Anabolic-androgenic steroids are controlled substances that are taken illicitly to enhance physical appearance and performance. In addition to the desired somatic effects, reasonably good evidence suggests that AASs are capable of influencing mood and behavior. A myriad of adverse effects have been reported. Although many of these effects appear to reverse with cessation of use, fatalities due to suicides, homicides, liver disease, heart attacks, and cancer have been reported infrequently among illicit users. Although studies are needed to quantify more precisely the long-term consequences and risks of using AASs, patterns of illicit use are particularly troublesome. The use of extremely high doses, needles, counterfeit and veterinary drugs, and multiple steroidal and nonsteroidal drugs simultaneously may further enhance the risks of using AASs. The clinician should suspect AAS use in high-risk individuals who manifest any of the possible consequences described in this article. Laboratory tests can be valuable for detection of use and assessment of consequences. Treatment approaches may borrow from proven techniques employed with other substance abusers, but should also address the special value that physical attributes and body image have for the AAS user.
Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone-containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 10%, varying between individuals) and these treatments tend to be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non-medical purposes.