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Adverse health effects of anabolic-androgenic steroids
Abstract
Anabolic-androgenic steroids (AAS) are synthetic drugs derived from testosterone. Illegally, these drugs are regularly self-administered by body builders and power lifters to enhance their sportive performance. Adverse side effects of AAS include sexual dysfunction, alterations of the cardiovascular system, psyche and behavior, and liver toxicity. However, severe side effects appear only following prolonged use of AAS at high dose and their occurrence is limited. Occasionally, AAS abuse may be linked to certain social and psychological traits of the user, like low self-esteem, low self-confidence, suffered hostility, childhood conduct disorder, and tendency to high-risk behavior. The overwhelming stereotype about AAS is that these compounds cause aggressive behavior in males. However, the underlying personality traits of a specific subgroup of the AAS abusers, who show aggression and hostility, may be relevant, as well. Use of AAS in combination with alcohol largely increases the risk of violence and aggression. The dependence liability of AAS is very low, and withdrawal effects are relatively mild. Based on the scores for acute and chronic adverse health effects, the prevalence of use, social harm and criminality, AAS were ranked among 19 illicit drugs as a group of drugs with a relatively low harm.
... AAS users also commonly experience enhanced neuromuscular coordination and motor unit recruitment, and this postulated to be a result of androgens increasing neurotransmitter synthesis, upregulating neurotransmitter expression, and accelerating synaptic vessel cycling 71 . However, each of these benefits are paired to caveats such as increased risk of violent behavior, hypertension, and neurotoxicity 52,72 . Therefore, neither AAS nor SARMs are superior: each class of PEDs maintains its unique benefit/side effect profile. ...
... Upon reaching this plateau, rather than simply increasing the dose of PEDs, one should first consider how to mitigate limiting variables. This is because PEDs often pose higher health risks at higher doses 41,52 . For instance, an enhanced bodybuilder with an attenuated acute inflammatory response to resistance exercise due to depleted ω-6 stores would probably benefit more from supplementing AA as opposed to simply increasing the dose of PEDs 50 . ...
... steroid hormones resemble a similar core structure derived from cholesterol and as a result, the structures of all type I nuclear receptors are also very similar, allowing multiple steroid ligands to bind and agonize/antagonize their activity29,51,59 . As shown by the testosterone/cortisol ratio in the model of overtraining, androgens and glucocorticoids generally antagonize each other's actions by displacing one another from their respective some of the protein-sparing effects of AAS are caused by GR antagonism19,52 . Various interactions between AAS and the ER have been described. ...
In the clinical setting, anabolic agents serve to ameliorate muscle- and bone-wasting diseases. However, many of these anabolic agents are also used by bodybuilders to surpass natural limits of body composition as performance-enhancing drugs (PEDs). The first generation of PEDs comprises testosterone-derived anabolic-androgenic steroids (AAS) which have demonstrated significant myotropic effects. However, AAS lack optimal tissue-selectively and thus, are prone to numerous adverse health consequences. Hence, a newer generation of PEDs, selective androgen receptor modulators (SARMs), was developed with the goal of achieving superior tissue-selectivity (i.e., exerting anabolic effects only in muscle and bone tissue, while minimally affecting other body systems). In general, AAS and SARMs enhance muscle growth primarily through androgen receptor (AR) agonism in target tissues. Despite multiple attempts, no single AAS nor SARM to date is completely risk free. As such, a significant portion of research efforts has been dedicated to manipulating anabolic pathways beyond the AR. Another class of PEDs, myostatin inhibitors, have shown to cause drastic muscle anabolism across multiple species by inhibiting myostatin, the primary deterrent to continuous muscle growth. The myostatin inhibitor, YK-11, blocks myostatin by upregulating its antagonist, follistatin. This effect appears to be mediated through the AR, suggesting a novel and promising gene-selective approach to engineering AR ligands that isolate benefits from risks. At any rate, the exact mechanisms by which these PEDs function is not well understood. Further pioneering regarding these topics is encouraged as it appears that the innovation of a truly tissue-selective anabolic agent is within reach.
... Duplicate searches from the same Google search engine user within a short period of time are excluded from the collected data, and RSV values less than 1% are expressed as 0. GT queries are not case sensitive (i.e., "SARMs" and "sarms" will generate identical RSV values); however, GT queries are character sensitive (i.e., "post cycle therapy" and "post-cycle therapy" will generate different RSV values). Previous studies by other healthcare providers have demonstrated that GT may be an effective tool for predicting trends in participation in vaccination, estimating participation in elective surgical procedures, and measuring social interest in science-related topics [3][4][5]. These studies suggest that the aggregate volume of search queries can be used to indirectly examine popularity within given temporal and regional parameters. ...
... Despite this, AAS are commonly used illicitly to induce skeletal muscle growth for a gain in overall muscle mass and aesthetic definition. This use is due in part to the lack of tissue specificity and expansive, systemic activation of androgen receptors when these compounds are either injected subcutaneously or ingested orally [4]. Biochemically, AAS function as ligands, passively diffusing through the plasma membrane of their target cell and interacting with androgenic receptors (ARs) in the cellular cytoplasm. ...
Performance-enhancing drugs (PEDs) can be categorized into various classes based on the physiological mechanism of the compound, with the most popular being anabolic steroids, selective androgen receptor modulators, and growth hormones. Ancillary compounds, such as selective estrogen receptor modulators (SERMs) and selective estrogen receptor degraders, are commonly utilized alongside a PED to counterbalance any potential undesired side effects. With little clinically relevant data to support the use of these ancillary compounds, medical education and evidence-based approaches aimed at monitoring the potential adverse effects of PED use are sparse.This study aims to identify emerging trends in the interest of PEDs and related ancillary compounds, hypothesize the physiological effects of the continued respective behavior, and propose a proxy for use by clinicians to approximate off-label drug use and subsequently modify their practices accordingly. Several significant trends were identified for non-FDA-regulated compounds (i.e., selective androgen receptor modulators such as RAD-140) and off-label indications for FDA-regulated drugs (i.e., SERMs such as tamoxifen). A significant increase in interest regarding selective androgen receptor modulators, mirrored by anecdotal reports in clinical settings and online forums, is coupled with stagnant or decreasing interest in both post-cycle therapies and anabolic steroids. Ultimately, we propose a call to action for utilizing social data and/or prescription data as a proxy for clinicians to better understand trends in these compounds and thus refine their treatment protocols in a concordant manner.
... AAS Abuse has become an important public health concern worldwide due to its serious and dangerous side effects. The evidence indicates that infertility, hair loss, pimples, acne, thickening of the voice, heart disease, cancer, and testicular atrophy are reported as the side effects of AAS abuse [5][6][7][8]. The AAS abuse has also led to psychological problems like depression, aggression, anxiety, and sleep disorders [7,[9][10][11]. ...
... The evidence indicates that infertility, hair loss, pimples, acne, thickening of the voice, heart disease, cancer, and testicular atrophy are reported as the side effects of AAS abuse [5][6][7][8]. The AAS abuse has also led to psychological problems like depression, aggression, anxiety, and sleep disorders [7,[9][10][11]. The results of a meta-analysis (2014) reported that the worldwide prevalence rates of AAS use by athletes and recreational athletes were estimated at 13.4% and 18.4%, respectively [12]. The prevalence rate of AAS use by Iranian bodybuilders has been estimated 32.9%. ...
Introduction
Nowadays, the use of androgenic-anabolic steroids (AAS) by competitive and non-competitive bodybuilders and its side effects have become a major public health problem. Many studies have focused on determining the role and severity of various factors in AAS use, but the existence of collinearity between the factors leads to the non-significance of important factors. The study aimed to determine factors affecting the androgenic-anabolic steroids use in Iranian bodybuilders.
Method
This descriptive-analytical study was performed on 280 male bodybuilders (142 non-competitive and 138 competitive bodybuilders) in Hamadan, west of Iran, in 2016. The participations were recruited a multistage sampling method. A self-administrated questionnaire was used, which included parts such as intrapersonal, interpersonal, and behavioral factors affecting on AAS use. To solve the consequences of collinearity was used ridge logistic regression model (RLRM) in R.3.5.1 software.
Results
The mean age of bodybuilders was 25.21 years (SD = 6.31). The prevalence rate of AAS use among non-competitive and competitive bodybuilders was 27.5% and 34.1%, respectively. Factors such as age, time of starting bodybuilding, attitude, physical self-concept, behavioral intention, coach and friend use AAS, alcohol consumption, and supplement use were associated with AAS use among non-competitive and competitive bodybuilders.
Conclusion
The results of the study indicated that a combination of intrapersonal, interpersonal and behavioral factors was effective on the androgenic-anabolic steroids use among Iranian bodybuilders. Adequate education about the side effects of AAS and improvement of individual skills seem to be helpful in reducing AAS use.
... Generally, abusers consume these products at high dosage, 10-100 times higher than the corresponding therapeutic dose (5). AAS are known to cause severe side effects when they are used on a long-term basis. ...
... AAS are known to cause severe side effects when they are used on a long-term basis. Indeed, their misuse can produce physical side effects like cardiac, hepatic and renal toxicity and psychological effects, including enhanced libido or increase of aggressiveness (5,6). ...
A 29-year-old man with no previous medical history was found dead at home. Anabolic products (tablets and oily solutions) and syringes were found at the scene. The man was known to train regularly at a fitness club and to use anabolic drugs. Following an unremarkable autopsy with normal histology, toxicological analyses were requested by the local prosecutor to provide further information. Blood, head hair (5 cm, black), body hair (axillary and leg), and toe and finger nail clippings were submitted to LC and GC–MS-MS methods to test for anabolic steroids. Blood tested positive for testosterone (4 ng/mL), boldenone (26 ng/mL), stanozolol (3 ng/mL) and trenbolone (< 1 ng/mL). Segmental head hair tests (2 x 2.5 cm) revealed a repeated consumption of testosterone (65–72 pg/mg), testosterone propionate (930–691 pg/mg), testosterone isocaproate (79 pg/mg–< 5 pg/mg), nandrolone decanoate (202–64 pg/mg), boldenone (16 pg/mg), stanozolol (575–670 pg/mg), trenbolone (4 pg/mg–not detected), drostanolone (112–30 pg/mg), drostanolone enanthate (26–5 pg/mg) and drostanolone propionate (15–4 pg/mg). In addition to the substances identified in head hair, testosterone decanoate, testosterone cypionate and nandrolone were identified in both body hair and nails. The experts concluded that the manner of death can be listed as toxic, due to massive repetitive use of anabolic steroids during the previous months. For anabolic agents, blood does not seem to be the best matrix to document a fatal intoxication. Indeed, these products are toxics when long term abused and are known to cause cardiac, hepatic and renal diseases. When compared to blood, hair and nails have a much larger window of detection. Therefore, keratinous matrices seems to be the best approach to test for anabolic steroids when a sudden death is observed in a context of possible abuse of steroids.
... As stated by Rezende et al. (9), physical inactivity directly influences CNCDrelated morbidity and mortality, representing 5.3% of all-cause mortality in the Southeastern region of Brazil. Ribeiro assessed the association between physical inactivity, chronic diseases and drug consumption in the elderly, and determined that these variables are strongly interrelated (44). ...
... Altered liver enzyme values caused by physical exercise were observed in two case studies, but they were explained after discontinuing or decreasing the practice of highintensity exercises (42,43). The use of steroids is related with some intercurrences, together with changes in the levels of these enzymes (44,45). Yet, in this study, no change was observed in the treated groups. ...
Context:
Exercise and anabolic steroids are anticipated to promote fat mass reduction and so to decrease the number of comorbidities related to excessive weight.
Objective:
The aim of this study was to verify the influence of aerobic exercise and the use of steroids on the accumulation of adipose tissue and on the biochemical limitations of Wistar rats nourished by a hypercaloric diet.
Methods:
Forty, young male Wistar rats were split into four groups: obese control (n=10), obese under treatment (n=10), obese under aerobic exercise (n=10) and obese under aerobic exercise and treatment (n=10). All animals were fed with a hypercaloric diet and animals under treatment received intramuscular testosterone. Body (weight and visceral fat) and blood (lipidogram, glucose, and liver enzymes) parameters were assessed.
Results:
The group treated with aerobic exercise and testosterone revealed a reduction in body weight and visceral, perirenal, retroperitoneal and epididymal fats, accompanied by the blood levels of glucose, lactate, LDL-cholesterol, HDL-cholesterol, and lactate dehydrogenase; following high-intensity physical activity.
Conclusion:
The results support the theory that the combination of steroids and physical activity reduces the side-effects of androgenic-anabolic hormones and conveys benefits to some constraints.
... The activity of anabolic androgen steroids targets numerous organs and systems. Therefore, anabolic androgenic steroids may have negative effects on the immune system, cardiovascular, cerebrovascular, hepatic, musculoskeletal, endocrine, renal, and hematological systems (5)(6)(7)(8). According to reports, anabolic androgenic steroids can improve the degree of protein synthesis during recovery and protect muscles from damage by increasing their capacity to withstand loading (9). ...
... Differently to the commonly abused drugs, they do not trigger amplified euphoric impulses nor do they present immediate intoxication, since they do not immediately alter the DA levels in the organism. However, they do activate the reward system (drug dependency), signaled by DA, and consequent, abstinence withdrawal syndrome 5,11,40 . AASs exert different effects on distinct DA receptors. ...
