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Anabolic Androgenic Steroids vs. Sleep Quality & Psychological Distress in Weightlifters (2024 Study)

Recent research has analyzed the relationship between the use of Anabolic Androgenic Steroids (AAS), sleep quality, and psychological distress.

A new study specifically evaluated the effects of anabolic steroids on sleep patterns during both active use and withdrawal phases, among male weightlifters in Norway.


  • A large proportion of men using AAS report experiencing sleep problems and often resort to sleep medication.
  • Sleep quality is significantly poorer during AAS withdrawal phases, indicating a strong link with hormonal fluctuations.
  • Psychological distress partially mediates the relationship between AAS use and poor sleep, with depression playing a more significant role than anxiety.
  • A study underscores the importance of addressing sleep disturbances in the treatment of AAS misuse and associated mental health issues.

Source: BMC Psychiatry (2024)

Rates of Anabolic Steroid Use

The rates of AAS use vary significantly across different populations, with higher prevalence observed in groups associated with bodybuilding, weightlifting, and professional athletics.

General Population

In the general population, the prevalence of AAS use is relatively low, often estimated to be less than 1%.

However, this figure can be misleading as it may not account for the underreporting due to the illegal status of AAS in many regions.

Gym-goers & Fitness Enthusiasts

Among gym-goers and individuals involved in recreational fitness activities, the rates of AAS use are notably higher.

Studies suggest that anywhere from 5% to 15% of these individuals might use steroids to enhance physical appearance or performance.

Professional Athletes & Weightlifters

The highest rates of AAS use are found among professional athletes and competitive weightlifters.

Some estimates suggest that up to 30-40% of individuals in these groups might have experimented with or regularly used AAS.

This higher rate is often attributed to the intense pressure to perform and the competitive advantage that AAS can provide.

General Effects of Anabolic Androgenic Steroids on Sleep & Mental Health

The use of Anabolic/Androgenic Steroids (AAS) has been consistently linked to a range of adverse psychological and physiological effects.

Two significant areas of concern are the impact of AAS on sleep patterns and psychological well-being.

Effect on Sleep

AAS use disrupts normal sleep patterns, often leading to difficulties in both falling asleep and maintaining sleep.

Users frequently report lower sleep quality, characterized by reduced sleep efficiency and disturbances throughout the night.

This disruption can be attributed to the physiological changes induced by AAS, including hormonal imbalances and alterations in the body’s natural circadian rhythms.

Psychological Distress

Alongside sleep disturbances, AAS use is associated with an increased risk of psychological issues such as anxiety, depression, and mood swings.

These mental health challenges can be both a direct effect of the steroids on brain chemistry and an indirect result of the stressors associated with altered physical appearance, performance pressures, and potential legal issues surrounding AAS use.

Need for Research

Given the profound impact on sleep and mental health, further research into the effects of AAS is crucial for several reasons:

  • Healthcare Guidance: Understanding these effects helps healthcare professionals provide better guidance and treatment to those using or recovering from AAS use.
  • Prevention & Education: Research findings can inform prevention and educational programs, particularly targeting populations like athletes and gym-goers.

Anabolic Androgenic Steroids in Male Weightlifters in Norway vs. Sleep & Psychological Distress (2024 Study)

Sandra Klonteig et al. investigated the relationship between the use of Anabolic Androgenic Steroids (AAS), sleep quality, and psychological distress.

Specifically, it sought to understand how phases of heavy AAS use and abstinence influence sleep patterns.

The research aimed to provide deeper insights into the sleep disturbances experienced by men who have long-term AAS use compared to non-using weightlifting controls.


  • Participants: The study comprised 126 male weightlifters, with 68 being current or past long-term AAS users and 58 serving as non-using weightlifting controls. A subgroup of 22 participants was monitored over approximately 6 months, covering phases of AAS use and withdrawal.
  • Tools & Assessment: Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Jenkins Sleep Scale (JSS). Psychological distress was measured using the Hopkins Symptoms Checklist (HSCL).
  • Statistical Analysis: Group differences on PSQI and JSS were evaluated using Kruskal-Wallis H tests. The study also employed structural equation modeling to evaluate the mediating role of psychological distress and linear mixed models to assess the role of AAS use and withdrawal on sleep quality.


