he incidence and prevalence of anabolic steroid abuse, especially by adolescents, carries with it significant social as well as health-risk concerns. There are a number of questions regarding this misuse that need to be addressed. Do results from well-controlled studies support the efficacy of anabolic steroids in increasing muscle mass and augmenting performance? What information is available on the health consequences of misuse of anabolic steroids at suprapharmacological doses over extended periods of time? Do steroids have the potential for development of tolerance and dependence, and do they meet the criteria for abuse potential as defined in strict pharmacological terms? Are adolescents at particular risk? These are among the questions that prompted the National Institute on Drug Abuse to undertake this review on anabolic steroid abuse in an effort to understand the extent and scope of the problem and to identify research priorities in this area. The contents of this monograph encompass a wide range of topics beginning with the important question of whether anabolic steroids possess abuse potential and whether they play a role in the abuse of other substances. There follows an historical overview of the discovery and development of anabolic steroids, a critical evaluation of the performance-enhancing effects of anabolic steroids, and an ethnographic study of anabolic steroid abuse in New York City. Next is a summary of the epidemiological evidence on the incidence and prevalence of steroid use. To better understand the health consequences of abuse, the normal endocrine physiology and pharmacology, as well as molecular and receptor mechanisms underlying the actions of anabolic steroids, are presented, followed by an appraisal of the health risks associated with abuse. Since adolescents are of special concern, a detailed account of the endocrinological effects of anabolic steroids in this special population is included. Finally, this review is completed with a discussion of the behavioral aspects of anabolic steroid use including indications of psychological dependence and evidence for steroid-induced mental status changes and aggressive behavior. This monograph represents a "state-of-the-art" information resource concerning anabolic steroid abuse and suggests future directions for research. It is hoped that this monograph will serve to stimulate further research in this area. The monograph should be valuable to members of the scientific community who are involved in drug abuse research; to those interested in the field of anabolic steroids, including professionals in sports medicine, endocrinology, psychiatry, and education; and to government agencies with regulatory responsibility, drug enforcement responsibility, or both. The editors would like to express their thanks to the authors of the chapters in this monograph and to all the participants in the technical review on which this monograph is based. We would especially like to thank Dr. Marvin Snyder, Director, Division of Preclinical Research, for his role in initiating and supporting this effort.