The abuse of anabolic-androgenic steroids (AASs) is associated with high morbidity and mortality rates. The highest incidence of this malpractice documented in males (prevalence rate about 6.4%), a third of which develop adverse reactions. Accordingly, the objective was to review published studies about the neurological complications triggered by the indiscriminate use of AASs, with focus on the pathogenesis of lesions in the nervous system (NS). As a result it was observed that at NS, these stimulants actuate through a complex signaling systems that include the neuroendocrine alteration of the hypothalamic-pituitary-gonadal axis, modification of neurotransmitters and their receptors, as well as the induction of neuronal death by apoptosis in several pathways. These organic neurological alterations can lead to a clinical symptomatology with neurological, mood and sleep disorders. Consequently, varying adverse effects were observed analogous to the class of AAS utilized, how it was administered and time of use. Even though to date, only a few classes were submitted for scientific analyses, on dosages, mode of administration and specific exposure times. Furthermore, the illegal use and production of these drugs does not propitiate their appropriate application, quality control and purity. It was concluded that the abuse of AAS has inimically severe and complex effects, including serious neurotoxic issues.
... Global lifetime prevalence is estimated to be 3.3% (6.4% among males, 1.6% among females); however, prevalence varies greatly by geographic location and is elevated among certain populations including bodybuilders (24.5%), people with substance use disorders (28.3%), and people in prison (28.5%) (Havnes et al. 2020a;Havnes et al. 2020b;Nakhaee et al. 2013;Sagoe et al. 2014). A number of side effects are associated with high-dose exogenous androgen use, including somatic, psychiatric, and cognitive symptoms (Barbosa Neto et al. 2018;Christoffersen et al. 2019;Christou et al. 2017;Hauger et al. 2021;Hauger et al. 2020;Kanayama et al. 2013;Thiblin et al. 2015;van Amsterdam et al. 2010). Furthermore, approximately one-third of people who use AAS develops a dependence and are often at higher risk for undesired side effects as a result of increased dose and prolonged use (de Zeeuw et al. 2023;Pope Jr. et al. 2014). ...
Rationale
Anabolic-androgenic steroids (AAS) are used to improve physical performance and appearance, but have been associated with deficits in social cognitive functioning. Approximately 30% of people who use AAS develop a dependence, increasing the risk for undesired effects.
Objectives
To assess the relationship between AAS use (current/previous), AAS dependence, and the ability to recognize emotional facial expressions, and investigate the potential mediating role of hormone levels.
Methods
In total 156 male weightlifters, including those with current (n = 45) or previous (n = 34) AAS use and never-using controls (n = 77), completed a facial Emotion Recognition Task (ERT). Participants were presented with faces expressing one out of six emotions (sadness, happiness, fear, anger, disgust, and surprise) and were instructed to indicate which of the six emotions each face displayed. ERT accuracy and response time were recorded and evaluated for association with AAS use status, AAS dependence, and serum reproductive hormone levels. Mediation models were used to evaluate the mediating role of androgens in the relationship between AAS use and ERT performance.
Results
Compared to never-using controls, men currently using AAS exhibited lower recognition accuracy for facial emotional expressions, particularly anger (Cohen’s d = −0.57, pFDR = 0.03) and disgust (d = −0.51, pFDR = 0.05). Those with AAS dependence (n = 47) demonstrated worse recognition of fear relative to men without dependence (d = 0.58, p = 0.03). Recognition of disgust was negatively correlated with serum free testosterone index (FTI); however, FTI did not significantly mediate the association between AAS use and recognition of disgust.
Conclusions
Our findings demonstrate impaired facial emotion recognition among men currently using AAS compared to controls. While further studies are needed to investigate potential mechanisms, our analysis did not support a simple mediation effect of serum FTI.
... The findings revealed that athletes demonstrated a comprehensive understanding of the amplified physiological stress resulting from PIED use and recognized the associated health risks, particularly in relation to cardiovascular health concerns which fits with extant work (van Amsterdam et al. 2010). These athletes strategically utilized these substances to enhance recovery during the competition preparation phase. ...
Existing data reveals prevalent performance and image-enhancing drug (PIED) use in specific global regions and higher rates among athletes, however, research on performance-enhancement experiences among elite untested athletes is lacking. Drawing on conceptual frameworks that emphasize the intersection of context and practice, this research aims to gain insights into the subjective perspectives, motivations, and challenges faced by athletes in managing and optimizing their performance while using PIEDs. In-depth interviews were conducted with seventeen strength sports athletes, including powerlifters and bodybuilders, who had competed at national and/or international levels within untested federations. Thematic analysis was employed to examine the interview data within a social constructivist ontology. Findings revealed that PIEDs have dual roles as tools for enhanced recovery and heightened training stress, a delicate balance that aligns with Foucault's notion of self-transformation through technological advancements. These substances exerted power beyond consumption events with long-term psychological effects such as anxiety and irrational behavior emerging as key concerns. Peers with lived experience were key actors in the relationship between responsible drug management, however, the need for informed guidance was acknowledged. Non-human actors, notably biometric data tracking, played a pivotal role in guiding substance consumption. The study underscores the need for further research and tailored frameworks to support the health and well-being of athletes in this domain while addressing the broader implications of PIED use in public health discourse. Specifically, this study highlights the significance of integrating lived experiences and social contexts, emphasizing the need for nuanced harm-reduction strategies in this space. ARTICLE HISTORY
... AAS inhibit the body's physiologic endogenous testosterone synthesis, and chronic ASA also has adverse effects on multiple organ systems (10). Adverse effects in men include sexual dysfunction, cardiovascular disease, endocrine abnormalities, psychiatric dysfunction, and hepatotoxicity (11)(12)(13). Impacts on sexual function include testicular atrophy, reduced sperm count, impotence, and infertility (14). Currently, both the American Urological Association and the Endocrine Society recommend against testosterone therapy in men who wish to preserve their fertility (15,16). ...
... Since AAS are generated from testosterone and its associated precursors [88], when they are chronically abused, their side effects become permanent and gender-specificgynecomastia, hirsutism, hypertrophy, prostate cancer, hepatotoxicity, kidney damage, increased cardiac activity, and cardiac death [89][90][91]. There is a far higher danger to public health from the synthetic or designer steroids (such as recorded for methasterone, 4,6-androstadien-17-ol-3-one, 4,6-androstadien-3,17-dione, 5-androsten-17-ol-3-one, 4,9estradien-3,17-dione), because almost nothing is known about their pharmacology and the effects of long-term exposure. ...
Health concerns associated with the consumption of food supplements rise in parallel with the rise in the popularity and market availability of these products. In pursuit of data related to the unauthorized presence of pharmaceuticals in food supplements, the Rapid Alert System for Food and Feed (RASFF) database was searched for the 2011–2022 period. The most “popular” pharmaceuticals for the adulteration of food supplements were phosphodiesterase-5 inhibitors (235 records); anorexics and laxatives (76), including sibutramine and its active metabolite N-didesmethyl sibutramine, phenolphthalein and 2,4-dinitrophenol; stimulants, among which 1,3-dimethylamine (97), and synephrine (53) were the most numerous; nootropic drugs (24); anabolics and prohormones (16); and cannabinoid cannabidiol (14) (pending authorization as a novel food ingredient). Over 65% of notifications of interest were classified as serious risks, and over 80% of these were alert or border rejection notifications, mainly generated as a result of official control on the market. The alarming number of RASFF notifications should be considered a public health issue, demanding clear and targeted recommendation for action for the legislature and authorities. A harmonized nutrivigilance system should be considered as a tool to detect and scrutinize the adverse health effects of food supplements, along with measures to improve their safety, quality, and testing.
... Considering that, supraphysiological doses are typically used to achieve desired esthetic and ergogenic effects, the number of side effects and additional health risks increases accordingly. The majority of AAS users experience at least one objective side effect (Smit et al., 2022;van Amsterdam et al., 2010). Despite this, many websites provided little or no information about the possible side effects of AAS intake and advertised a range of pre-stacked AAS courses. ...
Unlabelled:
Background: With the online proliferation of illegal substances, the Internet offers a wide variety of information on the acquisition and intake of anabolic-androgenic steroids (AAS) and other performance and image enhancing drugs. This study focuses on investigating the characteristics of the online AAS market in Central Asia.
Objectives:
The primary objectives of this study were to investigate the accessibility and features of the online market for AAS in Central Asia. To achieve this, we employed a netnographic approach for a systematic exploration of websites advertising and selling AAS. The study aimed to conduct a comprehensive analysis of several key aspects, including the variety of AAS products offered, the quality of health advice provided the level of product availability, the procedures involved in making purchases, and the pricing structures within this market.
Results:
Twenty-one websites supplying AAS in Central Asia met our inclusion criteria. Using content analysis, data were gathered on AAS offerings, quality of health advice provided, availability, purchase process, and prices. Data were synthesized using descriptive statistics. Results indicate that AAS are easily accessible for purchase without valid medical prescription in the Central Asia online market. Most websites advertised the aesthetic and ergogenic benefits of AAS use without indicating the potential complications and adverse effects.
Conclusions:
Public health efforts to mitigate AAS use in Central Asia should consider both the online accessibility of AAS and the lack of accompanying information on potential complications as well as adverse effects associated with their use. Efforts must be intensified to curtail the proliferation of AAS and related misleading information on the Central Asian online market.
... The AAS are well-known to enhance muscle growth (anabolic effect) and to promote masculinization (androgenic effect). In addition, the use of these substances may lead to harmful effects such as hypogonadism and cardiovascular risks [22]. These effects are mainly caused by the disturbance occurring through the administration of exogenous steroids, which results in a negative feedback on the secretion of natural steroid hormones. ...
Testosterone is a key compound of the anabolic androgenic steroids (AAS) family. It has largely been misused in human and animal doping targeting a muscle tissue growth and an enhancement of performances. Such practices constitute a violation against ethical values, food safety, and animal welfare. Consequently, the use of such substance is regulated by WADA and International committees for some animal species such as equine and bovine. Although efficient, the detection of testosterone misuse remains challenging in some cases due to its endogenous origin and its inter- and intra-individual level fluctuation in biological fluids. Novel analytical strategies have been developed and are continuously evolving in order to tackle this issue and to provide a better control of testosterone misuse.
... Global lifetime prevalence is estimated to be 3.3% (6.4% among males, 1.6% among females), however prevalence varies greatly by geographic location, and is elevated among certain populations including bodybuilders (24.5%), people with substance use disorders (28.3%), and people in prison (28.5%) (1)(2)(3)(4). A number of side effects are associated with high-dose exogenous androgen use, including somatic, psychiatric, and cognitive symptoms (5)(6)(7)(8)(9)(10)(11)(12). Furthermore, approximately one-third of people who use AAS develop a dependence, and are often at higher risk for undesired side effects as a result of increased dose and prolonged use (13,14). ...
Background: Anabolic-androgenic steroids (AAS) are used to improve physical performance and to achieve a muscular appearance, with significant physical and psychiatric consequences. Approximately 30% of people who use AAS develop a dependence, increasing the risk for undesired effects, largely driven by endocrine dysfunction. AAS use has been associated with antisocial behaviors and decreased empathy, indicating impaired social cognitive abilities, but the potential mediating role of hormone levels is not well-established.Methods: In total 156 male weightlifters, including those with current (n=45) or previous (n=34) AAS use and never-using controls (n=77), completed the Emotion Recognition Task (ERT) as part of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Participants were presented with morphed faces expressing one out of six emotions (sadness, happiness, fear, anger, disgust and surprise) and were instructed to indicate by a button press which of the six emotions the face displayed. ERT accuracy and response time were recorded and used as behavioral outcomes and evaluated for association with AAS use status, AAS dependence, and serum reproductive hormone levels. Mediation models were used to evaluate the mediating role of androgens in the relationship between AAS use and ERT performance. Results: Compared to never-using controls, men currently using AAS (“On”) exhibited lower recognition accuracy for facial emotional expressions, particularly anger (F=4.29, pFDR=0.03) and disgust (F=3.87, pFDR=0.05). Those with AAS dependence (n=47) demonstrated worse recognition of fear relative to men without dependence (t=-2.26, p=0.03). Recognition of disgust was negatively correlated with serum free testosterone index (FTI), however FTI did not significantly mediate the association between AAS use and recognition of disgust.Conclusions: Our findings demonstrate impaired facial emotion recognition among men currently using AAS compared to controls. While further studies are needed to investigate potential mechanisms, our analysis did not support a simple mediation effect of serum FTI.
... AAS use has been associated with a wide range of psychiatric and somatic health consequences including cognitive deficits, aggression, cardiovascular problems, and hypogonadism [4][5][6][7][8][9][10][11]. Approximately one-third of people who use AAS develop dependence [12,13], which is characterized by AAS withdrawal, including hypogonadism symptoms (depression, anxiety, fatigue and sexual dysfunction), anxiety due to reduced muscle volume, and continued use despite negative impacts on physical and mental health [14][15][16]. ...
Background
Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls.
Methods
A sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use.
Results
In a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified.
Conclusions
AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.
... Anabolic steroids are used therapeutically for various medical conditions and as ergogenic substance to augment muscular strength and enhance physical performance. [1] In recent years, anabolic-androgenic steroids (AAS) abuse has surged and become a serious global public health dilemma, as being not confined only to bodybuilders or high-level athletes but also spread to casual fitness enthusiasts. [2,3] In 2013, the United States Centers for Disease Control and Prevention reported that 3.2% of high school students had used AAS without a doctor's prescription at least once in their lifetime. ...
