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Steroids and Other Appearance and Performance Enhancing Drugs (APEDs)

How are anabolic steroids used?

Some anabolic steroids are taken orally, others are injected intramuscularly,29 and still others are provided in gels or creams that are applied to the skin.35 Many users start with the oral form and then progress to injectable forms,36 since the latter causes less liver damage. However, oral steroids clear more rapidly from the body, often making this the preferred route for users concerned with drug testing.29 Doses taken by people misusing these substances can be 10 to 100 times higher than the doses used to treat medical conditions.36

Commonly Misused Steroids

Oral Steroids

  • Anadrol (oxymetholone)
  • Anavar (oxandrolone)
  • Dianabol (methandienone )
  • Winstrol (stanozolol)
  • Restandol (testosterone undecanoate)

Injectable Steroids

  • Deca-Durabolin (nandrolone decanoate)
  • Durabolin (nandrolone phenpropionate)
  • Depo-Testosterone (testosterone cypionate)
  • Agovirin (testosterone propionate)
  • Retandrol (testosterone phenylpropionate)
  • Equipoise (boldenone undecylenate)29,34

Cycling, stacking, pyramiding, and plateauing

Steroids are often used in patterns called "cycling." This involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. People who misuse steroids also typically "stack" the drugs, meaning that they take two or more different anabolic steroids, mix oral and/or injectable types, and sometimes even take compounds that are designed for veterinary use.37,38 The belief is that different steroids interact to produce an effect on muscle size that is greater than the effects of each drug individually,36 a theory that has not been tested scientifically.

Another common mode of steroid misuse is referred to as "pyramiding," which typically involves taking them in a cycle of six to 12 weeks, tapering gradually rather than starting and finishing a cycle abruptly. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Steroid users believe that pyramiding allows the body time to adjust to the high doses, and the drug-free cycle allows the body's hormonal system time to recuperate.2

A technique called "plateauing" may also be used, whereby steroids are staggered, overlapped, or substituted with another type of steroid to avoid developing tolerance.36 As with stacking, the effects of pyramiding, cycling, and plateauing have not been substantiated scientifically.

This page was last updated February 2018

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NIDA. (2018, February 21). Steroids and Other Appearance and Performance Enhancing Drugs (APEDs). Retrieved from https://www.drugabuse.gov/publications/research-reports/steroids-other-appearance-performance-enhancing-drugs-apeds

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