Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 7
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Calzo, Jerel P. Horton, Nicholas J. Sonneville, Kendrin R. Swanson, Sonja A. Crosby, Ross D. Micali, Nadia Eddy, Kamryn T. and Field, Alison E. 2016. Male Eating Disorder Symptom Patterns and Health Correlates From 13 to 26 Years of Age. Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 55, Issue. 8, p. 693.

    Fayyazi Bordbar, Mohammad Reza Abdollahian, Ebrahim Samadi, Roya and Dolatabadi, Hamid 2014. Frequency of Use, Awareness, and Attitudes Toward Side Effects of Anabolic–Androgenic Steroids Consumption Among Male Medical Students in Iran. Substance Use & Misuse, Vol. 49, Issue. 13, p. 1751.

    Hildebrandt, Tom Shope, Sydney Varangis, Eleanna Klein, Diane Pfaff, Donald W. and Yehuda, Rachel 2014. Exercise reinforcement, stress, and β-endorphins: An initial examination of exercise in anabolic–androgenic steroid dependence. Drug and Alcohol Dependence, Vol. 139, p. 86.

    Hildebrandt, Tom and Greif, Rebecca 2013. Stress and addiction. Psychoneuroendocrinology, Vol. 38, Issue. 9, p. 1923.

    Kanayama, Gen and Pope, Harrison G. 2012. Illicit use of androgens and other hormones. Current Opinion in Endocrinology & Diabetes and Obesity, Vol. 19, Issue. 3, p. 211.

    Nyberg, Fred and Hallberg, Mathias 2012. New Perspectives of Central Nervous System Injury and Neuroprotection.

    Hildebrandt, Tom Lai, Justine K. Langenbucher, James W. Schneider, Melanie Yehuda, Rachel and Pfaff, Donald W. 2011. The diagnostic dilemma of pathological appearance and performance enhancing drug use. Drug and Alcohol Dependence, Vol. 114, Issue. 1, p. 1.


What can allostasis tell us about anabolic–androgenic steroid addiction?

  • Tom Hildebrandt (a1), Rachel Yehuda (a1) (a2) and Lauren Alfano (a1)
  • DOI:
  • Published online: 15 July 2011

Anabolic–androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction follow the traditional framework of drug abuse and dependence, which suggest that harmful use occurs as a result of the drug's ability to hijack the motivation–reward system. However, AASs, unlike typical drugs of abuse, are not used for acute intoxication effects or euphoria. Rather, AASs are used to affect the body through changes to the musculoskeletal system and the hypothalamic–pituitary–gonadal axis as opposed to stimulating the reward system. We offer an allostatic model of AAS addiction to resolve this inconsistency between traditional drug addiction and AAS addiction. This allostatic framework provides a way to (a) incorporate exercise into AAS misuse, (b) identify where AAS use transitions from recreational use into a drug problem, and (c) describe individual differences in vulnerability or resilience to AASs. Implications for this model of AAS addiction are discussed.

Corresponding author
Address correspondence and reprint requests to: Tom Hildebrandt, Eating and Weight Disorders Program, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029; E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

C. Ahlgrim , & M. Guglin (2009). Anabolics and cardiomyopathy in a bodybuilder: Case report and literature review. Journal of Cardiac Failure, 15, 496500.

K. Aizawa , M. Iemitsu , S. Maeda , T. Otsuki , K. Sato , T. Ushida , (2010). Acute exercise activates local bioactive androgen metabolism in skeletal muscle. Steroids, 75, 219223.

K. Aizawa , M. Iemitsu , T. Otsuki , S. Maeda , T. Miyauchi , & N. Mesaki (2008). Sex differences in steroidogenesis in skeletal muscle following a single bout of exercise in rats. Journal of Applied Physiology, 104, 6774.

A. Angeli , M. Minetto , A. Dovio , & P. Paccotti (2004). The overtraining syndrome in athletes: A stress-related disorder. Journal of Endocrinological Investment, 27, 603612.

M. S. Bahrke , & C. E. Yesalis (2004). Abuse of anabolic androgenic steroids and related substances in sport and exercise. Current Opinion in Pharmacology, 4, 614620.

S. Basaria (2010). Androgen abuse in athletes: Detection and consequences. Journal of Clinical Endocrinology & Metabolism, 95, 15331543.

D. H. Catlin , K. D. Fitch , & A. Ljungqvist (2008). Medicine and science in the fight against doping in sport. Journal of Internal Medicine, 264, 99114.

