader cycle of dependency. A comprehensive, informed approach is essential for helping individuals break this cycle and achieve true physical and mental well-being.