Anabolic Androgenic Steroids (AAS)

How are they used?

Steroids are usually taken either by injecting them into the muscles, or by swallowing them in pill form. Hi-ground provides a comprehensive list of commonly used AAS injectables and orals in Australia.

People use steroids in different ways. Common methods include:

• Cycling – periods of using steroids followed by a break to allow the body to recover.
• Blast and cruise – switching between high and low doses without taking a full break. This approach may increase health risks due to constant use.^1,14

After completing a cycle of steroid use, many people turn to Post Cycle Therapy (PCT), which involves taking other substances to support their body’s recovery by:

• helping restore natural testosterone production
• reducing side effects, such as testicular atrophy (shrinking of the testicles), gynecomastia (development of breasts), and mood changes
• maintaining muscle mass or 'gains' acquired during the cycle.^15,16

While there are various regimes of PCT reported, common PIEDs used during PCT include:

• Selective Estrogen Receptor Modulators (SERMs), e.g. Tamoxifen (Nolvadex), Clomiphene (Clomid) - to reduce estrogen-related side effects.
• Aromatase Inhibitors (AIs), e.g. Anastrozole (Arimidex) – to reduce estrogen related side effects.
• Human Chorionic Gonadotropin (hCG) - to stimulate natural testosterone production and reverse testicular atrophy (shrinking of the testicles).¹⁶

Side effects of anabolic steroids

The use of any drug can have risks. It’s important to be careful when taking any type of drug.

Steroids affect everyone differently, based on:

• size, weight, sex and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the duration of use
• the strength of the drug (varies from batch to batch).

General short-term side effects include:

• water retention and bloating
• fatigue
• sleep problems
• feeling irritated, mood swings or aggression
• changes in sex drive
• male pattern baldness (in both males and females)
• severe skin issues (e.g. rash, acne). ^2,17

Males (people assigned male sex at birth) may also experience:

• hypogonadism - decreased natural production of testosterone
• gynecomastia - development of breasts
• testicular atrophy - shrinking of the testicles
• erectile dysfunction
• infertility
• prostate issues. ^18-20

Females (people assigned female sex at birth) may also experience:

• excessive hair growth
• breast size reduction
• permanent deepened voice
• clitoral enlargement
• issues with menstrual cycle.^18,19

Long-term effects

Long-term side effects include:

• cardiovascular issues (e.g. early-onset coronary heart disease, high blood pressure, sudden cardiac death)
• abnormal liver function and increased risk of liver tumour/cancer
• kidney disease and failure
• tendon and ligament damage
• stunted growth in adolescents
• reduced cognitive and memory function
• psychological effects (e.g. depression and steroid dependence). ^17-19,21,22

Steroids and Mental Health

The use of steroids has been found to have an impact on mental health. People who use steroids are more likely than people who don’t use them to report mood swings, anxiety, depression, body dysmorphia disorder and self-harm/suicidal intentions.^18,23-26

Tolerance

There is limited research on whether people can develop a tolerance to anabolic steroids.

However, the muscle-building effects of steroids often plateau over time due to the body’s natural limits on muscle growth and hormonal regulation.

Even with higher doses, the rate of muscle gain may slow down, and reflect diminishing returns – meaning that as the dose increases, the added benefit may become smaller and less noticeable, rather than the body developing tolerance in the traditional sense.^27,28

Dependence

While steroid use does not cause physical dependence, individuals may develop a psychological reliance on them, often due to the confidence and self-esteem boost they may provide.^29-31 This reliance can make it difficult to stop using steroids, especially when there's a fear of losing muscle size or definition.³²

For those who become dependent, steroid use can begin to dominate thoughts, emotions, and daily activities.