P. Y. Choi , H. G. Pope Jr., & R. Olivardia (2002). Muscle dysmorphia: A new syndrome in weightlifters. British Journal of Sports Medicine, 36, 375376.

A. S. Clark , & L. P. Henderson (2003). Behavioral and physiological responses to anabolic–androgenic steroids. Neuroscience & Biobehavioral Reviews, 27, 413436.

A. S. Clark , R. C. Lindenfeld , & C. H. Gibbons (1996). Anabolic–androgenic steroids and brain reward. Pharmacology, Biochemistry, and Behavior, 53, 741745.

J. Copeland , R. Peters , & P. Dillon (2000). Anabolic–androgenic steroid use disorders among a sample of Australian competitive and recreational users. Drug and Alcohol Dependence, 60, 9196.

R. D. Dickerman , F. Schaller , & W. J. McConathy (1998). Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid use. Cardiology, 90, 145148.

R. D. Dickerman , F. Schaller , N. Y. Zachariah , & W. J. McConathy (1997). Left ventricular size and function in elite bodybuilders using anabolic steroids. Clinical Journal of Sport Medicine, 7, 9093.

S. J. Ellem , & G. P. Risbridger (2010). Aromatase and regulating the estrogen:androgen ratio in the prostate gland. Journal of Steroid Biochemistry and Molecular Biology, 118, 246251.

A. Eriksson , F. Kadi , C. Malm , & L. E. Thornell (2005). Skeletal muscle morphology in power-lifters with and without anabolic steroids. Histochemistry and Cell Biology, 124, 167175.

N. A. Evans (2004). Current concepts in anabolic–androgenic steroids. American Journal of Sports Medicine, 32, 534542.

J. P. Folland , & A. G. Williams (2007). The adaptations to strength training: Morphological and neurological contributions to increased strength. Sports Medicine, 37, 145168.

N. Galligani , A. Renck , & S. Hansen (1996). Personality profile of men using anabolic androgenic steroids. Hormones and Behavior, 30, 170175.

L. Hallsworth , T. Wade , & M. Tiggemann (2005). Individual differences in male body-image: An examination of self-objectification in recreational body builders. British Journal of Health Psychology, 10, 453465.

F. Hartgens , & H. Kuipers (2004). Effects of androgenic–anabolic steroids in athletes. Sports Medicine, 34, 513554.

M. J. Haykowsky , R. Dressendorfer , D. Taylor , S. Mandic , & D. Humen (2002). Resistance training and cardiac hypertrophy: Unravelling the training effect. Sports Medicine, 32, 837849.

T. Hildebrandt , L. Alfano , & J. Langenbucher (2010). Body image disturbance among 1000 appearance and performance enhancing drug users. Journal of Psychiatric Research, 44, 841846.

T. Hildebrandt , J. Langenbucher , S. Carr , P. Sanjuan , & S. Park (2006). Predicting intentions for long-term anabolic–androgenic steroid use among men: a covariance structure model. Psychology of Addictive Behaviors, 20, 234240.

T. Hildebrandt , J. W. Langenbucher , S. J. Carr , & P. Sanjuan (2007). Modeling population heterogeneity in appearance- and performance-enhancing drug (APED) use: Applications of mixture modeling in 400 regular APED users. Journal of Abnormal Psychology, 116, 717733.

T. Hildebrandt , D. Schlundt , J. Langenbucher , & T. Chung (2006). Presence of muscle dysmorphia symptomatology among male weightlifter. Comprehensive Psychiatry, 47, 127135.

F. Kadi (2008). Cellular and molecular mechanisms responsible for the action of testosterone on human skeletal muscle. A basis for illegal performance enhancement. British Journal of Pharmacology, 154, 522528.

G. Kanayama , K. J. Brower , R. I. Wood , J. I. Hudson , & H. G. Pope (2009a). Anabolic–androgenic steroid dependence: An emerging disorder. Addiction, 104, 19661978.

G. Kanayama , K. J. Brower , R. I. Wood , J. I. Hudson , & H. G. Pope (2009b). Issues for DSM-V: Clarifying the diagnostic criteria for anabolic–androgenic steroid dependence. American Journal of Psychiatry, 166, 642644.

G. Kanayama , J. I. Hudson , & H. G. Pope (2008). Long-term psychiatric and medical consequences of anabolic-androgenic steroid use: A looming public health concern? Drug and Alcohol Dependence, 98, 112.

F. Klotz , A. Petersson , D. Isacson , & I. Thiblin (2007). Violent crime and substance abuse: A medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs. Forensic Science International, 173, 5763.

