Metabolic & Cardiometabolic
anabolic-androgenic steroids increases aggression and anxiety
In plain terms: Do anabolic steroids increase aggression and anxiety?
Contested Metabolic & Cardiometabolic 🔬 Includes disconfirming
Part of: 💊 anabolic-androgenic steroids
RefutedContestedStrong support
consensus score -0.20
Only partly — controlled testosterone trials find increased aggression/anxiety in a minority at high doses, not uniformly; the blanket 'roid rage' framing runs ahead of the controlled evidence, even though heavy real-world abuse is linked to mood problems.
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: Human trials (RCT / n-of-1)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
3 support 4 contradict 1 tested null 9 mixed · 17 sources, 7 independent groups
What the evidence shows
Controlled testosterone trials find increased aggression or anxiety in a minority at high doses, not as a general effect. The supporting human data are self-report surveys — 35 percent of 470 users reporting more aggression, higher aggression scale scores among bodybuilders — which cannot separate drug effect from who chooses to use, and the trenbolone subgroup differs from the rest.
The evidence (22)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Bonenti B, Ahmadinejad B, Puljević C, Ferris J, Winstock A, Ganson KT, Nagata JM, Bradshaw A, Piatkowski T 2026 · Drug and alcohol review | observational | mixed | low | In 1146 men with past-year AAS use, the trenbolone subgroup (n=237) reported significantly more mood instability, irritability and depressive symptoms than non-trenbolone AAS users (all p<0.001, phi=0.13-0.20). Cross-sectional self-report c |
| Santos BM, de Souza JPA, Goulart LRP, Petrine JCP, Alves FHF, Del Bianco-Borges B 2024 · Saudi Pharm J | observational | supports | low | Narrative review: 'This review aims to elucidate the various ways in which AAS can impact female physiology'; cites that 'Studies in female rodents have shown that AAS can lead to increased aggression'. No own data — review, zero weight. |
| Grant B, Kean J, Vali N, Campbell J, Maden L, Bijral P, Dhillo WS, McVeigh J, Quinton R, Jayasena CN 2023 · Substance abuse treatment, prevention, and policy | observational | supports | low | Anonymous survey of 470 men using AAS: 35.3% self-reported increased aggression as an on-cycle effect (51.7% reported no issues at all). Purely descriptive self-report survey with no comparator group or validated aggression scale. |
| Berger K, Schiefner F, Rudolf M, Awiszus F, Junne F, Vogel M, Lohmann CH 2024 · Orthopadie (Heidelberg, Germany) | observational | mixed | low | Comparison of doped adolescent athletes vs non-doped athletes vs non-athletes (retrospective, GDR-era cohort): doping group showed more neuroticism, less extraversion, and more depression/PTSD symptoms. Authors explicitly attribute part of |
| Ceto E, Yigitoglu PH, Yavuz HU 2025 · Medicina (Kaunas, Lithuania) | observational | supports | low | 319 male bodybuilders: AAS users scored significantly higher on the Buss-Perry Aggression Scale overall and every sub-dimension (physical aggression, anger, hostility, verbal aggression; all p<0.001) plus narcissism (p<0.001). Cross-section |
| Bonenti B, Steve V, Puljević C, Ferris J, Barratt MJ, Winstock A, Ball L, Armstrong M, Piatkowski T 2025 · American journal of lifestyle medicine | observational | mixed | low | 1146 men with past-year AAS use, stratified by age: younger users (<40) were significantly more likely than older users to report anger and depression (chi-square p<0.045). Cross-sectional, AAS-only sample (no non-user comparator) with self |
| Çınaroğlu M et al 2025 · Frontiers in psychiatry | observational | mixed | low | 285 gym-goers (87 long-term PED/AAS users, 95 short-term, 103 non-users): long-term users reported significantly higher anxiety (BAI) and depression (BDI-II) than short-term users and non-users, with a duration-dependent gradient. Cross-sec |
| Henriksen HCB, Havnes IA, Jørstad ML, Bjørnebekk A 2023 · Substance abuse treatment, prevention, and policy | observational | mixed | low | Cross-sectional self-report of 90 Norwegian men with >12 months AAS use: all 90 reported side effects, and treatment-seekers reported significantly more depression and anxiety than non-treatment-seekers. No non-AAS-user comparison group; en |
| Lieberman HR, Caldwell JA, Vartanian O, Carmichael OT, Karl JP, Berryman CE, Gadde KM, Niro PJ, Harris MN, Rood JC, Pasiakos SM 2024 · Psychopharmacology | RCT | contradicts | low | Double-blind placebo-controlled RCT (NCT02734238), n=50 healthy young men under 28-day severe energy deficit (which suppressed endogenous testosterone): testosterone enanthate 200 mg/wk x4 (n=24) vs placebo (n=26). No drug x day interaction on any behavioural measure. Drug main effects: POMS Tension/Anxiety F=0.02, p=0.88 (eta2 0.000); Buss-Perry Anger p=0.85 (eta2 0.001); POMS Anger p=0.96; Buss-Perry total p=0.23; only Buss-Perry physical subscale a trend p=0.08 (eta2 0.062; direction cannot-tell from available text). Clean null on anxiety and anger. Indirect exposure: short replacement-to-supraphysiological testosterone in an energy-deficit hypogonadal state, not multi-agent AAS misuse; sample size powered for lean mass, not behaviour. |