  • Sleep Quality: The AAS user group showed significantly lower sleep quality compared to the control group, particularly during withdrawal phases.
  • Sleep Problems & Medication Use: Among the AAS group, 66% reported sleep problems as a side effect, and 38% had used sleep medication.
  • Psychological Distress: There was a strong correlation between poor sleep and high levels of psychological distress, particularly depression.
  • Impact of AAS Use & Withdrawal: Sleep quality was notably poorer during AAS withdrawal phases than periods of AAS use, indicating a potential link between sleep disturbances and hormone levels.
  • Mediating Role of Psychological Distress: Psychological distress partially mediated the relationship between AAS use and sleep problems, with depression showing a more significant effect than anxiety.


  • Causality Unknown: The cross-sectional nature of the data limits the ability to establish causal relationships.
  • Sample Representativeness: The study’s findings are based on a specific sample of Norwegian male weightlifters, which may not be generalizable to other populations or contexts.
  • Self-Reported Data: The reliance on self-reported measures for sleep and mental health may introduce biases or inaccuracies.
  • Confounding Factors: The study did not fully control for potential confounding factors such as lifestyle choices, medical conditions, or concurrent substance use that might influence sleep and mental health.
  • Longitudinal Data: The longitudinal aspect of the study had a relatively small sample size, potentially limiting the robustness and generalizability of these specific findings.

Details of Results: AAS Users, Sleep, Psychological Distress (2024)

Sleep Quality

  • PSQI Scores: AAS users had significantly higher global PSQI scores, indicating worse overall sleep quality. This was observed across most subscales, except for “sleep latency.”
  • Use of Sleep Medication: A notable finding was the high prevalence (38%) of sleep medication usage among AAS users, suggesting clinical-level sleep disturbances.
  • Sleep During Withdrawal: Particularly striking was the deterioration in sleep quality during AAS withdrawal phases, with PSQI scores indicating significantly poorer sleep compared to periods of AAS use.

Psychological Distress & Sleep

  • HSCL Scores: The AAS group demonstrated higher levels of depression and anxiety, as indicated by their HSCL scores.
  • Correlation with Sleep Quality: There was a robust correlation between overall PSQI scores and HSCL total scores, underlining the strong relationship between sleep quality and psychological distress.

Specifics of AAS Use

  • Duration & Dosage: The study did not find a significant correlation between the duration or dosage of AAS use and the severity of sleep disturbances or psychological distress, suggesting that these factors may be independent of specific AAS usage patterns.

How Anabolic Steroids Alter Sleep & Psychological States (Possible Mechanisms)

Anabolic Androgenic Steroids (AAS) have profound effects on both physiological and psychological aspects of the human body.

Understanding the mechanisms by which AAS impact sleep and psychological states is crucial for comprehending their overall effects on users.

1. Hormonal Imbalances & Sleep Disruption

  • Alteration of Sleep Architecture: AAS can significantly disrupt the normal architecture of sleep. They interfere with various stages of sleep, especially the rapid eye movement (REM) and deep sleep phases, which are crucial for cognitive function and overall well-being.
  • Circadian Rhythm Disturbance: AAS can disrupt the body’s natural circadian rhythms due to their impact on the secretion of cortisol and other hormones. This disruption can lead to insomnia or a disturbed sleep-wake cycle.

2. Neurotransmitter Imbalances

  • Impact on Serotonin & GABA: AAS can affect the levels of neurotransmitters like serotonin and gamma-aminobutyric acid (GABA), both of which play significant roles in regulating mood and sleep. Alterations in these neurotransmitters can lead to sleep disturbances and mood swings.
  • Dopamine Dysregulation: AAS use can also impact dopamine pathways, which may contribute to the development of addictive behaviors and mood disorders.

3. Psychological Stress

  • Anxiety & Depression: The use of AAS has been linked to increased incidences of anxiety and depression. The psychological stress of maintaining enhanced physical performance, fear of losing muscle mass during withdrawal periods, and societal stigma can contribute to these mental health issues.
  • Body Image Disorders: AAS are often used for aesthetic purposes. The constant pressure to maintain a certain physique can lead to body image disorders, further exacerbating psychological distress.