G. E. Koob (1992). Drugs of abuse: Anatomy, pharmacology, and function of reward pathways. Trends in Pharmacological Sciences, 13, 177184.

G. E. Koob , & M. Le Moal (1997). Drug abuse: Hedonic homeostatic dysregulation. Science, 278, 5258.

G. E. Koob , & M. Le Moal (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59, 2953.

G. F. Koob (2003). Alcoholism: Allostasis and beyond. Alcoholism—Clinical and Experimental Research, 27, 232243.

G. F. Koob , & M. Le Moal (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24, 97129.

W. J. Kraemer (1988). Endocrine responses to resistance exercise. Medicine & Science in Sports & Exercise, 20(Suppl. 5), S152S157.

M. Le Moal (2009). Drug abuse: Vulnerability and transition to addiction. Pharmacopsychiatry, 42(Suppl. 1), S42S55.

M. Lehmann , C. Foster , H. H. Dickhuth , & U. Gastman (1998). Autonomic imbalance hypothesis and overtraining syndrome. Medicine & Science in Sports & Exercise, 30, 11401145.

Q. Ma (2008). Beneficial effects of moderate voluntary physical exercise and its biological mechanisms on brain health. Neuroscience Bulletin, 24, 265270.

B. Mangweth , H. G. Pope Jr., G. Kemmler , C. Ebenbichler , A. Hausmann , C. De Col , etr al. (2001). Body image and psychopathology in male bodybuilders. Psychotherapy and Psychosomatics, 70, 3843.

C. S. Martin , T. Chung , & J. W. Langenbucher (2008). How should we revise diagnostic criteria for substance use disorders in the DSM-V? Journal of Abnormal Psychology, 117, 561575.

N. M. Martin , B. K. Abu Dayyeh , & R. T. Chung (2008). Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage. World Journal of Gastroenterology, 14, 45734575.

S. Martinez-Sanchis , C. M. Aragon , & A. Salvador (2002). Cocaine-induced locomotor activity is enhanced by exogenous testosterone. Physiology & Behavior, 76, 605609.

J. Mata , R. J. Thompson , & I. H. Gotlib (2010). BDNF genotype moderates the relation between physical activity and depressive symptoms. Health Psychology, 29, 130133.

B. S. McEwen (1998). Stress, adaptation, and disease—Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 3344.

B. S. McEwen , & E. Stellar (1993). Stress and the individual—Mechanisms leading to disease. Archives of Internal Medicine, 153, 20932101.

M. Y. McGinnis (2004). Anabolic androgenic steroids and aggression: Studies using animal models. Annals of the New York Academy of Sciences, 1036, 399415.

L. F. Monaghan (2002). Vocabularies of motive for illicit steroid use among bodybuilders. Social Science & Medicine, 55, 695708.

J. P. Morton , A. C. Kayani , A. McArdle , & B. Drust (2009). The exercise-induced stress response of skeletal muscle, with specific emphasis on humans. Sports Medicine, 39, 643662.

A. Nakao , K. Sakagami , Y. Nakata , K. Komazawa , T. Amimoto , K. Nakashima , (2000). Multiple hepatic adenomas caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis. Journal of Gastroenterology, 35, 557562.

A. Noorafshan , S. Karbalay-Doust , & F. M. Ardekani (2005). High doses of nandrolone decanoate reduce volume of testis and length of seminiferous tubules in rats. Acta Pathologica, Microbiologica et Immunologica Scandinavica, 113, 122125.

T. A. Pagonis , N. V. Angelopoulos , G. N. Koukoulis , & C. S. Hadjichristodoulou (2006). Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. European Psychiatry, 21, 551562.

A. B. Parkinson , & N. A. Evans (2006). Anabolic androgenic steroids: A survey of 500 users. Medicine & Science in Sports & Exercise, 38, 644651.

P. J. Perry , B. C. Lund , M. J. Deninger , E. C. Kutscher , & J. Schneider (2005). Anabolic steroid use in weightlifters and bodybuilders: An internet survey of drug utilization. Clinical Journal of Sport Medicine, 15, 326330.

A. Petersson , M. Garle , F. Granath , & I. Thiblin (2006). Morbidity and mortality in patients testing positively for the presence of anabolic androgenic steroids in connection with receiving medical care. A controlled retrospective cohort study. Drug and Alcohol Dependence, 81, 215220.

F. Pibiri , M. Nelson , G. Carboni , & G. Pinna (2006). Neurosteroids regulate mouse aggression induced by anabolic androgenic steroids. NeuroReport, 17, 15371541.

