Behavioral and Psychological Changes Associated with Anabolic Steroid Use: A Comprehensive Review

Abstract

Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone widely used for medical purposes but increasingly misused for performance enhancement and body image improvement. The rising prevalence of AAS abuse, particularly among athletes, bodybuilders, and young adults, has become a significant public health concern. This review aims to comprehensively evaluate the behavioral and psychological changes associated with AAS use, focusing on underlying neurobiological mechanisms, patterns of abuse, and clinical implications. Evidence indicates that AAS misuse is associated with a broad spectrum of behavioral alterations, including increased aggression, impulsivity, risk-taking behavior, and, in severe cases, violent or criminal tendencies. In addition, users frequently experience psychological disturbances such as mood disorders (depression, mania, and anxiety), dependence, withdrawal symptoms, and cognitive impairments, including memory deficits and poor judgment. These effects are primarily mediated through alterations in central neurotransmitter systems, including dopamine, serotonin, and gamma-aminobutyric acid, as well as structural and functional changes in brain regions such as the amygdala and hippocampus. Both short-term and long-term use of AAS contribute to adverse mental health outcomes, with chronic exposure leading to persistent psychiatric disorders. Risk factors such as high dosage, prolonged use, early initiation, and environmental influences further increase susceptibility. Despite growing evidence, challenges such as underreporting and limited long-term human studies persist. Overall, AAS misuse is strongly linked to significant neuropsychiatric disturbances, highlighting the need for improved awareness, preventive strategies, and multidisciplinary clinical management.