4. Direct Effects on the Brain

  • Alteration in Brain Structure and Function: Long-term AAS use can lead to changes in brain structure and function, particularly in areas responsible for mood regulation and decision-making.
  • Impaired Cognitive Function: Cognitive functions, including memory and attention, can be impaired by AAS use, contributing to psychological distress and sleep disruption.

5. Withdrawal Effects

  • Rebound Effects during Withdrawal: Withdrawal from AAS can lead to a “rebound effect,” where the sudden absence of enhanced testosterone levels causes significant hormonal imbalance, affecting both psychological well-being and sleep quality.

Strategies to Optimize Sleep in Anabolic Steroid Users (Ideas)

Optimizing sleep in individuals using Anabolic Androgenic Steroids (AAS) involves a multifaceted approach, focusing on lifestyle modifications, psychological interventions, and medical management.

1. Healthy Sleep Hygiene

  • Consistent Sleep Schedule: Encourage regular sleep patterns by going to bed and waking up at the same time every day, even on weekends.
  • Optimizing the Sleep Environment: Create a sleep-friendly environment that is dark, quiet, and cool. Investing in a comfortable mattress and pillows can also be beneficial.
  • Limiting Screen Time: Reducing exposure to screens and blue light, especially in the hours leading up to bedtime, can help in regulating sleep patterns.

2. Lifestyle Modifications

  • Physical Activity: Regular exercise can improve sleep quality, but it should be avoided close to bedtime as it can be stimulating.
  • Dietary Considerations: Avoiding caffeine, nicotine, and heavy meals in the evening can help prevent sleep disturbances. Incorporating foods rich in magnesium and melatonin may aid in better sleep.
  • Stress-Reducing Techniques: Practices such as yoga, meditation, and deep breathing exercises can reduce stress and improve sleep quality.

3. Psychological Interventions

  • Cognitive Behavioral Therapy (CBT): CBT for insomnia (CBT-I) can be particularly effective. It involves restructuring negative thoughts about sleep, promoting relaxation techniques, and establishing a healthy sleep routine.
  • Counseling & Support Groups: Psychological counseling can address underlying issues like anxiety or depression. Support groups may also provide a platform for sharing experiences and strategies for coping with sleep issues.

4. Medical Doctors

  • Gradual Withdrawal from AAS: If possible, gradually reducing the use of AAS can help in minimizing withdrawal symptoms and improving sleep.
  • Monitoring Hormone Levels: Regular monitoring and, if necessary, medical intervention to balance hormone levels can be crucial.
  • Use of Sleep Aids: In some cases, short-term use of sleep aids may be prescribed by a healthcare provider. However, these should be used cautiously due to the potential for dependency and tolerance.

5. Education & Awareness

  • Understanding the Impact of AAS: Educating users about the potential side effects of AAS, including sleep disturbances, can encourage more responsible use or cessation.
  • Seeking Professional Help: Encouraging individuals to seek professional medical and psychological help if they are struggling with sleep or other side effects of AAS use.

6. Alternative Therapies

  • Mindfulness and Relaxation Techniques: Techniques like progressive muscle relaxation or guided imagery can help in reducing bedtime anxiety and improving sleep.
  • Natural Supplements: In some cases, supplements like melatonin or magnesium may be recommended, but users should consult with a healthcare provider before starting any supplement.

Takeaways: Anabolic Steroids vs. Sleep & Mental Health

The study provides a compelling look into how AAS use significantly impairs sleep quality and contributes to psychological distress.

The notable deterioration in sleep during AAS withdrawal phases suggests a complex interplay between hormonal fluctuations and sleep regulation.

These findings underscore the necessity of incorporating sleep quality management and mental health screenings as fundamental components of care for AAS users.

Additionally, they highlight the importance of educating the athletic community about the potential consequences of AAS use.

Future research should focus on exploring these relationships further, with an emphasis on longitudinal studies and diverse populations, to broaden our understanding and refine treatment approaches for AAS users.


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