Muscle dysmorphia (MD) is a subtype of body dysmorphic disorder characterized by an obsessive
belief that one’s body is insufficiently muscular. This review provides a comprehensive examination of
the addiction cycle in MD, particularly in the context of anabolic steroid and performance‑enhancing
drug (PED) use. Utilizing a systematic search across databases such as PubMed, PsycINFO, Scopus,
and Web of Science, the review draws on peer‑reviewed literature published in the past two decades
to uncover the roles of hormonal and neural alterations in perpetuating this cycle. Inclusion and
exclusion criteria were meticulously applied to ensure a robust analysis of relevant studies. The
article details the interaction between exogenous hormonal supplementation from steroids and PEDs
and brain receptors, which significantly disrupt neurotransmitter systems and affect mood, cognition,
and stress responses. The synthesis of data reveals that hormonal imbalances due to substance abuse
lead to profound changes in brain plasticity and function, instigating psychiatric disorders and
complicating withdrawal and treatment. Therapeutic strategies are critically assessed, with emphasis
on the success of cognitive‑behavioral therapy, the role of pharmacological management, and the
promise of emerging treatments targeting neuroendocrine disruptions. The review suggests an
integrated, holistic treatment model that includes hormonal therapy and neurological considerations,
underscoring the importance of personalized and sustained interventions. In conclusion, the intricate
cycle of addiction in MD, fueled by the hormonal effects of steroids and PEDs on the brain, calls for
an integrated approach to treatment. Future research should focus on the neuroendocrine impact of
these substances to refine therapeutic strategies for MD.