S. A. Sato , K. A. Schulz , C. L. Sisk , & R. I. Wood (2008). Adolescents and androgens, receptors and rewards. Hormones and Behavior, 53, 647658.

N. T. Shahidi (2001). A review of the chemistry, biological action, and clinical applications of anabolic–androgenic steroids. Clinical Therapeutics, 23, 13551390.

L. L. Smith (2000). Cytokine hypothesis of overtraining: A physiological adaptation to excessive stress? Medicine & Science in Sports & Exercise, 32, 317331.

L. Socas , M. Zumbado , O. Perez-Luzardo , A. Ramos , C. Perez , J. R. Hernandez , (2005). Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: A report of two cases and a review of the literature. British Journal of Sports Medicine, 39, e27.

R. L. Solomon , & J. D. Corbit (1974). Opponent-process theory of motivation. 1. Temporal dynamics of affect. Psychological Review, 81, 119145.

M. L. Sullivan , C. M. Martinez , P. Gennis , & E. J. Gallagher (1998). The cardiac toxicity of anabolic steroids. Progress in Cardiovascular Diseases, 41, 115.

I. Thiblin , O. Lindquist , & J. Rajs (2000). Cause and manner of death among users of anabolic androgenic steroids. Journal of Forensic Sciences, 45, 1623.

A. Tsatsoulis , & S. Fountoulakis (2006). The protective role of exercise on stress system dysregulation and comorbidities. Annals of the New York Academy of Sciences, 1083, 196213.

A. Urhausen , T. Albers , & W. Kindermann (2004). Are the cardiac effects of anabolic steroid abuse in strength athletes reversible? Heart, 90, 496501.

R. P. Vieira , R. F. Franca , N. R. Damaceno-Rodrigues , M. Dolhnikoff , E. G. Caldini , C. R. Carvalho , (2008). Dose-dependent hepatic response to subchronic administration of nandrolone decanoate. Medicine & Science in Sports & Exercise, 40, 842847.

D. W. Wesson , & M. Y. McGinnis (2006). Stacking anabolic androgenic steroids (AAS) during puberty in rats: A neuroendocrine and behavioral assessment. Pharmacology Biochemistry, and Behavior, 83, 410419.

R. I. Wood (2002). Oral testosterone self-administration in male hamsters: Dose–response, voluntary exercise, and individual differences. Hormones and Behavior, 41, 247258.

R. I. Wood (2004). Reinforcing aspects of androgens. Physiology & Behavior, 83, 279289.

R. I. Wood , & K. D. Peters (2008). Anabolic–androgenic steroid dependence? Insights from animals and humans. Frontiers in Neuroendocrinology, 29, 490506.

L. J. Woodhouse , N. Gupta , M. Bhasin , A. B. Singh , R. Ross , J. Phillips , (2004). Dose-dependent effects of testosterone on regional adipose tissue distribution in healthy young men. Journal of Clinical Endocrinology & Metabolism, 89, 718726.

L. J. Woodhouse , S. Reisz-Porszasz , M. Javanbakht , T. W. Storer , M. Lee , H. Zerounian , (2003). Development of models to predict anabolic response to testosterone administration in healthy young men. American Journal of Physiology—Endocrinology & Metabolism, 284, E1009–E1017.

W. R. Yates , P. J. Perry , J. MacIndoe , T. Holman , & V. Ellingrod (1999). Psychosexual effects of three doses of testosterone cycling in normal men. Biological Psychiatry, 45, 254260.

Z. Pausova , M. Abrahamowicz , A. Mahboubi , C. Syme , G. T. Leonard , M. Perron , (2010). Functional variation in the androgen-receptor gene is associated with visceral adiposity and blood pressure in male adolescents. Hypertension, 55, 706714.

R. J. Handa , L. H. Burgess , J. E. Kerr , & J. A. O'Keefe (1994). Gonadal steroid hormone receptors and sex differences in the hypothalamo–pituitary–adrenal axis. Hormones and Behavior, 28, 464476.

D. Romer , & E. F. Walker (2007). Adolescent psychopathology and the developing brain: Integrating brain and prevention science. New York: Oxford University Press.

L. Spear (2000). The adolescent brain and age-related behavioral manifestations. Neuroscience and Biobehavioral Reviews, 24, 417463.

A. Raznahan , Y. Lee , R. Stidd , R. Long , D. Greenstein , L. Clasen , (2010). Longitudinally mapping the influence of sex and androgen signaling on the dynamics of human cortical maturation in adolescence. Proceedings of the National Academy of Sciences of the United States of America, 107, 1698816993.

