People take steroids in several different ways depending on the type of steroid and the reason for using it. The most common methods are swallowing pills, injecting into muscle, applying creams or gels to the skin, using inhalers, and wearing adhesive patches. The right method depends on whether someone is using corticosteroids for a medical condition or anabolic steroids for hormone therapy or muscle growth, and each route carries its own set of trade-offs.
Two Very Different Types of Steroids
The word “steroid” covers two completely different categories of drugs, and understanding the difference matters because they work differently in the body and are taken in different ways.
Corticosteroids are prescription medications that reduce inflammation. They mimic cortisol, a hormone your body produces naturally, and doctors prescribe them for conditions like asthma, rheumatoid arthritis, lupus, eczema, severe allergies, and tendinitis. These are the steroids most people encounter in a medical setting.
Anabolic steroids are synthetic forms of testosterone. Doctors prescribe them in limited cases, primarily to treat low testosterone levels. Outside of medical use, people take them to build muscle and improve athletic performance. Anabolic steroids are classified as Schedule III controlled substances under the Controlled Substances Act, meaning it’s illegal to use them without a prescription.
How Corticosteroids Are Taken
Corticosteroids come in more forms than most people realize. Your doctor chooses the delivery method based on where the inflammation is and how widespread it is.
- Oral tablets, capsules, or syrups. These treat widespread inflammation from conditions like arthritis, lupus, or severe allergic reactions. The medication travels through your bloodstream and affects your whole body.
- Inhalers and nasal sprays. These deliver the drug directly to your airways or nasal passages, treating asthma and nasal allergies with less impact on the rest of your body.
- Topical creams and ointments. Applied directly to the skin for conditions like eczema, psoriasis, and other inflammatory skin problems.
- Injections into a joint or muscle. Used for localized pain and inflammation from tendinitis, bursitis, or arthritis in a specific joint.
- Eye drops. These treat swelling and irritation in conditions like uveitis.
- Intravenous (through a vein). Reserved for severe situations, typically in a hospital setting.
The goal with corticosteroids is generally to use the most targeted delivery method possible. An inhaler puts medication right where it’s needed in the lungs, for example, which reduces the side effects that come with swallowing a pill that affects your entire system.
How Anabolic Steroids Are Taken
Anabolic steroids are taken in four main ways: oral pills, intramuscular injections, topical gels or creams, and skin patches. Each route gets the synthetic testosterone into the bloodstream, but the speed, convenience, and risks differ.
Oral Pills
Pills are the simplest method, but they come with a significant downside. Oral steroids pass through the liver before reaching the bloodstream, which puts strain on the organ and increases the risk of liver damage over time. For this reason, most oral testosterone preparations carry warnings about liver toxicity. One formulation (testosterone undecanoate) is FDA-approved for oral use because it’s absorbed through the lymphatic system rather than passing directly through the liver, but it remains the exception rather than the rule.
Intramuscular Injections
Injection is the most common method for both prescribed testosterone therapy and non-medical use. The steroid is dissolved in oil and injected deep into a large muscle, where it absorbs slowly into the bloodstream over days or weeks. The most frequently used injection sites are the upper outer portion of the buttock (the ventrogluteal and dorsogluteal regions), the outer thigh (vastus lateralis), and the deltoid muscle in the upper arm. Needles in the range of 22 to 23 gauge are typical for these injections.
In a medical setting, injectable testosterone is administered once to four times per month. Non-medical users often inject more frequently and at higher doses, which increases the risk of complications at the injection site, including infection, scarring, and abscesses.
Topical Gels and Creams
Testosterone gels are rubbed into the skin, usually on the upper arms, shoulders, or abdomen. The hormone absorbs through the skin and enters the bloodstream gradually. Patches work similarly, delivering a steady dose through an adhesive pad applied once daily. The standard patch dose is 50 mg per day, with a maximum of 100 mg. Both gels and patches are used almost exclusively in prescribed hormone therapy rather than for performance enhancement, because the doses they deliver are designed to mimic normal testosterone levels rather than exceed them.
Cycling, Stacking, and Pyramiding
People who use anabolic steroids without a prescription typically don’t take them continuously. Instead, they follow patterns designed to maximize muscle-building effects while trying to limit side effects and detection.
Cycling means taking steroids for a set period, usually several weeks to a few months, then stopping for an equal or longer period before starting again. The “on” phase is the cycle, and the “off” phase is meant to give the body time to recover its natural hormone production.
Stacking refers to using two or more different steroids at the same time, sometimes combining an oral steroid with an injectable one. The idea is that different compounds complement each other, though this also compounds the risks.
Pyramiding involves gradually increasing the dose during the first half of a cycle, peaking in the middle, then tapering back down. Users believe this lets the body adjust, though there’s no clinical evidence that pyramiding reduces harm.
What Happens When a Cycle Ends
When someone stops taking anabolic steroids after weeks or months of use, their body’s natural testosterone production is suppressed. The testes have essentially been idle because external testosterone signaled to the brain that no more was needed. This can cause withdrawal symptoms including fatigue, low mood, reduced sex drive, and muscle loss.
To try to restart natural hormone production faster, many users self-administer what’s called post-cycle therapy (PCT). This typically involves medications that stimulate the testes to begin producing testosterone again. A survey of 470 men who used anabolic steroids found that those who used PCT reported fewer withdrawal symptoms than those who simply stopped. However, most PCT protocols are self-designed and not medically supervised, which introduces its own risks.
Visible Signs of Anabolic Steroid Misuse
Using anabolic steroids above therapeutic doses produces physical changes that often become noticeable over time. Severe cystic acne, particularly on the back and shoulders, is one of the most recognizable signs. Men frequently develop breast tissue enlargement, a condition caused by excess testosterone converting to estrogen in the body. Rapid weight gain, especially lean muscle mass added faster than natural training would allow, is another common indicator.
These effects tend to be dose-dependent: the higher the dose and the longer the use, the more pronounced they become.
How Common Steroid Use Is
Non-prescribed anabolic steroid use is far more widespread than many people assume. A large survey of over 3,600 people who regularly lift weights found that 53% of men and 42% of women reported using anabolic steroids. The study noted that use was particularly high among young adults with limited training experience, suggesting that many people turn to steroids early in their fitness journey rather than after years of natural training.
These numbers reflect gym-going populations specifically, not the general public, but they illustrate how normalized steroid use has become in strength training culture.