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Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects. We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database. About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial, or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be slightly adapted for cumulatively acting drugs such as AAS. AAS dependence is a valid diagnostic entity, and likely a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to better characterize AAS dependence, identify risk factors for this syndrome, and develop treatment strategies. The anabolic-androgenic steroids (AAS) are a family of lipophilic hormones derived from cholesterol that includes the natural male hormone, testosterone, together with numerous synthetic testosterone derivatives (1). By ingesting supraphysiological doses of these hormones, in combination with intensive weight lifting and appropriate nutrition, AAS users can greatly increase their muscle mass, often well beyond the limits attainable by natural means (2). For decades, elite athletes have used AAS to improve performance (3). Today, however, most AAS users are not competitive athletes, but simply individuals who want to look leaner and more muscular (1, 4’8). As we have explained in detail elsewhere (9), this much larger but less visible population of illicit AAS users began to emerge in the 1980s ‘ a trend stimulated in part by the appearance of progressively more sophisticated underground guides on how to self-administer AAS (10’14). Western cultural developments also likely contributed to the increased prevalence of use of AAS, as media images increasingly focused on male muscularity (15’18). Over the last few decades, even children’s action toys, such as “GI Joe” in America and “Action Man” in the British Commonwealth, have begun to acquire the bodies of AAS users (19). Perhaps as a result of these trends, illicit AAS use has now grown into a widespread form of substance abuse throughout Western societies, including the United States (20’22), British Commonwealth countries (23’25), Scandinavian countries (26’28), and others (25, 29’31). Although epidemiologic studies in these various countries have produced a wide range of prevalence estimates, most have reported a lifetime prevalence of AAS use of at least 3% in young men, suggesting that some tens of millions of individuals worldwide have used these drugs. By contrast, AAS use in women is uncommon, since women are less likely to want to become very muscular, and are also vulnerable to the masculinizing effects of AAS, such as beard growth, deepening of the voice, and masculinized sexual characteristics (32’35), sustanon 250 mg injectable steroids $49.00 sustanon (testosterone blend). AAS users generally self-administer their drugs for blocks of time, colloquially called “cycles. Planned cycles of increasing and decreasing AAS doses (“pyramiding”) allow users to avoid plateauing (developing tolerance), minimize withdrawal symptoms at the end of a cycle, and conserve drug supplies (38). Perhaps the most important rationale for cycles, however, is the fact that exogenous AAS administration suppresses the hypothalamic-pituitary-testicular (HPT) axis, leading to decreased endogenous testosterone production in men (39, 40). 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