... AAS may have reinforcing psychoactive effects including increased self-confidence and aggressiveness, even though they are not generally considered intoxicating substances [33]. For men, the androgenic effects of exogenous AAS may cause suppression of the hypothalamic-pituitary-gonadal axis and sometimes translates into AAS withdrawal syndrome [34] which may cause individuals to be prone to effects of dysphoria and, thus, increase the likelihood of resuming AAS use. However, the present sample did have a number of female users, one of whom reported multiple instances of trenbolone use. ...
Introduction:
There are a variety of harms associated with anabolic-androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users.
Method:
As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16).
Results:
Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS-using peers and family members of users reported the readily observable effect of trenbolone.
Discussion and conclusions:
Users should be cognisant of the potential for significant harms and health-care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users.
... However, by focusing on the potential neurodegenerative disease due to androgen use, especially in light of the limited data to support the notion of such a hazard, it could be argued that this risks further alienating a population that already views the opinions of physicians and mainstream medical advice with some skepticism [89]. It was not long ago that those abusing androgens were told that they were not actually effective [90], while the risks of their use and abuse may have been exaggerated [91][92][93][94][95]. Nevertheless, it should be acknowledged that potential risks with long-term abuse exist, especially with respect to adverse cardiovascular effects [96], while the health effects associated with long-term TRT use are still being investigated [97]. ...
Testosterone is the predominant androgen in men and has important physiological functions. Due to declining testosterone levels from a variety of causes, testosterone replacement therapy (TRT) is increasingly utilized, while testosterone is also abused for aesthetic and performance-enhancing purposes. It has been increasingly speculated that aside from more well-established side effects, testosterone may cause neurological damage. However, the in vitro data utilized to support such claims is limited due to the high concentrations used, lack of consideration of tissue distribution, and species differences in sensitivity to testosterone. In most cases, the concentrations studied in vitro are unlikely to be reached in the human brain. Observational data in humans concerning the potential for deleterious changes in brain structure and function are limited by their inherent design as well as significant potential confounders. More research is needed as the currently available data are limited; however, what is available provides rather weak evidence to suggest that testosterone use or abuse has neurotoxic potential in humans.
... The prevalence of moderate-severe AASUD of 24% is in line with earlier results of about 30% of all AAS consumers developing AAS dependence, based on the DSM-3-R/DSM-4 criteria for dependence (≥3 of 7 criteria) [16] and is in contrast with some previous reviews, stating that dependence liability of AAS is probably low [30]. A recent review, including data from 10 studies (total N = 1,247 AAS consumers), found a mean prevalence of AAS dependence across all studies of 32.5% (95% CI: 25.4-39.7), ...
Introduction:
The use of anabolic androgenic steroids (AAS) and other image- and performance-enhancing drugs is a growing public health concern. AAS use is associated with various physical and mental harms, including cardiovascular risks, cognitive deficiencies, and dependence. The aim of this study was to determine whether patterns of AAS use and other variables are associated with the presence of an AAS use disorder (AASUD).
Methods:
An online survey was completed by 103 male AAS consumers visiting gyms. The association of different patterns of AAS consumption (cycling vs. continuous forms of AAS use), psychoactive substance use, mental health disorders, and sociodemographic variables with moderate-severe AASUD (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ≥4 criteria) was investigated. The associations between duration of AAS use and the AAS dose with moderate-severe AASUD were investigated using logistic regression analysis with moderate-severe AASUD as the dependent variable.
Results:
Moderate-severe AASUD was present in 25 (24.3%) of the participants. AAS consumers meeting criteria for moderate-severe AASUD, compared to those that did not, in the last 12 months reported a longer duration of AAS use (in weeks), a higher average AAS dose (mg/week), and a greater number of AAS side effects. Duration of AAS use and the AAS dose were the only independent predictors, with an increase of 3.4% in the probability of moderate-severe AASUD with every week increase of the duration of AAS use in the last year (p < 0.05) and an increase in moderate-severe AASUD of 0.1% with every 10 mg increase in the average AAS dose per week (p < 0.05), respectively.
Conclusion:
Our findings show that moderate-severe AASUD is relatively frequent among male AAS consumers and is positively associated with the duration and average dose of AAS use in the last 12 months.
... Key motivations for the use of PIEDs are to change body shape and appearance and enhance physical performance (Brennan, Wells & Van Hout, 2017;Piacentino et al, 2017). However, it is recognised that the use of PIEDs carries health risks (Piacentino et al, 2017) from infections to sudden death (Darke, Torok & Duflou, 2014;Hope et al, 2013;van Amsterdam, Opperhuizen & Hartgens, 2010). ...
Recent reports have identified that PIEDs use is rising within the Armed Forces leading to concerns over health and concomitant operational risks. The aim of this study was to identify the roles of gateways and gatekeepers on PIEDs use among a cohort of UK military veterans. Semi-structured interviews were conducted with 14 ex-Service personnel. Interviews were transcribed verbatim and thematically analysed using NVivo12 software. Common themes were identified around the ways in which the veterans were introduced to PIEDs and how they accessed them. Gateways consisted of two categories of Circumstances and Behaviour, including excessive gym use, the need to cope with fitness demands of military service, overseas deployment, and previous experiences with nutritional and body-building supplements. Gatekeepers included friends, colleagues, and mentors and their roles were captured in two categories of Procurement of PIEDs and Information Dissemination. Recommendations include the need for further research on the roles of gatekeepers and gateways as important pathways to PIEDS use. Additionally, there is a need to build on themes suggested by earlier researchers to identify social, cultural, and economic factors that underpin motives for PIEDs use in the uniformed services. These two recommendations would inform the design and evaluation of PIEDs-related interventions.
... Through the conspicuous consumption of these drugs, men who exercise in a gym are provided with a principal ingredient for the attainment of immaculate external looks at the expense of their internal organs, such as the brain, the heart, the liver and the kidney, which can be severely affected (Ahlgrim & Guglin, 2009;Esperón et al., 2016;Fineschi et al., 2007;Goldman & Basaria, 2018;Junior et al., 2018;Lusetti et al., 2015;Nieschlag & Vorona, 2015;Van Amsterdam et al., 2010). ...
Cosmetic surgery is a thriving industry worldwide and Thailand is one of the market leaders. However, research which has explored issues concerning cosmetic surgery largely focuses on that of females. Moreover, it revolves around surveying clients, either quantitatively or qualitatively, rather than investigating the text which they consume. Even among the studies examining such text, they are predominantly conducted with the text published in offline media and within a Western context.
Therefore, the current study seeks to address such knowledge gaps by concentrating on online texts which male clients possibly consult for cosmetic surgery in Thailand. Since it is required by law that cosmetic surgery be conducted within authorised medical establishments, Thai cosmetic hospitals play a vital role in pursuing particular discursive strategies to communicate with clients. It is those strategies which the present study intends to investigate. To be exact, it intends to answer the following research questions: (1) What discursive strategies are employed by Thai cosmetic hospitals to propagate the ideologies about cosmetic surgery for masculinity enhancement? and (2) How do such strategies operate?
To answer the first question, the present study employs Van Dijk’s conception of the ideological square. It consists of how to: (1) emphasise our good things, (2) de-emphasise our bad things, (3) emphasise their bad things and (4) de-emphasise their good things. This framework is useful in providing a general principle of how hospitals are likely to communicate with clients. However, an additional issue may arise with regard to, for example, in which way hospitals actually emphasise the good things of cosmetic surgery. Such an issue connects with the second research question. Hence, the other framework, Taylor’s six-segment message strategy model, comes into play by functioning as a specific tool to answer it. The model consists of the ego, social, sensory, routine, acute need, and ration message strategies.
Methodologically, the present study utilises a corpus-assisted discourse analysis which amalgamates a quantitative method (the identification of significant keywords and collocations) into a qualitative analysis (the investigation of data extracts containing those significant lexical items). The corpus consists of the English version of webpage content belonging to 20 Thai hospitals with a total number of 73,168 words.
The findings reveal that, firstly, to emphasise the good things of cosmetic surgery, hospitals implement the ego, social, sensory and ration strategies. Secondly, to de-emphasise the bad things of post-operative complications, hospitals employ the ration strategy. Thirdly, to emphasise the bad things of not undergoing cosmetic surgery, hospitals adopt the ego strategy. Fourthly, to de-emphasise the good things of other means which are perceived as a rival to cosmetic surgery, hospitals pursue the ego and ration strategies. Overall, a preponderance of these strategies revolves around the notion of masculinity, which is conceptualised as the ideology concerning how to feel like a man, act like a man and have a body touted as a man.
The current study makes a theoretical and practical contribution. Theoretically, it is among the first which triangulates the discourse and the communication frameworks to analyse gender-related discourse pertaining to cosmetic surgery for masculinity enhancement in the Thai context. Practically, it hopes to raise awareness and promote media literacy among male clients about how cosmetic hospitals manifest and medicalise the ideology of masculinity via their online platforms.
https://repository.nida.ac.th/items/6a3f7631-7c7f-4bf0-8aa2-2bd75486e535
... In recent years, large doses of androgens were found to be associated with hypertension [46][47][48]. In 1980, a patient with HAE exhibiting hypertension after danazol treatment was administered small doses of diuretics to normalize their blood pressure level [49]. ...
Hereditary angioedema (HAE) is a rare autosomal dominant genetic disease characterized by repetitive subcutaneous or submucosal angioedema, activation of the kinin system, and increased vascular permeability. C1-inhibitor (C1-INH) deficiency, the main mechanism of HAE pathogenesis, occurs when abnormal activation of plasma kallikrein, bradykinin, and factor XII, or mutation of genes such as SERPING1 cause quantitative or functional C1-INH defects. Although androgens are not approved for HAE treatment in many countries, they are widely used in China and Brazil to reduce the frequency and severity of HAE attacks. The long-term adverse effects of androgen treatment are concerning for both physicians and patients. Virilization, weight gain, acne, hirsutism, liver damage, headache, myalgia, hematuria, menstrual disorders, diminished libido, arterial hypertension, dyslipidemia, and anxiety/depression are commonly observed during long-term treatment with androgens. These adverse effects can affect the quality of life of HAE patients and often lead to treatment interruption, especially in women and children. In-depth studies of the pathogenesis of HAE have led to the approval of alternative treatment strategies, including plasma-derived C1 inhibitor, recombinant human C1 inhibitor, plasma Kallikrein inhibitor (ecallantide; lanadelumab), and bradykinin B2 receptor antagonist (icatibant), some of which have achieved satisfactory results with mostly non-serious side effects. Therefore, a new standard of medical care may expand possibilities for the management of HAE in emerging countries.
... Selective androgen receptor modulators (SARMs) are a class of engineered anabolic compounds that bind differentially to the androgen receptor (AR) and alter receptor function (Christiansen et al., 2020;Solomon et al., 2019). They are posited to exert potent anabolic effects in skeletal muscle and bone (Bhasin & Jasuja, 2009;Narayanan et al., 2018), whilst lacking the undesired androgenic-related side effects (testicular atrophy, fluid retention, hypertension, gynecomastia, alopecia, decreased libido, etc.) commonly associated with anabolic androgenic steroids (Davani-Davari et al., 2019;Efimenko et al., 2021;Rahnema et al., 2014;van Amsterdam et al., 2010). This is primarily attributable to the tissueselective nature of these compounds along with their limited ability to cross-react with other steroid receptors, aromatize to estradiol or reduce to dihydrotestosterone. ...
New findings:
What is the central question of this study? How does LGD-4033 and MK-677 co-administration impact body composition, muscular strength, circulating androgen- and health-related biomarkers, in addition to intramuscular androgenic hormone and receptor concentrations. What is the main finding and importance? LGD-4033 and MK-677 co-administration increased body mass, lean mass, and fat mass while negatively impacting bone, serum lipids, liver enzymes, testosterone (total and free), and, likely, follicle stimulating hormone. Further, our cross-sectional data imply these compounds may alter intramuscular androgenic hormone and receptor concentrations along with promoting muscular strength when compared to previously published trained males.
Abstract:
LGD-4033, a selective androgen receptor modulator, and MK-677, a growth hormone secretagogue, are becoming increasingly used amongst recreationally-active demographics. However, limited data exist describing their effects on health- and androgen-related biomarkers. The purpose of this case study is to report changes in body composition and biomarkers during and after continued co-administration of LGD-4033 and MK-677. We additionally aimed to examine muscular strength and intramuscular androgen-associated biomarkers relative to non-users. A 25-year-old male ingested LGD-4033 [10 mg] and MK-677 [15 mg] daily for 5 weeks. Blood and body composition metrics were obtained pre-, on-, and post-cycle. One repetition maximum (1RM) leg and bench press, as well as intramuscular androgens, and androgen receptor (AR) content were analyzed on-cycle. We observed pre- to on-cycle changes in body composition [BM:Δ+6.0%; LBMtotal :Δ+3.1%; LBMtrunk :Δ+6.6%; LBMappendicular :Δ+4.3%; FMtotal :Δ+15.4%; FMtrunk :Δ+2.8%; FMappendicular :Δ+14.8%], bone [BMC:Δ-3.60%; area:Δ-1.1%; BMD:Δ-2.1%], serum lipid- [cholesterol:Δ+14.8%; triglycerides:Δ+39.2%; LDL-C:Δ+40.0%; HDL-C:Δ-36.4%], liver- [AST:Δ+95.8%; ALT:Δ+205.0%], and androgen- [free testosterone:Δ-85.7%; total testosterone:Δ-62.3%; SHBG:Δ-79.6%] associated biomarkers; however, all variables returned to pre-cycle values post-cycle, aside from FMtotal , FMappendicular , bone area, total cholesterol, and LDL-C. Follicle stimulating hormone (FSH) was below clinical reference values on- [1.2IU/L] and post-cycle [1.3IU/L]. Intramuscular AR [-44.6%], testosterone [+47.8%], and dihydrotestosterone [+34.4%] in addition to 1RM leg press and bench press [+39.2%; +32.0%] were different in the case subject compared to non-users. These data demonstrate LGD-4033 and MK-677 increased several body composition parameters, whilst negatively impacting bone and several serum biomarkers. Given the sparsity of data in recreationally-using demographics, further research is warranted to elucidate the acute and chronic physiological effects of these anabolic agents. This article is protected by copyright. All rights reserved.