A. E. Kelley , T. Schochet , & C. F. Landry (2004). Risk taking and novelty seeking in adolescence: Introduction to part I. Annals of the New York Academy of Sciences, 1021, 2732.

P. J. Perry , K. H. Andersen , & W. R. Yates (1990). Illicit anabolic steroid use in athletes. A case series analysis. American Journal of Sports Medicine, 18, 422428.

P. J. Perry , E. C. Kutscher , B. C. Lund , W. R. Yates , T. L. Holman , & L. Demers (2003). Measures of aggression and mood changes in male weightlifters with and without androgenic anabolic steroid use. Journal of Forensic Science, 48, 646651.

R. H. DuRant , V. I. Rickert , C. S. Ashworth , C. Newman , & G. Slavens (1993). Use of multiple drugs among adolescents who use anabolic steroids. New England Journal of Medicine, 328, 922926.

L. M. Irving , M. Wall , D. Neumark-Sztainer , & M. Story (2002). Steroid use among adolescents: Findings from Project EAT. Journal of Adolescent Health, 30, 243252.

M. Y. McGinnis , A. R. Lumia , M. J. Tetel , H. A. Molenda-Figueira , & B. Possidente (2007). Effects of anabolic androgenic steroids on the development and expression of running wheel activity and circadian rhythms in male rats. Physiology & Behavior, 92, 10101018.

H. G. Pope Jr., & D. L. Katz (1994). Psychiatric and medical effects of anabolic–androgenic steroid use. A controlled study of 160 athletes. Archives of General Psychiatry, 51, 375382.

P. Mayer , & V. Hollt (2001). Allelic and somatic variations in the endogenous opioid system of humans. Pharmacology & Therapeutics, 91, 167177.

M. Mendez , & M. Morales-Mulia (2008). Role of mu and delta opioid receptors in alcohol drinking behaviour. Current Drug Abuse Reviews, 1, 239252.

P. Steensland , M. Hallberg , A. Kindlundh , C. Fahlke , & F. Nyberg (2005). Amphetamine-induced aggression is enhanced in rats pre-treated with the anabolic androgenic steroid nandrolone decanoate. Steroids, 70, 199204.

A. Leal-Cerro , A. Gippini , M. J. Amaya , M. Lage , J. A. Mato , C. Dieguez , (2003). Mechanisms underlying the neuroendocrine response to physical exercise. Journal of Endocrinological Investigation, 26, 879885.

P. Pervanidou (2008). Biology of post-traumatic stress disorder in childhood and adolescence. Journal of Neuroendocrinology, 20, 632638.

R. Yehuda , & L. M. Bierer (2008). Transgenerational transmission of cortisol and PTSD risk. Progress in Brain Research, 167, 121135.

M. J. Meaney , J. Diorio , D. Francis , J. Widdowson , P. LaPlante , C. Caldji , (1996). Early environmental regulation of forebrain glucocorticoid receptor gene expression: Implications for adrenocortical responses to stress. Developmental Neuroscience, 18, 4972.

S. Walsh , J. M. Zmuda , J. A. Cauley , P. R. Shea , E. J. Metter , B. F. Hurley , (2005). Androgen receptor CAG repeat polymorphism is associated with fat-free mass in men. Journal of Applied Physiology, 98, 132137.

S. B. Manuck , A. L. Marsland , J. D. Flory , A. Gorka , R. E. Ferrell , & A. R. Hariri (2010). Salivary testosterone and a trinucleotide (CAG) length polymorphism in the androgen receptor gene predict amygdala reactivity in men. Psychoneuroendocrinology, 35, 94104.

A. Wyce , Y. Bai , S. Nagpal , & C. C. Thompson (2010). Research resource: The androgen receptor modulates expression of genes with critical roles in muscle development and function. Molecular Endocrinology, 24, 16651674.

N. C. Bennett , R. A. Gardiner , J. D. Hooper , D. W. Johnson , & G. C. Gobe (2010). Molecular cell biology of androgen receptor signalling. International Journal of Biochemistry & Cell Biology, 42, 813827.

U. S. Zimmermann , D. Blomeyer , M. Laucht , & K. F. Mann (2007). How gene–stress–behavior interactions can promote adolescent alcohol use: The roles of predrinking allostatic load and childhood behavior disorders. Pharmacology, Biochemistry, and Behavior, 86, 246262.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Development and Psychopathology
  • ISSN: 0954-5794
  • EISSN: 1469-2198
  • URL: /core/journals/development-and-psychopathology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *