Case reports and small studies indicate that anabolic steroids increase irritability and aggression,75 although findings may be confounded by personality traits that are overrepresented in steroid users (i.e., antisocial, borderline, and histrionic personality disorder)78 and use of other drugs.79 People who misuse anabolic steroids report more anger than nonusers,80 as well as more fights, verbal aggression, and violence toward their significant others,81 sometimes called "roid rage." One study suggests that the mood and behavioral effects seen during anabolic-androgenic steroid misuse may result from secondary hormonal changes.82
Scientists have attempted to test the association between anabolic steroids and aggression by administering high steroid doses or placebo for days or weeks to human volunteers and then assessing behavioral symptoms. In one such study, researchers found that testosterone over a six week period was associated with increased aggression, as assessed by a questionnaire and computer-based model of aggressive behavior.83 In addition, high steroid doses produced greater feelings of irritability and aggression than placebo,84 although the effects appear to be highly variable across individuals,19 and other studies have not shown that effect.85 One possible explanation, according to the researchers, is that some but not all anabolic steroids increase irritability and aggression.
Anabolic steroid users are more likely than nonusers to report anxiety.34,86 Moderate to high doses of anabolic steroids are also associated with major mood disorders such as mania, hypomania,87 and major depression.86,87 In one study, manic symptoms were not uniform across individuals, with most showing little psychological change, whereas a few demonstrated prominent effects.19
Other Drug Use
Anabolic steroid users are more likely to use drugs such as marijuana, prescription opioids, cocaine,88 or heroin.86 In a study of men admitted to treatment for opioid use disorders, 25 percent reported prior use of anabolic steroids. Some described first learning about opioids from friends at the gym, and that they first purchased opioids from the same person who had sold them the anabolic steroids.89 In a study of anabolic steroid users dependent upon the injectable opioid analgesic nalbuphine, most reported that they began using nalbuphine to treat pain from weightlifting injuries. They also described widespread use of nalbuphine in their gyms.90
Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for addiction to heroin or other opioids found that 9.3 percent had previously misused anabolic steroids. Of these, most reported using opioids to counteract insomnia, irritability, depression, and withdrawal from anabolic steroids.91