... International Agency for Research on Cancer classifies boldenone as "class 2A" (growth promoter and steroid; probable human carcinogen with a high carcinogenic index) [4]. Apart from causing acne, stretch marks, hair growth, voice changes, pain, and liver changes (e.g., cholestasis, adenoma, and carcinoma), AAS can also cause notable cardiac events, such as hypertension, thrombosis, arrhythmias, systolic and diastolic dysfunction, left ventricular hypertrophy, and myocardial infarction [5]. According to a meta-analysis including 187 studies, worldwide AAS lifetime use was 3.3% and higher in men (6.4%) than women (1.6%) [1]. ...
Introduction
Anabolic-androgenic steroid (AAS) abuse is routine in athletes to enhance their overall physique. It often leads to detrimental effects, including cardiovascular diseases, hormonal imbalances, and cancer. Our case presentation emphasizes two important aspects: the first is the importance of thorough history taking in correctly diagnosing diseases with multiple etiologies. The second one relates to the reversible and preventable hazards of the increasing incidence of usage of illicit drugs, mainly androgenic anabolic steroids in young adults.
Case presentation
We present a case of a 30-year-old male bodybuilder with presenting complaints of increased anxiousness, excessive anger, and dyspnea on minimal exertion. Echocardiogram showed a dilated cardiomyopathy with left ventricular ejection fraction (LVEF) of 20%. The patient was counseled for quitting AAS and symptomatically treated on heart failure management guidelines. He responded well to the management plan and now enjoying a healthy life.
Conclusion
It is imperative to raise awareness regarding the substantial adverse effects of AAS abuse that might precipitate severe cardiovascular system complications leading to morbidity and eventual mortality. Most of the times, the pathological changes due to AAS abuse are reversible. This shows a good prognosis and better compliance with the management plan advised to the patients.
... Overuse of AASs causes serious side effects that involve the cardiovascular system, mood disorders ,the reproductive system and the liver (van Amsterdam et al., 2010).At present, neurobiological mechanisms and sites of action of AASs are unclear. In vitro, low AAS concentrations increase the death of excitotoxi cneurons (Orlando et al., 2007).In normal male volunteers, high doses of AAS cause cognitive impairment (Daly et al., 2003).The neurotoxicity induced by AASs can be complicated by the induction of excitotoxicity effect. ...
The aim of this study is to investigate the protection role of the organic selenium (high-selenium yeast) in adult male rabbits treated with Methandienone and combination with selenium. A total of 20 intact male rabbits were divided into four equal groups: control group receiving distal water, (T1) receiving Methandienone (oral dose of 0.35 mg / kg.),(T2) receiving high-selenium yeast (3 µg/ kg orally)and (T3) receiving both methandienone and selenium. A significant decrease in GSH with an increase in SOD activity were found and a significant increase in the oxidative markers MDA and PCCin serum (0.97+0.021)and in brain tissue (1.01+0.058) in T1 compared with other groups (control, T2 and T3). On the other hand, T3 group shows an increase in serum GSH and a decrease in SOD, MDA and PCC in serum and brain tissue. These changes are significant compared to AAS group (T1). Moreover, there is a significant increase in reverse transcription (mRNA) of Nrf2,TSPO and CYP19A1genes in AAS group(T1) as compared with other groups (T2 and T3). In addition, we showed a significant decrease in levels Nrf2, TSPO, and CYP19A1 mRNA in the selenium-yeast group compared to the AAS group (T1). In conclusion, these results showed that organic selenium (high selenium yeast) has a positive effect (protective role) against oxidative damage to the brain caused by AAS.
... Androgens (also known as anabolic androgenic steroids) are among the most common performance and image enhancing drugs (PIEDs), with the global prevalence rate of approximately 5% in men and 1% in women [1]. Androgens can affect men and women differently [2], but both can experience short and long-term physical side-effects [3][4][5]. However, one study found female androgen users were more likely to fit the description of substance dependence disorder (SDD), have been diagnosed with a psychiatric illness, and have a history of sexual and physical abuse [3]. ...
Purpose of review:
This paper reviews the mixed-methods studies from the last 2 years (2021-2022) into androgen use to highlight the most relevant developments within the field (see video, http://links.lww.com/COE/A35).
Recent findings:
The literature review found seven papers from 2021 to 2022. These seven cover a range of important considerations, including interventions to reduce androgen use, educational tools to increase professionals' knowledge, explorations on the comorbidity of use with other substances, motivations for use, potential risks factors for androgens' initiation, or risks of using androgens. Key findings include a greater understanding of motivations for use, particularly in females and older males; identification of potential risks for starting use/using androgens; benefits of including practical strength exercises in preventive intervention programmes and the efficacy of e-learning tools to increase professionals' knowledge of androgens use, as well as an increase in their confidence to support androgen users.
Summary:
The key implications for clinical practice are that we still need to support healthcare professionals to overcome the barriers for increasing their skills and knowledge around androgen use. A recognition that people who have become dependent on androgen use are potentially at risk of considerable harm, with further research needed into sub-groups of androgen users.
... Cholestatic jaundice, hepatic peliosis, and hepatocellular neoplasms (hepatic adenoma and hepatocellular carcinoma) have been reported. Several underlying mechanisms are claimed: oxidative stress in the hepatic cells, increase in the reactive oxygen species ROS associated with androgen receptors activation, and enhancement of mitochondrial B-oxidation (Bond et al. 2016, van Amsterdam et al. 2010). Further, the undesirable mental health outcomes up to successful suicide, uncontrolled aggressive behavior, or even criminal offenses have been linked to the continuous nontherapeutic use of anabolic androgenic steroids as well as withdrawal (Klötz et al. 2006). ...
Background
The market for performance enhancement substances (PESs) is currently one of the fastest expanding sectors. Most studies have always concentrated on athletes in terms of PESs’ misuse, ignoring a critical segment of the community: the future health-care workers. Thus, the aim of the study was to probe the knowledge, perception, and attitude of medical students regarding the misuse of PESs in sports and medical academic study. A cross-sectional study was conducted among students of Alexandria Faculty of Medicine, Egypt. Data were collected via self-administered electronic survey from 208 students of both sexes (aged from 18 to 26 years old). Analysis of factors affecting the consumption of PESs like gender differences, and their prior knowledge and perception was performed using logistic regression models.
Results
More than half of the participants have no idea about law concerning the use of doping substances. There were no significant disparities in knowledge and perception between males and females. Female students, on the other hand, consistently reported having a better understanding of the negative impacts of PESs’ misuse. Surprisingly, females are more prone to consume PESs for cognitive enhancement rather than the physical performance.
Conclusions
The study is the first to explore the awareness of the medical students, their attitude, and perception towards different ethical scenarios confronted in the daily practice. This finding pinpoints that the common trend of striving for fitness and an ideal body shape and weight has produced a shift in the prevalence of the PESs use according to gender in Egypt. Moreover, females in medicine academics are more prone to use PESs to improve the cognitive functions albeit it is nonsignificant statistically. Therefore, efforts should be directed to raise the awareness of medical practitioners of diverse categories of these substances, health hazards, laws, and penalties. More importantly, policy measures for their production, marketing, and misuse among university students should be reconsidered by the government.
... To attenuate these impacts, many anabolic steroids have been developed (1). The side effects of these drugs-polycytemia, hepatotoxicity, and debated cardiovascular effects-are other concerns (1,2,9), as well as deterioration of glucose metabolism associated with higher insulin resistance (IR) and visceral adipose tissue accumulation (10,11). ...
The primary objective of this 4-volume book series is to educate PharmD students on the subject of medicinal chemistry. The book set serves as a reference guide to pharmacists on aspects of the chemical basis of drug action. Medicinal Chemistry of Drugs Affecting Cardiovascular and Endocrine Systems is the third volume of the series. This volume features 8 chapters focusing on a comprehensive account of drugs affecting both the cardiovascular system and the endocrine functions. The volume informs readers about the medicinal chemistry of relevant drugs, which includes the mechanism of drug action, detailed structure-activity relationships and metabolism. Topics covered include drugs that affect the renin-angiotensin system, calcium channel blockers, diuretics, hematological agents (anticoagulants, thrombolytic and antiplatelet agents), antidiabetics, antihistamines, proton pump inhibitors and therapeutic hormones. Each chapter also offers case studies and self-assessments to facilitate discussion and learning. The book equips students with a scientific foundation to competently evaluate, recommend and counsel patients and health care professionals regarding the safe, appropriate, and cost-effective use of medications. Students and teachers will also be able to integrate the knowledge presented in the book and apply medicinal chemistry concepts to understand the pharmacodynamics and pharmacokinetics of therapeutic agents in the body. The information offered by the book chapters will give readers a strong neuropharmacology knowledge base required for a practicing pharmacist.
Background
Sexual dysfunction is commonly observed in individuals with Major Depressive Disorder (MDD), along with various psychological symptoms such as anxiety, somatic complaints, interpersonal sensitivity, and obsessive-compulsive tendencies. However, there is a research gap in understanding the impact of these psychological symptoms on sexual functioning in MDD. Furthermore, there is limited data on the incidence of sexual dysfunction among drug-naive MDD patients in West China. This study aims to determine the prevalence of sexual dysfunction in this patient population and explore its association with other psychological indicators.
Methods
We conducted a retrospective analysis of patient data from October 2020 to September 2022 using propensity score matching. A focused group of 165 males and 490 females was selected from a total of 1941 MDD patients. This allowed for a comparative analysis of demographic data, as well as scores from the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Symptom Checklist-90 (SCL-90), the Arizona Sexual Experience Scale (ASEX).
Results
Our findings reveal that 46.2% of drug-naive MDD patients experienced sexual dysfunction. Notably, there was a higher prevalence of sexual dysfunction among female patients (50.3%) compared to males (37.5%). MDD patients without sexual dysfunction consistently exhibited higher SDS scores than those with sexual dysfunction (p < 0.01), There were no statistically significant differences between male and female MDD patients with or without concomitant sexual dysfunction in terms of Somatic complaints, Obsessive-compulsive, Interpersonal sensitivity, Anxiety, Phobic anxiety, Paranoid ideation, Psychoticism and Diet/sleep difficulties (p > 0.05). In addition, male MDD patients with sexual dysfunction showed a emerging trend towards elevated Hostility scores on the SCL-90 (p = 0.058), male MDD patients with sexual dysfunction showed an increasing trend in hostility scores on the SCL-90, whereas female MDD patients with sexual dysfunction did not show such a trend.
Conclusion
The study highlights a significant gender difference in the prevalence of sexual dysfunction among MDD patients, with females being more susceptible than males. There is a positive correlation between the severity of depression and sexual dysfunction in both genders. Interestingly, male MDD patients demonstrated a potential protective effect of hostility against sexual dysfunction, which was not observed in female patients.
Introduction: Doping and steroid use represent a serious threat to animal health and can even lead to their untimely and painful death. However, doping is an acute problem in today’s animal racing world, particularly in camel racing. Testosterone and its ten esters (benzoate, valerate, isocaproate, hexahydrobenzoate, decanoate, undecanoate, laurate, enanthate, cypionate, and caproate) are of utmost importance, because when they are administered to animals it is difficult to measure them efficiently. The levels of testosterone and its esters in camels and other animals are typically determined using urine and blood tests. The aim of this study was to develop and validate a liquid chromatographic–mass spectrometric (LC-MS/MS) method to determine testosterone esters in camel hair, and to apply the validated method to determine testosterone esters in collected samples. To our knowledge, this is the first report of such research. Results and Discussion: The levels of testosterone and its ten derivatives, along with the cortisol-D4 internal standard, were optimised for LC–MS/MS analysis; however, only testosterone along with its seven esters (namely benzoate, valerate, isocaproate, hexahydrobenzoate, decanoate, undecanoate and laurate) could be validated in camel hair. Only five testosterone esters could be determined in camel hair samples; the concentrations were obtained as 10.5–14.9 pg/mg for valerate (in three camels), 12.5–151.6 pg/mg for hexahydrobenzoate (in six camels), 4.8–32.1 pg/mg for laurate (in five camels), 5.1 pg/mg decanoate (in one camel), and 8.35–169 pg/mg for testosterone (in all 24 camels). Interestingly, the three racing camels displayed high concentrations of testosterone (59.2–169 pg/mg, all three camels), laurate (4.8–14.5 pg/mg, two camels), hexahydrobenzoate (116 pg/mg, one camel), decanoate (5.1 pg/mg, one camel), and valerate (11.7 pg/mg, one camel). Methods: Camel hair samples were collected from 21 non-racing dromedary camels along with three racing camels in Al Ain, UAE; these were decontaminated, pulverised, sonicated, and extracted prior to analysis. An LC–MS/MS method was employed to determine the levels of testosterone esters in the hair samples. Conclusions: This novel camel-hair test procedure is accurate, sensitive, rapid, and robust. The findings reported in this study could be significant to evaluate racing camels for suspected doping offenses. Further controlled testosterone supplementation studies are required to evaluate individual esters’ effects on camel health and diseases and on performance enhancement levels. This new hair test could promote further studies in doping control, toxicology, and pharmacology, as well as having other clinical applications relating to camel health, injury, and disease.