| Panagiotidis D, Clemens B, Habel U, Schneider F, Schneider I, Wagels L, Votinov M 2017 · Eur Neuropsychopharmacol | RCT | mixed | moderate | Exogenous testosterone potentiated provocation-related anger but did not increase actual aggressive behavior. |
| Börjesson A, Ekebergh M, Dahl ML, Ekström L, Lehtihet M, Vicente V 2024 · International journal of qualitative studies on health and well-being | observational | mixed | low | Qualitative phenomenological interviews with 12 next-of-kin of AAS users describe observed 'mood swings, aggressiveness...anxiety, and emotional coldness' in the user. Third-party qualitative report, no validated instruments, small sample |
| Mhillaj E, Morgese MG, Tucci P, Bove M, Schiavone S, Trabace L 2015 · Front Neurosci | observational | mixed | low | Preclinical and clinical review links supratherapeutic AAS to anxiety, aggression and irritability via reward-system and neurotransmitter changes. |
| Windfeld-Mathiasen J, Christoffersen T, Strand NAW, Dalhoff K, Andersen JT, Horwitz H 2022 · Depression and anxiety | observational | mixed | low | 545 men doping-sanctioned for AAS vs 5450 matched controls (national registry data): incidence of anxiolytic (HR 2.34) and antipsychotic (HR 2.69) prescriptions rose sharply after AAS sanction, and antidepressant use was already elevated pr |
| Tricker R, Casaburi R, Storer TW, Clevenger B, Berman N, Shirazi A, Bhasin S 1996 · J Clin Endocrinol Metab | RCT | contradicts | high | Double-blind placebo-controlled 2x2 RCT, 43 healthy eugonadal men, testosterone enanthate 600 mg/week vs placebo (with/without strength training) for 10 weeks. No differences between placebo and testosterone on any of the 5 Multi-Dimensional Anger Inventory subdomains, and no significant changes in self- or observer-rated mood inventories. Authors: supraphysiological testosterone 'do[es] not increase angry behavior'. Clean null; anxiety not separately reported; single agent, screened men. |
| Bahrke MS, Yesalis CE, Wright JE 1996 · Sports Med | observational | mixed | moderate | Narrative review update, not evidence: moderate testosterone doses show 'essentially no adverse effects on male sexual and aggressive behaviour' while higher-dose athlete reports show associations; 'Only 3 prospective, blinded studies demonstrating aggression ... have been reported.' Review — zero weight. |
| Vorona E, Nieschlag E 2018 · Minerva Endocrinol | observational | supports | low | Review reports increased irritability, depressive mood and, in abusers, persistent anxiety and depression associated with AAS use. |
| Cueva C, Roberts RE, Spencer TJ, Rani N, Tempest M, Tobler PN, Herbert J, Rustichini A 2017 · Horm Behav | RCT | tested-null | moderate | 48-hour testosterone administration did not affect ultimatum-game rejections or aggressive mood in healthy men. |
| Talih F, Fattal O, Malone D 2007 · Cleve Clin J Med | observational | supports | low | Review describes AAS abuse as associated with mania, aggression and depression, with withdrawal-related psychiatric symptoms. |
| Pope HG, Kouri EM, Hudson JI 2000 · Arch Gen Psychiatry | RCT | mixed | high | Supraphysiologic testosterone produced significant manic/aggressive responses in a minority of men, with most showing little change (marked individual variability). |
| Dubol M, Jonasson M, Takahashi K, Wikström J, Watanabe Y, Antoni G, Lubberink M, Biegon A, Sundström-Poromaa I, Comasco E 2026 · J Neuroendocrinol | observational | contradicts | low | Single-arm pre-post pilot (no control arm), n=10 healthy premenopausal women, transdermal testosterone 10 mg/day for 1 week (serum testosterone up 18% to 3329%). Aggression (AQ-RSV) 19.67 to 18.3, p=.65; state anxiety (STAI-S) 37.60 to 36.30, p=.64 — both point estimates moved away from the claim. Bayesian BF10 0.28 for the hypothesised aggression increase (moderate evidence for no change); anxiety evidence for the null anecdotal (BF10 0.45). Clean null against the claim, but indirect: therapeutic low-dose testosterone in women for one week, not supraphysiologic AAS use. |
| Freire-Arvelo JA, Rivero CJ, Santiago-Marrero IG, Mendez-Morales A, González-Segarra AJ, Pérez-Cardona EU, Torres-Ramirez RJ, Segarra AC 2025 · Scientific reports | animal | contradicts | moderate | Prepubertal male rats given daily nandrolone decanoate (20 mg/kg, days 28-37) showed REDUCED anxiety-like behavior and ambulation, not increased anxiety, alongside altered striatal/cortical D2 dopamine receptors. No self-selection confound |
| Jørstad ML, Scarth M, Torgersen S, Pope HG, Bjørnebekk A 2023 · Brain and behavior | observational | supports | low | 118 male AAS users vs 97 non-using weightlifters (MCMI-III): AAS users scored significantly higher on nearly all personality-disorder and clinical-syndrome scales (anxiety-related syndromes among them), with a distinct 'severe multipatholog |
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