People use steroids for two broad reasons: to treat medical conditions under a doctor’s supervision, or to build muscle, boost athletic performance, and change how they look. The term “steroids” actually covers two very different drug classes, and understanding which type people are talking about clears up most of the confusion around the topic.
Two Types of Steroids, Two Different Purposes
Corticosteroids are anti-inflammatory drugs prescribed for conditions like allergies, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, lupus, and certain blood cancers. They work by dialing down the immune system’s overreaction. When your doctor prescribes a steroid inhaler for asthma or a cortisone shot for joint pain, these are corticosteroids. They don’t build muscle and aren’t the steroids people mean when they talk about doping or bodybuilding.
Anabolic steroids are synthetic versions of testosterone. They promote muscle growth (the anabolic effect) and the development of male physical traits (the androgenic effect). These are the steroids at the center of most public conversation, and the ones people use both medically and non-medically.
Legitimate Medical Uses
The FDA has approved anabolic steroids for a specific set of conditions. The most common is male hypogonadism, where the body doesn’t produce enough testosterone on its own. Without treatment, low testosterone leads to fatigue, loss of muscle mass, weakened bones, low sex drive, and mood problems. Testosterone replacement therapy can improve sexual desire and function, increase bone mineral density, restore energy and mood, and shift body composition toward more lean mass and less fat.
Beyond hypogonadism, anabolic steroids are also approved for delayed puberty in boys, certain types of breast cancer in women, endometriosis, and muscle wasting caused by cancer or AIDS. In these cases, the goal is to counteract the body’s breakdown of tissue or to jumpstart a developmental process that hasn’t occurred on schedule.
How Steroids Build Muscle
Anabolic steroids increase muscle size through several overlapping mechanisms. At the most basic level, they ramp up protein synthesis, the process your muscles use to repair and grow after being stressed by exercise. They also activate satellite cells, which are a type of stem cell that sits on the surface of muscle fibers. When activated, satellite cells fuse into existing muscle fibers or create entirely new ones, both of which make the muscle larger and stronger.
At the same time, steroids reduce the activity of pathways that break muscle down. So the net effect is double: more building, less breakdown. This is why people on steroids recover faster between workouts and can train harder and more frequently than their bodies would otherwise allow. Over time, this creates a compounding advantage in both size and strength.
How Large Is the Performance Advantage?
A landmark study published in the New England Journal of Medicine put numbers on the effect. Researchers gave some men high-dose testosterone and others a placebo, then split each group into exercisers and non-exercisers. The results were striking: men who received testosterone but did no exercise at all gained more muscle size and strength than men who trained with weights but received a placebo. Testosterone without any training added about 9 kg to bench press strength and 16 kg to squat strength over 10 weeks.
Men who combined testosterone with exercise saw the largest gains by far, adding 22 kg to their bench press and 38 kg to their squat, along with an average of 6.1 kg of fat-free mass. For context, a natural lifter might work for a year or more to achieve gains of that magnitude. This enormous shortcut is the core reason people use steroids outside of medicine.
Who Uses Them and Why
The typical non-medical user is male, between 20 and 40, and involved in weight training, bodybuilding, or combat sports. Among gym-goers specifically, usage rates range from about 6% to 29% depending on the country and the population studied. The motivations fall into a few categories.
For competitive athletes and bodybuilders, the reason is straightforward: winning. Steroids allow them to push past natural limits in muscle size, strength, and leanness. In sports where physique is judged or where raw power determines the outcome, the advantage is difficult to match through training alone.
For recreational lifters, appearance is usually the primary driver. Many users aren’t competing in anything. They want to look a certain way, and steroids dramatically accelerate the timeline. Social media has intensified this by flooding feeds with images of physiques that are, in many cases, unattainable without pharmacological help. As one group of police officers noted in a study on doping culture, young men today often get their masculine ideals from social media, see visible muscles as a marker of success, and search for quicker ways to reach that standard.
In physically demanding occupations like law enforcement and military service, some individuals use steroids to meet the strength and endurance requirements of the job, or simply to project physical authority. Steroid use has also been linked to gang and criminal subcultures, where physical size serves as both a tool and a signal.
Body Image and the “Never Enough” Cycle
A significant subset of steroid users are driven by a condition called muscle dysmorphia, sometimes referred to as bigorexia. It’s a body image disorder characterized by an obsessive preoccupation with muscularity, compulsive exercise, rigid dieting, and constant body checking. Despite being objectively muscular, people with this condition perceive themselves as small or weak.
Muscle dysmorphia predominantly affects men, and steroid use is so common in this population that it’s sometimes considered a hallmark of the disorder’s severity. The relationship between the condition and steroid use can become self-reinforcing: steroids enable longer, harder training sessions and bigger muscles, which deepens the person’s investment in the muscular ideal and increases their reliance on the drug. The fear of losing muscle if they stop, and the loss of self-worth that comes with it, becomes a powerful motivator to keep using. Researchers have described this pattern as a form of substance use disorder, where the steroid essentially feeds the obsession at its core.
The Trade-Offs People Accept
Non-medical steroid use carries significant health risks that users either underestimate or consciously accept. The cardiovascular system takes the hardest hit. Steroids shift cholesterol profiles in unfavorable directions, stiffen arteries, enlarge the heart in ways that impair its function, and raise the risk of heart attack and stroke, particularly with long-term use.
The liver is vulnerable too, especially with oral steroids that must pass through it. Hormonal disruption is essentially guaranteed: the body detects the external testosterone and shuts down its own production, which can lead to shrunken testicles, reduced sperm count, and infertility that may or may not reverse after stopping. In women, anabolic steroids cause deepening of the voice, facial hair growth, and menstrual irregularities.
Psychologically, steroids can cause mood swings, irritability, and aggression, sometimes referred to as “roid rage,” though the severity varies widely between individuals. Depression is common during withdrawal as the body’s natural hormone production takes weeks or months to recover. Acne, hair loss, and tendon injuries round out a list of side effects that many users view as the cost of the physique or performance they’re chasing.
For people with muscle dysmorphia, these trade-offs barely register against the distress of feeling undersized. For competitive athletes, the calculation is different but equally clear-eyed: they weigh career success against long-term health consequences and decide the payoff is worth it. Understanding these motivations doesn’t require endorsing them, but it does explain why steroid use persists despite widespread knowledge of the risks.