Food supplements are products intended to complement the normal diet and consist of concentrated sources of nutrients or other substances with a nutritional or physiological effect. Although they are generally considered safe if the manufacturer's recommendations are followed, many of them have shown hepatotoxic properties. This can cause many diseases (e.g. steatohepatitis and cirrhosis) characterized by progressive damage and malfunction of the liver that in the long term can lead to death. A review of the literature was carried out to elucidate which dietary supplements have been associated with cases of hepatotoxicity in recent years, with emphasis on those relevant to the consumer and the new trends (e.g. cannabidiol). It has been reported that the supplements described as hepatotoxic are mainly of botanical origin (e.g. green tea or turmeric) and those used in sports (mainly anabolic androgenic steroids). There is a great variability of compounds described as causing liver damage, although sometimes it is not possible to identify them, because they are contaminants or adulterants of the products. In addition, the prevalence of toxic effects after the administration of supplements is difficult to define due to underreporting and the lack of specific studies. Globally regarding hepatotoxicity of dietary supplements, there is a paucity of well-conducted clinical trials on the efficacy of these compounds and the frequency of related liver damage, as the use of these products is largely uncontrolled.
Introduction
The use of anabolic androgenic steroids among recreational athletes has received growing attention in recent decades. Several countries have implemented bans on doping; however, recreational athletes and other subpopulations continue to use doping substances. Recognizing that the police play a crucial role in preventing the use and dealing of doping substances in Sweden, efforts have been made to intensify police interventions and enhance collaboration with other key actors. This study examined police officers’ perceptions of doping as defined in Swedish law, related problems, and suggestions for effective prevention of doping in the society.
Methods
A cross-sectional survey study was conducted using a web survey of police officers ( N = 597). Data were analyzed using descriptive statistics and free-form text responses were analyzed using content analysis.
Results
Participant responses to the survey (73.7% response rate) indicated that approximately 62.6% thought that doping is a societal problem, and approximately 26% perceived that the availability of doping substances has increased over the past three years. A total of 95.6% of respondents believed that doping occurred in connection with other crimes such as intimate partner violence (88.2%) and drug-related crimes (88.0%). Further, 96.3% of respondents perceived that it was their duty to prevent doping, but 63.8% indicated that doping-related work was not prioritized within their local police district.
Discussion
Police officers perceived doping as a societal problem and expressed motivation to counteract it, highlighting increased knowledge, legislative changes, intensified doping prevention in gyms, and commitment from other societal actors to increase the effectiveness of doping prevention. Suggestions for increasing the efficiency of doping prevention included education and increased knowledge at all levels in the police organization, intensified prevention efforts at gyms, legislative changes to permit simplified doping test procedures, and breach of secrecy for postal items. There was also a suggestion for further engagement from other actors, such as healthcare workers, school officials, and non-governmental organizations.
Beyond prescription of testosterone for its only valid indication, testosterone replacement therapy for pathological hypogonadism, in most countries there is increasing prevalence of testosterone misuse and abuse. Testosterone misuse is prescribing testosterone for non-valid medical indications such as male infertility, sexual dysfunction (in men without pathological hypogonadism) but most commonly for anti-ageing. Androgen abuse is the non-prescription use of testosterone or a synthetic androgen unrelated to medical indications but for doping, bodybuilding or other recreational, cosmetic or occupational reasons.KeywordsTestosteroneAndrogenAndrogen abuseDopingTestosterone prescribingAnti-dopingAndropauseLowTHypogonadism
Background
Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understanding and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls.
Methods
A sample of 153 men who had used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: 1) AAS dependence symptoms among men who has used AAS 2) muscle dysmorphia symptoms among men who had used AAS and weight-lifting controls in two separate networks, which were compared using a network comparison test, and 3) AAS dependence and muscle dysmorphia symptoms among men who had used AAS.
Results
In a network of AAS dependence symptoms, continuing use despite physical and mental problems, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men who had used AAS demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms among men who had used, no significant connections between symptom groups were identified.
Conclusions
AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target.
Background: Athletes’ use of androgenic-anabolic steroids (AASs) is a significant health problem. This study aimed to determine factors associated with AAS in male bodybuilders by applying the theory of planned behavior (TPB). Methods: Using a multistage random sampling procedure, this descriptive-analytical cross-sectional study was performed on 429 athletes participating in gyms in Qom, Iran, in 2019. The data collection tool was a questionnaire, including demographic information and questions related to TPB constructs. Data were analyzed by descriptive statistics, Chi-square test, logistic regression, and linear regression using SPSS software, version 16. Results: The results demonstrated that 188 (48.2%) athletes had a history of AAS use. The attitude (β=0.39), subjective norm (β=0.26), and perceived behavioral control (β=-0.36) predicted 38% of the variance of intention to AAS use. Further, behavioral intention was the statistically significant predictor of AAS use among the studied athletes (OR=0.83, 95% CI: 0.78-0.87). Variables such as having friends (OR=2.06, 95% CI: 1.28-3.30) or a sports coach using AAS (OR=3.1, 95% CI: 1.58-6.42) and having a history of supplementation use (OR=5.8, 95% CI: 2.65-12.8), along with age (OR=4.3, 95% CI: 0.35-53.6) had a significantly predictive role in using AAS. Conclusion: The findings revealed that nearly half of the studied athletes had a history of using AAS and supplements. TPB is applicable to identify the determinants of beliefs, intention, and behavior to use AAS among athletes. These findings can be useful in designing appropriate programs to prevent AAS use.
In this commentary/short communication we build upon our existing research and viewpoints related to the deleterious effects that AAS/Androgen use has, and the growing body of work and case studies/reports that identify the substantially increased risks that AAS/Androgen use presents to those who have (or have had) COVID-19. We position this commentary/short communication then, as one that builds on our prior calls for public health policy to be in part framed by, or at least to recognise the risks, of AAS/Androgen use. This is of particular contemporary importance now that COVID-19 is endemic, and we report on how long COVID-19 (Post COVID-19 syndrome) can present a wide range of lasting cardiovascular problems, a particular issue given that AAS/Androgen use may well exacerbate future health risks aligned to COVID-19.
Background
Doping is a societal problem associated with health problems, violence, and other crimes, especially when combined with alcohol and drugs. Elite, as well as recreational athletes who exercise in gyms may use doping to enhance their performance and/or improve their appearance. According to Swedish law, manufacturing, selling, supplying, possessing, and using anabolic androgenic steroids and growth hormones is forbidden. Exceptions apply if these substances are used for medical purposes and prescribed by doctors. As doping is illegal, the police authority is vital in counteracting doping.
Aim
We aimed to identify facilitators and barriers to effective doping prevention at gyms by examining police officers' views on doping as a societal problem, their experiences of doping prevention efforts, and their perceptions on what enables or hinders doping prevention.
Methods
Interviews with police officers (n = 15) were conducted from December 2021 to May 2022. The interviews were recorded and transcribed verbatim. A targeted content analysis of the material was performed.
Results
Facilitators for effective doping prevention involving the police included the recognition of doping as a societal problem; mobilization of key actors; motivated police management and officers; adequate resource allocation; collaboration between the police, gyms, and other relevant authorities; and skills development for police and other professions. Barriers to effective doping prevention included a lack of knowledge about doping, time-consuming processes around the detection and collection of evidence in doping offenses, and competing tasks for police officers.
Conclusion
Doping prevention should become more efficient by taking advantage of existing facilitators and removing remaining barriers. This study could guide recommendations linked to the police organization and the surrounding society regarding doping prevention.
Mental health emergencies, like other medical emergencies, are characterized by the presence of a high level of risk and the need for a rapid response. The individual presents with an acute disturbance in their mental state that might include features such as severe agitation, aggression or violence, and impaired insight and judgment. Data on the incidence of mental health emergency presentations in sport are sparse, but a broad range of mental health disorders, including delirium, have the potential to lead to a mental health emergency. Those who work with athletes should have a basic awareness of what constitutes an emergency and how to respond, including who to call and how to access emergency care. The priority in the immediate management of the situation is the safety of the athlete and those in the near vicinity. Sports organizations and teams should have clear and accessible mental health emergency plans that are consistent with other medical emergency plans and that include review processes and post-incident debriefing.KeywordsAthletesSportsSports psychiatryMental healthMental illnessMental disordersEmergencyMedical emergency
Anabolic-androgenic steroids (AAS) are primarily used to improve physical appearance and increase lean muscle mass. Due to their masculinizing properties, the majority of people using AAS are men; however, AAS use among females may increase with changing body ideals trending towards a more muscular appearance. AAS use among males have been associated with risky behavior, and increased prevalence of personality disorders and psychopathology. As a result of low perceived prevalence and stigma among females who use AAS, the relationship between AAS use and psychopathology in this population is not well-known. AAS using women (n = 16) and weight-lifting controls (WLC) (n = 16) completed questionnaires regarding AAS use, health and training information. Psychopathology was evaluated using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Group differences on demographic variables and scores on MCMI-III scales were evaluated with Mann-Whitney U tests. The clinical cut-off was then applied to all MCMI-III scales and groups were compared using Fisher's exact test. AAS consumers demonstrated significantly greater psychopathology than WLC on several scales. Externalizing personality disorder scales were elevated among those who use AAS relative to controls, such as borderline (p < 0.001), antisocial (p = 0.007) and sadistic (p = 0.002), and in addition depressive (p = 0.012), negativistic (p = 0.001) and masochistic (p = 0.029) personality disorders scales. Furthermore, all clinical syndromes were elevated among AAS consumers. AAS consumers thus demonstrated multi-pathology, and 56% (n = 9) of the group met the clinical criteria for six or more disorders. Females who use AAS experience in general increased levels of psychopathology compared to WLC. Clinicians should be aware of these traits and the challenges they present in providing care to this population.
Radiation pneumonitis (RP) occurs in some patients treated with thoracic radiation therapy. RP often self-resolves, but when severe it is most commonly treated with corticosteroids because of their anti-inflammatory properties. Androgens and human growth hormone (HGH) also have anti-inflammatory and healing properties in the lung, but have not been studied as a remedy for RP. Here we present a case of corticosteroid-refractory RP that resolved with androgen and HGH-based therapy.
Case Presentation
A 62 year old male body builder with excellent performance status presented with locally advanced non-small cell lung cancer characterized by a 7 cm mass in the right lower lobe and associated right hilar and subcarinal lymph node involvement. He was treated with chemoradiation and an excellent tumor response was observed. However, 2 months post-treatment he developed severe shortness of breath and imaging was consistent with RP. His RP was refractory to prednisone and antibiotic therapy, despite various regimens over a 9 month period. The patient self-treated with an androgen and HGH-based regimen and the RP promptly resolved.
Conclusion
The anti-inflammatory properties of androgens and HGH have prompted an exploration of their potential role in therapeutic strategies to treat pro-inflammatory conditions such as sepsis, infections and interstitial lung disease. This case study suggests a potential role for the use of androgens for the treatment of steroid-refractory RP after radiation therapy. However, the applicability of this strategy to general populations should be weighed carefully against secondary effects of these agents, especially in the setting of cancer survivorship.
Research has documented the harms associated with performance and image enhancing drug (PIED) use and lack of disclosure of use to healthcare providers (HCPs). Given that the relationship between HCPs and PIED consumers plays an important role in harm reduction, research is required to understand the barriers and facilitators for consumers to engage in help-seeking. This qualitative study explored the attitudes around current harm reduction frameworks for PIED consumers in Australia. Interviews were conducted with identified key stakeholders, who included a variety of PIED consumers as well as HCPs who come into frequent contact with PIED consumers. All participants were asked questions regarding the key barriers and facilitators for PIED consumers to help-seek, and how to best increase engagement among PIED consumers with HCPs. HCPs in Australia are calling for education around PIEDs, which is reflected as a ‘therapeutic barrier’ by consumers. This barrier represents an ongoing need to upskill HCPs in working with PIED consumers. Our data also showed a ‘safe space’ dynamic among peer-consumers in this space. Optimising harm reduction frameworks requires more synergy between peers and needle and syringe programs (NSPs), which remain safe and trusted environments for PIED consumers. We recommend harm reduction frameworks be strengthened through an increase in, and leveraging of, peer-led education programs.