Withdrawal

Discontinuing the use of steroids may lead to several withdrawal symptoms, which can include:

• severe fatigue
• loss of appetite resulting in weight loss
• reduced physical strength
• feelings of depression.³¹

The use of steroids suppresses the body’s natural production of testosterone. When steroid use stops, there is often a delay - sometimes lasting weeks or even months - before natural testosterone levels begin to recover.²⁰

Overdose

Steroid use does not usually result in acute toxicity or overdose (when immediate harmful effects occur shortly after taking too much of a drug).

Prolonged non-medical use of steroids - particularly at high doses - can result in serious long-term health consequences and may increase the risk of premature death.^33,34

Mixing with other drugs

Steroid use may often involve polypharmacy – where a person mixes multiple substances to enhance results, manage side effects, or achieve specific aesthetic or performance goals.

This practice is commonly referred to as 'stacking' among people who use steroids. Stacking usually involves taking two or more types of steroids at the same time, often combining oral and injectable forms. While it can involve the use of different steroids, stacking can also include a wider variety of PIEDs.³⁵

Stacking is often believed to improve performance and aesthetic outcomes, but it can significantly increase the risk of health harms.³⁵

People who use steroids have been found to also use other illicit drugs, such as amphetamine, cannabis and cocaine at higher rates than the general population.35, 36

Mixing steroids with other drugs can have unpredictable effects and increase the risk of harm.

• Mixing steroids with stimulants (e.g. amphetamine, cocaine) – can lead to increased blood pressure and heart strain, and increases the risk of anxiety, aggression and overheating.
• Mixing steroids with depressants (e.g. alcohol, GHB, ketamine) – can impact your mood, slow down recovery, and raise the risk of overdose or injury.

Reducing harm

Steroids should be used with a valid prescription for a specific medical condition and under the supervision of a healthcare professional. For individuals who choose to use steroids for non-medical purposes, it’s crucial to take steps to minimise potential harm:

• If Injecting:
  • Always use new, sterile equipment and in a clean environment to reduce the risk of infections and transmission of blood-borne viruses. You can access free, sterile injecting equipment from local Needle and Syringe Programs (NSP).
  • Avoid spot injecting into small muscles (e.g. biceps, calves, pectorals). This does not enhance local muscle growth and instead significantly increases the risk of complications.
  • Rotate injection sites regularly to prevent tissue damage and reduce the risk of abscesses or scarring.
• Monitor your health: Schedule regular health check-ups, including blood tests (e.g. liver and kidney function, lipid profile, hormone levels) and cardiovascular screening to detect any issues early.
• Take regular breaks: Avoid continuous use of steroids. Taking regular breaks can help reduce long-term health risks and allow your body to recover.
• Avoid polydrug use: Refrain from using multiple steroids or PIEDs simultaneously, and do not mix them with illicit or pharmaceutical drugs. These combinations can lead to unpredictable effects and significantly increase the risk of harm.
• Be cautious with purchasing steroids from unregulated markets: Steroids from unregulated sources may be counterfeit or contaminated.³⁷ The Steroid Checking Project highlights the widespread presence of substandard steroids in Australia and offers valuable information for safer use.
• Rely on trusted sources for information: Peer networks and online forums may provide inconsistent or inaccurate advice. Hi-ground offers reliable resources, including A Practical Primer on Safer Use of Anabolic Steroids and Other Performance Enhancing Drugs - a comprehensive harm reduction guide designed to support informed and safer use practices.

Getting Help

If your use of anabolic steroids is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about a loved one, you can find help and support.

• National Alcohol and Other Drug Hotline (1800 250 015) – a free and confidential advice, information and counselling about alcohol and other drugs
• Counselling Online – a free and confidential online service that provides support to people across Australia affected by alcohol or drug use. 24 hours a day, 7 days a week.
• Steroid QNECT (1800 175 889) – a free and confidential service run by QuIVAA to provide support to people who use AAS and other PIEDs across Queensland. Mon – Fri, 9am-4pm. sonyaw@quivaa.org.au

You can discuss anabolic steroid use with your doctor, even if you have been using without a prescription. It can also help to have a chat with a counsellor about the potential reasons you are using anabolic steroids.