Du fait de leur accès facilité par Internet, de nombreux produits sont détournés par les sportifs de haut niveau mais également par les amateurs (culturistes, par exemple) pour améliorer leur performance physique, esthétique et/ou mentale. Dans le cadre de cette thèse, je me suis intéressée aux substances de la performance suivantes, qui sont interdites en permanence par l’Agence Mondiale Anti-dopage (AMA) : les agents anabolisants classés S1 - les modulateurs sélectifs des récepteurs des androgènes (SARMs) S1.2 - les modulateurs hormonaux et métaboliques S4 et enfin la classe S5 qui comprend les diurétiques et les agents masquants. L’abus de ces substances peut conduire à des effets secondaires de type psychiatrique, de l’agressivité et à des complications pour la santé pouvant mener jusqu’au décès. Il est donc important de savoir les identifier dans un laboratoire de toxicologie médico-légale. Afin de comprendre si les résultats anormaux (dopage) ou positifs (médico-légal) observés sont dus à des contaminations environnementales, à des malversations ou à des pratiques dopantes caractérisées, l’analyse des phanères (cheveux, poils) a été choisie. L’objectif principal de cette thèse a été d’établir des critères d’interprétation pour expliquer les résultats dans les phanères. La première partie du travail a été consacrée à la mise en place d’une stratégie analytique et au développement et à la validation de trois méthodes d’analyses robustes et sensibles dans les cheveux à l’aide de systèmes de chromatographie liquide/gazeuse couplée à des détecteurs de spectrométrie de masse en tandem. A ce jour, les librairies de spectres MS comportent 20 stéroïdes anabolisants et 10 esters de testostérone, nandrolone, drostanolone et boldenone, 9 SARMs et 2 modulateurs métaboliques associés à la consommation de SARMs et enfin 9 diurétiques. Les méthodes MS sont mises à jour dès lors qu’un nouveau produit est commercialisé. Après la mise en place des méthodes analytiques, ma thèse a porté sur la caractérisation de l’incorporation de ces substances dans les cheveux, les poils et/ou les ongles. Pour ce faire, les méthodes ont été appliquées à des cas de dopage dans des cas de suspicion de contamination, à des affaires médico-légales dans des cas de violence ou de décès lié à l’abus d’agents anabolisants et à des cas cliniques dans le cadre du suivi thérapeutique des patients admis à l’hôpital. Pour finir, afin d’augmenter la spécificité des méthodes, d’identifier de nouveaux produits et leurs métabolites dans les urines ou d’identifier des produits inconnus avec précision, il a été nécessaire d’utiliser deux outils supplémentaires : les microsomes hépatiques humains (HLMs) et la spectrométrie de masse haute résolution (HRMS). Ces travaux ont donné lieu à 22 publications nationales et internationales ainsi qu’à de nombreuses collaborations.
Apprehensions of formulations of anabolic-androgenic steroids (AASs) have been significantly increasing worldwide. It is known that the consumption of synthetic steroids can lead to several side effects including liver damage, heart failure and psychological disorders. Nonetheless, there are few studies evaluating the toxicity of anabolic agents’ formulations. In this sense, the aims of this work were to determine the chemical profile of AASs apprehended in Brazil by Gas Chromatography-Mass Spectrometry as well as to determine their cytotoxicity by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Results showed that most formulations had their constitution adulterated or falsified by the lack of active ingredients. By the colorimetric MTT assay, it could be observed that most anabolic agents had cytotoxicity in concentrations of 0.5 mg.mL-1 in a general dose-dependent manner. Product #3 can be cited as displaying minimum cell viability (5.67 ± 0.25%) at 0.5 mg.mL-1 increasing to 91.82 ± 4.78% at 0.125 mg.mL-1. Therefore, in this study, apprehended formulations of AASs were mostly counterfeit materials with in vitro cytotoxicity, which shows the importance of analyzing these materials and indicating the adverse effects they pose to human health.
Anabolic androgenic steroids (commonly known as anabolic steroids) are synthetic derivatives of the hormone testosterone. They are being increasingly used by professional and recreational athletes to enhance performance, and by men and women to improve physical appearance. This article discusses the characteristics of such steroid 'misusers' and the techniques of use. It highlights the psychiatric complications associated with these steroids, including increased risk of aggression, personality disorders, psychosis and mood disorders, particularly manic symptoms. Medical complications of steroid use are common and frequently reversible. Use is associated with an increased risk of injury, cardiovascular events, gastrointestinal complications, virilisation in women, and gynaecomastia and testicular atrophy in men. Whether addiction to these steroids can occur is debatable, but there is evidence for dependence and a withdrawal syndrome. Steroid use may be a'gateway' to other addictions. Users are often reluctant to seek treatment and the psychiatrist's role in the recognition and management of use is presented.
This study aimed to determine through a questionnaire applied to interviewers, the current or past use of anabolic androgenic steroids (AAS), as well as other hormones (OH), and other medicines (OM), food supplement and illicit drugs among strength training apprentices in the city of Porto Alegre, RS. We interviewed 288 subjects draw from a sample of 13 gyms. The prevalence of current and past use of AAS was about 11.1% (32/288), OH 5.2% (16/288) and OM 4.2% (12/288). The most used AAS were nandrolone and stanozolol; the OH were gonadotropin, triiodothyronine (T3) and OM, like lipostabil, diuretics and veterinary medicines (Monovin E). The most frequent side-effects were behavioral such as humor oscillation, irritability and hostility, and endocrine disturbances such as acne and increased or decreased libido. When analyzed together with other hormones in a variable named "hormonal agents" (AH), AAS presented a statistical difference (p
Anabolic-androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. 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 adapted slightly for cumulatively acting drugs such as AAS.
AAS dependence is a valid diagnostic entity, and probably 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 characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies.
Background:
The prevalence of the use of androgenic anabolic steroids has been poorly studied in Europe. This study was undertaken to examine the prevalence of the misuse--the non-medical use--of androgenic anabolic steroids among adolescents in a county of Sweden.
Methods:
The total population of 16 and 17 year old male and female adolescents in a county on the south-west coast of Sweden was studied. The investigation was done by an anonymous multiple-choice questionnaire. The questionnaire was completed by 5,827 pupils and statistically analysed. The participation rate was 95%.
Results:
Among male adolescents 16 and 17 years old, 3.6% and 2.8% had misused androgenic anabolic steroids, respectively. These male adolescents had also misused alcohol, growth hormones and narcotic drugs more than the steroid hormone non-users. Among female adolescents there was no recorded misuse of these drugs (0.0%).
Conclusions:
The misuse of androgenic anabolic steroids is a reality in both small and large municipalities in Sweden. The prevalence figures are higher among 16 year old compared to 17 year old male adolescents. There is an association between this drug misuse and other substance misuse such as narcotic drugs. Female adolescents do not misuse steroid hormones. The findings indicate the need for preventive work among male adolescents in order to induce adolescents not to start misusing androgenic anabolic steroids.
Anabolic steroid-induced hypogonadism (ASIH) is the functional incompetence of the testes with subnormal or impaired production of testosterone and/or spermatozoa due to administration of androgens or anabolic steroids. Anabolic-androgenic steroid (AAS), both prescription and nonprescription, use is a cause of ASIH. Current AAS use includes prescribing for wasting associated conditions. Nonprescription AAS use is also believed to lead to AAS dependency or addiction. Together these two uses account for more than four million males taking AAS in one form or another for a limited duration. While both of these uses deal with the effects of AAS administration they do not account for the period after AAS cessation. The signs and symptoms of ASIH directly impact the observation of an increase in muscle mass and muscle strength from AAS administration and also reflect what is believed to demonstrate AAS dependency. More significantly, AAS prescribing after cessation adds the comorbid condition of hypogonadism to their already existing chronic illness. ASIH is critical towards any future planned use of AAS or similar compound to effect positive changes in muscle mass and muscle strength as well as an understanding for what has been termed anabolic steroid dependency. The further understanding and treatments that mitigate or prevent ASIH could contribute to androgen therapies for wasting associated diseases and stopping nonprescription AAS use. This paper proposes a unified hypothesis that the net effects for anabolic steroid administration must necessarily include the period after their cessation or ASIH.
We have reviewed contemporary aspects of the use of anabolic-androgenic steroids by athletes. Although no specific study shows clear-cut results, there are too many 'slightly positive' studies (despite inadequate design) and anecdotal stories to deter us from stating that anabolic-androgenic steroids are efficacious. Many of the recognized side effects especially of the 17-α-alkylated agents are transient or uncommon and occur much later than the perceived salutary effects. However, issues of abnormalities in lipid metabolism, but especially the behavioral effects of heightened aggression, dependence, and addiction are understudied and may be the most prominent and difficult to attribute to the ingestion of the agents. Even with the higher doses, there has been no epidemic of severe side-effects and deaths. The unknown quality of the increasing numbers of black market drugs should add an additional note of caution. Until the appropriate research studies have been completed no proper informed decision can be made of the benefit-to-risk ratio as can presently be made for tobacco, alcohol, and narcotic drugs. Our recommendation is that these agents should not be taken based on both ethical (fair play) considerations for competitive athletes and health (physical and psychological) for all nonathletes and athletes whether in competition or not.
Forty-nine male weight lifters, all users of anabolic-androgenic steroids (AASs), completed an anonymous, self-administered questionnaire to investigate addictive patterns of use. At least one DSM-III-R symptom of dependence was reported by 94% of the sample. Three or more symptoms, consistent with a diagnosis of dependence, were reported by 57%. Dependent users (n = 28) could be distinguished from non-dependent users (n = 21) by their use of larger doses, more cycles of use, more dissatisfaction with body size, and more aggressive symptoms. Multiple regression analysis revealed that dosage and dissatisfaction with body size were the best predictors of dependent use. Patterns of other substances used, although not predictive of AAS dependence, revealed very low cigarette use and at the same time high alcohol consumption. These data support the notion that AASs are addicting, and suggest that dissatisfaction with body size may lead to dependent patterns of use. The implications for both prevention and treatment are discussed.
The use of anabolic-androgenic steroids (AS) is perceived by the media, by segments of the sports medicine and athletic communities, and by the public to have grown to epidemic proportions. Unfortunately, the incidence and prevalence of AS use among elite, amateur, and recreational athletes is poorly documented. This study was designed to help identify AS use patterns among the male portion of the general adolescent population. The overall participation rate on a schoolwide basis was 68.7% and on an individual basis reached 50.3%. Participants in this investigation were 12th-grade male students (N = 3403) in 46 private and public high schools across the nation who completed a questionnaire that established current or previous use of AS as well as user and nonuser characteristics. Results indicate that 6.6% of 12th grade male students use or have used AS and that over two thirds of the user group initiated use when they were 16 years of age or younger. Approximately 21% of users reported that a health professional was their primary source. The evidence indicates that educational intervention strategies should begin as early as junior high school; the intervention should not be directed only toward those individuals who participate in school-based athletics.
Over the past several decades we have seen an increase in the prevalence of anabolic steroid use by athletes. Because use of anabolic steroids is illicit, much of our knowledge of their side effects is derived from case reports, retrospective studies, or comparisons with studies in other similar patient groups. It has been shown that high-dose anabolic steroids have an effect on lowering high-density lipoprotein, increasing low-density lipoprotein, and increasing the atherogenic-promoting apolipoprotein A. Steroid abuse can also be hepatotoxic, promoting disturbances such as biliary stasis, peliosis hepatis, and even hepatomas, which are all usually reversible upon discontinuation. Suppression of the hypothalamic adrenal axis can also lead to profound adrenal changes that are also reversible with time. Although rare, renal side effects have also been documented, leading to acute renal failure and even Wilms’ tumors in isolated cases. Much of our knowledge of these potentially severe but usually limited side effects is confounded by use of combinations of different steroid preparations and by the concomitant use with other substances. Physicians must target their efforts at counseling adolescents and other athletes about the potential harms of androgenic anabolic steroids and the legal options to improve strength and performance.
In addition to their use as replacement therapy for hypogonadal males, androgens, particularly testosterone (T), are being explored as potential hormonal male contraceptive agents, alone or in combination with other compounds. Androgens have regulatory effects on a variety of physiological systems in addition to gonadotropin secretion and spermatogenesis. Therefore, as hormonal contraceptive regiments that alter serum T levels are explored, it is important to evaluate their effects on these aspects of normal male physiology. The effects of exogenous T on suppression of spermatogenesis in 19 healthy men were recently compared, using a T dosage of 200 mg im/week for 20 weeks. Before treatment, the men were evaluated during a 3-month pretreatment period, and after treatment, they were followed for 4-6 months or until their sperm counts normalized. Because of the lack of information regarding the effects of exogenous T on nonreproductive physiology, we examined the effects of high-dose T on plasma lipids, calcium metabolism, and sexual behavior in our subjects. Mean serum T and estradiol levels increased significantly during the treatment period. Plasma high-density lipoprotein (HDL) cholesterol levels decreased significantly within the first month and remained suppressed during the duration of T administration. At the end of the treatment period, mean plasma HDL cholesterol had decreased by 13 +/- 2% (P < 0.05); plasma levels of HDL2, HDL3, and apoprotein AI also decreased significantly; mean levels of low density lipoprotein cholesterol and triglycerides were unchanged. After 1 month of the recovery period, plasma HDL levels had returned to the baseline range. Serum calcium levels decreased slightly during treatment; this decrease was statistically significant. Urinary calcium excretion did not change. Mean levels of serum intact PTH increased by 84 +/- 17% (P < 0.05) during T administration; in contrast, 25-hydroxyvitamin D levels decreased by 16 +/- 4% (P < 0.05), and 1, 25-dihydroxyvitamin D levels did not change significantly. All markers of calcium metabolism returned to baseline during the posttreatment period. Little change was found in self-reported sexual and aggressive behaviors during the study. There was a trend toward increased arousal and spontaneous erections during T administration, but this did not reach statistical significance. Frequency of sexual intercourse, masturbation, and kissing and fondling did not change, nor was the subjects' satisfaction in their relationships affected by T administration. Mean body weight increased by 4.0 +/- 0.5 kg. Approximately half the men noted mild acne. Body weight and acne symptoms returned to baseline during the recovery period. These data demonstrate that the serum levels of T produced by administration of T enanthate, 200 mg im weekly, lead to suppressed levels of plasma HDL cholesterol, alterations in calcium metabolism, increased body weight, and in some men, mild acne. These results imply that T enanthate at this dosage is moderately supraphysiological and may be inappropriately high for long-term administration to large groups of normal men for the purpose of contraception.
There are many treatment options for female sexual dysfunction (FSD), with the optimal therapy depending on the etiology of the problem. The cause of sexual dysfunction is multifactorial and may include psychological problems such as depression or anxiety disorders, conflict within the relationship, partner performance and technique, issues relating to prior abuse, medical illness, medications, fatigue, stress, or gynecological problems that make sexual activity uncomfortable. The role of low androgen concentrations in FSD is gaining increasing attention. Available therapeutic options include adjusting medications, counseling, treating depression or anxiety, reducing stress and fatigue, sex therapy, devices, estrogen therapy for genitourinary atrophy, and possibly vasoactive substances. Although no androgen therapies are currently approved by the Food and Drug Administration for FSD, they are being used in clinical practice, and early clinical trial results suggest that they may be both effective and safe in the treatment of FSD, specifically low libido. Androgen therapy should be considered primarily in women who have a physiological reason for reduced androgen concentrations, including aging, hypopituitarism, oophorectomy, or adrenal insufficiency. Products in use include oral methyltestosterone and dehydroepiandrosterone, topical testosterone ointment, and testosterone implants and injections. Products available for men, including skin patches and gels, are currently being studied at doses appropriate for women. Possible risks include hirsutism, acne, liver dysfunction, lowering of the voice, adverse lipid changes, virilization of a female fetus, and, as androgens are aromatized to estrogens, potentially the risks of estrogen therapy.
The use of anabolic-androgenic steroids (AS) is perceived by the media, by segments of the sports medicine and athletic communities, and by the public to have grown to epidemic proportions. Unfortunately, the incidence and prevalence of AS use among elite, amateur, and recreational athletes is poorly documented. This study was designed to help identify AS use patterns among the male portion of the general adolescent population. The overall participation rate on a schoolwide basis was 68.7% and on an individual basis reached 50.3%. Participants in this investigation were 12th-grade male students (N = 3403) in 46 private and public high schools across the nation who completed a questionnaire that established current or previous use of AS as well as user and nonuser characteristics. Results indicate that 6.6% of 12th grade male students use or have used AS and that over two thirds of the user group initiated use when they were 16 years of age or younger. Approximately 21% of users reported that a health professional was their primary source. The evidence indicates that educational intervention strategies should begin as early as junior high school; the intervention should not be directed only toward those individuals who participate in school-based athletics.
(JAMA 1988;260:3441-3445)
Background:
We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them.Methods:
We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed.Results:
Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol—high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes—mania, hypomania, or major depression—in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P<.001) and significantly more frequently than nonusers (P<.01). Users rarely abused other drugs simultaneously with steroids.Conclusion:
Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression.
Oral anabolic steroids produce striking reductions in serum concentrations of high-density lipoprotein (HDL) cholesterol. We hypothesized that this effect related to their route of administration and was unrelated to their androgenic potency. We administered oral stanozolol (6 mg/d) or supraphysiological doses of intramuscular testosterone enanthate (200 mg/wk) to 11 male weight lifters for six weeks in a crossover design. Stanozolol reduced HDL-cholesterol and the HDL2 subfraction by 33% and 71%, respectively. In contrast, testosterone decreased HDL-cholesterol concentration by only 9% and the decrease was in the HDL3 subfraction. Apolipoprotein A-I level decreased 40% during stanozolol but only 8% during testosterone treatment. The low-density lipoprotein cholesterol concentration increased 29% with stanozolol and decreased 16% with testosterone treatment. Stanozolol, moreover, increased postheparin hepatic triglyceride lipase activity by 123%, whereas the maximum change during testosterone therapy ( + 25%) was not significant. Weight gain was similar with both drugs, but testosterone was more effective in suppressing gonadotropic hormones. We conclude that the undesirable lipoprotein effects of 17-α-alkylated steroids given orally are different from those of parenteral testosterone and that the latter may be preferable in many clinical situations.
(JAMA. 1989;261:1165-1168)
This review examines the liver-damaging side effects of anabolic-androgenic steroids (AAS). It seems that AAS can cause development of peliosis hepatis, subcellular changes of hepatocytes, hepatocellular hyperplasia and hepatocellular adenomas. On the other hand, it has not been convincingly proved that AAS can cause development of hepatocellular carcinomas when used in the usual therapeutic doses. Tumours reported as hepatocellular carcinomas caused by AAS seems to be hyperplastic lesions of a benign nature able to regress with withdrawal of the putative agent. The effects of untraditional combinations and high-dose AAS are not yet known, leaving the possibility of a carcinogenic effect in those cases.
This investigation characterized the symptom patterns and mental status changes precipitated by anabolic steroid abuse. Twenty male weightlifters who were currently using anabolic steroids were compared to 20 male weightlifters who had never used steroids. The steroid users had significantly (p < 0.005) more somatic, depressive, anxiety, hostility, and paranoid complaints when using steroids than when they were not using the drugs. When contrasted to the weightlifter controls, the steroid users had a significantly (p < 0.005) greater number of complaints of depression, anxiety, and hostility during cycles of steroid use. However, no differences in the frequency of major mental disorders were found between the two groups. It is concluded that the organic affective changes associated with anabolic steroid abuse usually present as a subsyndromal depressive disorder of insufficient severity to be classified as a psychiatric disorder.
Objective: the purpose of the study is to give an account of psychiatric symptoms, aggressiveness and violent behaviour among users of anabolic androgenic steroids (AAS). The method used is retrospective evaluation based on information from forensic psychiatric evaluations (FPE), police reports and court records. Fourteen violent offenders were evaluated for current or previous use of AAS. The results suggest that AAS may produce violent behaviour and other mental disturbances, including psychosis. Besides previously described AAS-related violence, termed ‘roid rage’, two new patterns are described: (1) the cold-blooded executioner (‘Terminator’), and (2) the temporary AAS-user who takes the drug for the purpose of encouragement shortly before a criminal act (‘Stürmscknapps behaviour’). The effects of AAS on the central nervous system seem to be particularly detrimental to individuals with an inherent psychiatric disorder. It appears that use of AAS may lead to violent acts in vulnerable persons not only during current use but also after withdrawal.
Forty-nine male weight lifters, all users of anabolic-androgenic steroids (AASs), completed an anonymous, self-administered questionnaire to investigate addictive patterns of use. At least one DSM-III-R symptom of dependence was reported by 94% of the sample. Three or more symptoms, consistent with a diagnosis of dependence, were reported by 57%. Dependent users (n=28) could be distinguished from non-dependent users (n=21) by their use of larger doses, more cycles of use, more dissatisfaction with body size, and more aggressive symptoms. Multiple regression analysis revealed that dosage and dissatisfaction with body size were the best predictors of dependent use. Patterns of other substances used, although not predictive of AAS dependence, revealed very low cigarette use and at the same time high alcohol consumption. These data support the notion that AASs are addicting, and suggest that dissatisfaction with body size may lead to dependent patterns of use. The implications for both prevention and treatment are discussed.
This review examines the liver-damaging side effects of anabolic-androgenic steroids (AAS). It seems that AAS can cause development of peliosis hepatis, subcellular changes of hepatocytes, hepatocellular hyperplasia and hepatocellular adenomas. On the other hand, it has not been convincingly proved that AAS can cause development of hepatocellular carcinomas when used in the usual therapeutic doses. Tumours reported as hepatocellular carcinomas caused by AAS seem to be hyperplastic lesions of a benign nature able to regress with withdrawal of the putative agent. The effects of untraditional combinations and high-dose AAS are not yet known, leaving the possibility of a carcinogenic effect in those cases.
The nonmedical use of anabolic-androgenic steroids (AAS) appeals to athletes across several sports, particularly those whose activity makes muscle size and strength advantageous, and in individuals (usually men) with body dysmorphic disorder. Patterns of nonmedical use, including supratherapeutic doses of illicitly obtained drugs, increase the risk for adverse psychiatric and other medical consequences. Although AAS users may be more likely to consult physicians for nonpsychiatric medical consequences than changes in their mental status, it is argued that the motivation for persistent use despite adverse consequences is sustained in large part by psychological variables. Therefore, all physicians who treat nonmedical AAS users will benefit from an understanding of these psychological variables, including the potential for AAS to cause dependence. This article aims to aid such understanding, and guidelines are suggested for assessment and treatment of nonmedical AAS users.
This study suggests that patients receiving daily doses of 40 mg of prednisone or its equivalent, are at greater risk for developing steroid psychosis. Psychotic reactions were twice as likely to occur during the first 5 days of treatment as subsequently. Premorbid personality, history of previous psychiatric disorder, and a history of previous steroid psychosis did not clearly increase the patient's risk of developing psychotic reaction during any given course of therapy. Steroid psychoses present as spectrum psychoses with symptoms ranging from affective through schizophreniform to those of an organic brain syndrome. No characteristic stable presentation was observed in these 14 cases reported here. The most prominent symptom constellation to appear some time during the course of the illness consisted of emotional lability, anxiety, distractibility, pressured speech, sensory flooding, insomnia, depression, perplexity, agitation, auditory and visual hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions, apathy, and hypomania. Phenothiazines administered in average daily doses of 212 mg produced excellent response in all patients studied. Of particular note was the fact that tricyclic antidepressants produced an exacerbation or worsening of the clinical state in all patients to whom they were administered.
The effects of supraphysiological levels of testosterone, used for male contraception, on sexual behavior and mood were studied in a single-blind, placebo-controlled manner in a group of 31 normal men. After 4 weeks of baseline observations, the men were randomized into two groups: one group received 200 mg testosterone enanthate (TE) weekly by im injection for 8 weeks (Testosterone Only group), the other received placebo injections once weekly for the first 4 weeks followed by TE 200 mg weekly for the following 4 weeks (Placebo/Testosterone group). The testosterone administration increased trough plasma testosterone levels by 80%, compatible with peak testosterone levels 400-500% above baseline. Various aspects of sexuality were assessed using sexuality experience scales (SES) questionnaires at the end of each 4-week period while sexual activity and mood states were recorded by daily dairies and self-rating scales. In both groups there was a significant increase in scores in the Psychosexual Stimulation Scale of the SES (i.e. SES 2) following testosterone administration, but not with placebo. There were no changes in SES 3, which measures aspects of sexual interaction with the partner. In both groups there were no changes in frequency of sexual intercourse, masturbation, or penile erection on waking nor in any of the moods reported. The Placebo/Testosterone group showed an increase in self-reported interest in sex during testosterone treatment but not with placebo. The SES 2 results suggest that sexual awareness and arousability can be increased by supraphysiological levels of testosterone. However, these changes are not reflected in modifications of overt sexual behavior, which in eugonadal men may be more determined by sexual relationship factors. This contrasts with hypogonadal men, in whom testosterone replacement clearly stimulates sexual behavior. There was no evidence to suggest an alteration in any of the mood states studied, in particular those associated with increased aggression. We conclude that supraphysiological levels of testosterone maintained for up to 2 months can promote some aspects of sexual arousability without stimulating sexual activity in eugonadal men within stable heterosexual relationships. Raising testosterone does not increase self-reported ratings of aggressive feelings.
The abuse of anabolic-androgenic steroids by athletes has recently been associated with the development of myocardial infarction and stroke. Because platelets play a pathogenic role in these disorders, the authors hypothesized that androgenic steroid abuse among weight lifters was associated with increased platelet aggregation as measured in vitro. Twenty-eight study participants were recruited. Twelve denied current androgen use. However, 8 of these 12 tested positive for urinary androgens. Nonsignificant trends toward increased platelet counts and increased platelet aggregation to adenosine diphosphate were noted when androgen users were compared to nonusers. However, when stratified by age, older (greater than 22 years) androgen users required lower concentrations of collagen to produce 50% aggregation of test platelets than did younger (less than or equal to 22 years) androgen users (1.47 versus 3.35 micrograms/ml; p = .01). Further subgroup analysis revealed nonsignificant trends toward increased adenosine diphosphate-induced aggregability and nonsignificant trends in the platelet count in older weight lifters. Subsequent studies using collagen threshold aggregometry revealed no age-dependent effect in 17 other men (aged 18 to 46 years) not specifically selected for activity (r = .17). This study suggests an association between androgen use, age, and increased platelet sensitivity to collagen in weight lifters and may be helpful in explaining recent thrombotic disease in androgen users. It additionally calls into question the validity of subjective reporting when assessing androgen use among weight lifters.
All eight users of anabolic androgenic steroids in a pilot survey of weight lifters reported withdrawal symptoms and continued steroid use despite adverse consequences. Psychiatric (especially, depressive) symptoms were prominent in dependent users, underscoring the importance of diagnosing steroid dependence in clinical practice.
Widespread illicit anabolic steroid use has recently been reported. A review of available evidence suggests that elevations of serum levels of steroid hormones, including anabolic steroids, have profound psychological effects. Long-term, high-dose anabolic steroid use may lead to a preoccupation with drug use, difficulty stopping despite psychological side effects, and drug craving. Reductions in serum levels of steroid hormones appear to result in acute hyperadrenergic withdrawal symptoms that respond to steroid replacement or to agents that also ameliorate withdrawal symptoms in alcohol and opioid dependence. A delayed depression syndrome when serum steroid levels drop precipitously has been reported that appears similar to that observed in withdrawing cocaine-dependent individuals. We conclude that a proportion of anabolic steroid abusers may develop a previously unrecognized sex steroid hormone-dependence disorder and that treatment should be based on research into steroid effects on opioid and aminergic neurotransmission systems and relapse prevention.
A fatal rupture of an hepatic tumour occurred in an athlete who had been taking anabolic steroids for several years as an aid to body building. The case illustrates the hazards of non-therapeutic androgen administration, and emphasises the need for athletes to be made clear of the disturbances to gonadal function, liver structure and function, and the threat to life.
Oral anabolic steroids produce striking reductions in serum concentrations of high-density lipoprotein (HDL) cholesterol. We hypothesized that this effect related to their route of administration and was unrelated to their androgenic potency. We administered oral stanozolol (6 mg/d) or supraphysiological doses of intramuscular testosterone enanthate (200 mg/wk) to 11 male weight lifters for six weeks in a crossover design. Stanozolol reduced HDL-cholesterol and the HDL2 subfraction by 33% and 71%, respectively. In contrast, testosterone decreased HDL-cholesterol concentration by only 9% and the decrease was in the HDL3 subfraction. Apolipoprotein A-I level decreased 40% during stanozolol but only 8% during testosterone treatment. The low-density lipoprotein cholesterol concentration increased 29% with stanozolol and decreased 16% with testosterone treatment. Stanozolol, moreover, increased postheparin hepatic triglyceride lipase activity by 123%, whereas the maximum change during testosterone therapy (+25%) was not significant. Weight gain was similar with both drugs, but testosterone was more effective in suppressing gonadotropic hormones. We conclude that the undesirable lipoprotein effects of 17-alpha-alkylated steroids given orally are different from those of parenteral testosterone and that the latter may be preferable in many clinical situations.
Introduction ANDROGEN abuse by athletes constitutes only a portion of the problem of androgen misuse by the general population (1) and only a minor aspect of the doping of athletes with drugs presumed to enhance athletic ability (2, 3). Indeed, of the drugs banned by the International Olympic Committee, steroids account only for about 15% (4). This particular form of drug abuse stems from the convergence of several separate misconceptions. The first was the recognition that the administration of androgens to hypogonadal males causes an increase in nitrogen retention and an increase in muscle mass and lean body weight (5). It followed that the differences in muscle mass between men and women are largely due to differences in testosterone levels, and it was assumed that the administration of androgens in supraphysiological amounts to normal men would do even more than the normal amount. The second misconception was that the anabolic (muscle promoting) and androgenic (virilizing) actions of the hormone are e...
To assess the frequency of affective and psychotic symptoms in athletes taking anabolic steroids, the authors performed structured interviews of 41 body-builders and football players who had used steroids. According to DSM-III-R, nine subjects (22%) displayed a full affective syndrome, and five (12%) displayed psychotic symptoms in association with steroid use. These findings suggest that major psychiatric symptoms may be a common adverse effect of these drugs.
Use of anabolic androgenic steroids among athletes has grown at an alarming rate in recent years, despite the knowledge that their use has resulted in such side effects as severe depression of high-density lipoprotein levels, increased low-density lipoprotein/cholesterol levels, and hepatocellular carcinoma. We report here the case of a 34-year-old man whose hobby was body building, in the course of which he had been taking various anabolic androgenic agents for four years. Seventeen days before a scheduled body physique contest, he developed an acute right hemiparesis and experienced difficulty in speaking. In the emergency room he developed a simple partial seizure activity; an electroencephalogram showed abnormal slowing suggestive of left hemispheric structural lesion. After rehabilitation, he was able to ambulate independently; he had mild motor weakness in the right upper extremity with no sensory changes at discharge. Physicians working with athletes who use anabolic androgenic steroids should warn them of the risk of stroke.
The effect of testosterone and anabolic steroids on the size of sebaceous glands was studied by means of interactive morphometry in skin biopsies of power athletes. The subjects used self-administered high doses of testosterone and anabolic steroids during a 4-week strength training period. After 4 weeks' use of hormones, the area of sectioned sebaceous glands enlarged significantly by a factor of 89.2% (p less than 0.005). The number of cells in the so-called differentiating cell pool (DCP) and in the undifferentiated cell pool (UCP) also increased significantly (p less than 0.025, p less than 0.05, respectively). The size of the area occupied by UCP cells increased significantly (p less than 0.05). The study suggests that high doses of testosterone and anabolic steroids lead to an enlargement of sebaceous glands in male power athletes.
Data from human subjects given various amounts of anabolic steroids show that the resultant increment in lean body mass (LBM) has the features of a typical dose response curve. Low doses produce a very modest effect, while large doses result in a progressive augmentation of the LBM. Endogenous testosterone production during male adolescence is accompanied by a sex differential in LBM that is comparable to the LBM increment generated by exogenous steroids given to adults.
To determine the relationship between lipid profiles and the type of weight training and to assess the effects of anabolic-androgenic steroids on lipids, bodybuilders and powerlifters of similar age, body fat, and testosterone levels were studied before and after androgen use. Before androgen administration powerlifters had lower levels of plasma high-density-lipoprotein cholesterol (HDL-C) and HDL2-C (38 +/- 2; 6 +/- 1 mg/dL; means +/- SE, n = 8) than bodybuilders (55 +/- 2; 12 +/- 1 mg/dL; n = 8) and runners of comparable age and body fat (47 +/- 2; 14 +/- 2 mg/dL; n = 8), while levels of low-density-lipoprotein cholesterol (LDL-C) were higher in powerlifters (138 +/- 10 mg/dL) than in bodybuilders (104 +/- 7 mg/dL) and runners (110 +/- 6 mg/dL). Therefore, powerlifters had higher LDL-C/HDL-C ratios (3.7 +/- 0.3) than bodybuilders (2.0 +/- 0.2) and runners (2.4 +/- 0.2). Androgen use by eight bodybuilders and four powerlifters lowered values of both HDL-C and HDL2-C by 55% and raised values of LDL-C (61% +/- 10%) and LDL-C/HDL-C ratios (280% +/- 40%). Therefore, the training regimen of bodybuilders is associated with a more favorable lipid profile than the training used by powerlifters. Androgen use by strength-trained athletes may increase their risk for coronary heart disease.
This study examined the relationships between anabolic-steroid use and the use of other drugs, sports participation, strength training, and school performance among a nationally representative sample of US high school students.
Randomized survey data from the 1991 Centers for Disease Control and Prevention Youth Risk Behavior Survey.
Public and private schools in the 50 United States and District of Columbia.
A total of 12,272 9th through 12th grade students.
Prevalence of anabolic-steroid use.
The frequency of anabolic-steroid use was significantly associated with the frequency of use of cocaine, the use of other drugs such as amphetamines and heroin, tobacco smoking, and alcohol use. The weighted prevalences of anabolic-steroid use were higher among male (4.08%) than female students (1.2%). Students living in the South (3.46%) reported higher prevalences than students in the Midwest (3.0%), West (2.02%), or Northeast (1.71%). Students with self-perceived below-average academic performances (5.10%) and students reporting injected drug use also reported higher anabolic-steroid use (51.57%). Based on a multiple logistic regression, the following variables were found to be significant predictors of anabolic-steroid use: injectable drug use (odds ratio [OR], 17.86), use of other drugs (OR, 4.19), male gender (OR, 2.79), alcohol use (OR, 1.38), and strength training (OR, 1.73). The variables that were significantly associated with anabolic-steroid use varied by gender and by region of the country.
These data suggest that adolescent anabolic-steroid users in this country are more likely to engage in strength training, injected drug use, and the use of multiple drugs, even after controlling for sports participation and poorer academic performance. These data confirm previous findings of an association between multiple drug use and anabolic-steroid use. Also, engaging in strength-training exercises continued to be associated with anabolic-steroid use after controlling for drug use and other predictors.
Recent reports show that androgenic anabolic steroids are used by many teenagers, not as a deliberate attempt to give them strength, better athletic performance, etc., but to improve their looks. The so-called macho cult among young boys tempts them into using androgenic anabolic steroids to give them bigger muscles and a more powerful appearance.
This study was undertaken to investigate the prevalence of androgenic anabolic steroid use among teenagers in a small town and to create a platform for future work with the aim of decreasing the misuse of these drugs.
In Falkenberg, a town in the county of Halland in the west of Sweden, the pupils at two high schools were investigated by means of an anonymous multiple-choice questionnaire. A total of 1383 students (688 males and 695 females) aged 14–19 years participated in the study, giving a participation rate of 96%. The number of answers completed was 99%. The use of androgenic anabolic steroids is a reality among male teenagers in Falkenberg, with 5.8% of them using the drugs. Among 15- to 16-year-old boys misuse of these drugs is as high as 10%, and of these 50% (5.0% of total) also inject ampoules of the drugs. This prevalence is alarming since the adverse effects of androgenic anabolic steroids are more serious in teenagers. Serious action must be taken to inform teenagers of the consequences of misusing drugs.
Substantial evidence now suggests that increased aggression is associated with illicit use of anabolic-androgenic steroids (AAS) by athletes. Anecdotal reports claim that wives and girlfriends of the athlete sometimes become victims of physical abuse when their significant other is using these drugs. We sought to investigate these claims empirically. Twenty-three AAS user strength athletes and 14 nonuser athletes, recruited in the course of a larger study, were interviewed using the Dyadic Adjustment Scale and the Conflict Tactics Scales to assess their relationships with their significant other. AAS users were asked about their relationship during their most recent "cycle" of AAS use and their most recent AAS-free period. Nonusers were asked about their relationship in the last 3 months. AAS users reported significantly more fights, verbal aggression, and violence toward their significant others when using AAS than when not using AAS. The AAS users on-drug differed significantly from nonusers on two of these indices, but AAS users off-drug did not significantly differ from nonusers. These findings support the anecdotal evidence that wives and girlfriends of AAS users may be at risk of serious injury from users while they are on-drug. Thus, AAS use may impose risks not only to the user, but also to the women close to them.
In addition to their use as replacement therapy for hypogonadal males, androgens, particularly testosterone (T), are being explored as potential hormonal male contraceptive agents, alone or in combination with other compounds. Androgens have regulatory effects on a variety of physiological systems in addition to gonadotropin secretion and spermatogenesis. Therefore, as hormonal contraceptive regiments that alter serum T levels are explored, it is important to evaluate their effects on these aspects of normal male physiology. The effects of exogenous T on suppression of spermatogenesis in 19 healthy men were recently compared, using a T dosage of 200 mg im/week for 20 weeks. Before treatment, the men were evaluated during a 3-month pretreatment period, and after treatment, they were followed for 4-6 months or until their sperm counts normalized. Because of the lack of information regarding the effects of exogenous T on nonreproductive physiology, we examined the effects of high-dose T on plasma lipids, calcium metabolism, and sexual behavior in our subjects. Mean serum T and estradiol levels increased significantly during the treatment period. Plasma high-density lipoprotein (HDL) cholesterol levels decreased significantly within the first month and remained suppressed during the duration of T administration. At the end of the treatment period, mean plasma HDL cholesterol had decreased by 13 +/- 2% (P < 0.05); plasma levels of HDL2, HDL3, and apoprotein AI also decreased significantly; mean levels of low density lipoprotein cholesterol and triglycerides were unchanged. After 1 month of the recovery period, plasma HDL levels had returned to the baseline range. Serum calcium levels decreased slightly during treatment; this decrease was statistically significant. Urinary calcium excretion did not change. Mean levels of serum intact PTH increased by 84 +/- 17% (P < 0.05) during T administration; in contrast, 25-hydroxyvitamin D levels decreased by 16 +/- 4% (P < 0.05), and 1,25-dihydroxyvitamin D levels did not change significantly. All markers of calcium metabolism returned to baseline during the posttreatment period. Little change was found in self-reported sexual and aggressive behaviors during the study. There was a trend toward increased arousal and spontaneous erections during T administration, but this did not reach statistical significance. Frequency of sexual intercourse, masturbation, and kissing and fondling did not change, nor was the subjects' satisfaction in their relationships affected by T administration. Mean body weight increased by 4.0 +/- 0.5 kg. Approximately half the men noted mild acne. Body weight and acne symptoms returned to baseline during the recovery period.(ABSTRACT TRUNCATED AT 400 WORDS)
We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them.
We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed.
Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol-high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes--mania, hypomania, or major depression--in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P < .001) and significantly more frequently than nonusers (P < .01). Users rarely abused other drugs simultaneously with steroids.
Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression.
To determine the rate of current or previous use of anabolic steroids by students at a UK college of technology, a questionnaire survey of 687 day students was conducted. The questionnaire began with a general section for all of the students, which ended with the question 'Have you ever used anabolic steroids?'. A further section specifically for anabolic steroid users examined patterns of use, and how certain circumstances might affect the individual's decision to use anabolic steroids. The response rate to the questionnaire was 92%. The overall rate of current or previous use of anabolic steroids was 2.8% (4.4% in males, 1.0% in females). Of these, 56% had first used anabolic steroids at age 15 or less. Anabolic steroid users were more likely to be male, under 17 years of age, and participating in bodybuilding, weight-lifting or rugby. The results of this survey, if confirmed in other groups of young people, would suggest that use of anabolic steroids may be widespread in the UK.