No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Human Growth Hormone Abuse in Male Weightlifters
Abstract
In a study of performance-enhancing substance use among 231 experienced young male weightlifters, we found that 27 (12%) reported illicit use of human growth hormone (HGH) or its bioactive derivative, insulin-like growth factor-1. All of these 27 men also reported use of anabolic-androgenic steroids (AAS) and 22 (81%) met criteria for current or past AAS dependence. Fifteen (56%) also reported current or past dependence on opioids, cocaine, and/or ecstasy. These findings suggest that among young male weightlifters, illicit HGH use has become a common form of substance abuse, frequently associated with both AAS dependence and classical substance dependence.
... [9][10][11][12][13][14] Surprisingly, many of people who use AAS also abuse other banned substances and illicit drugs including stimulants and somatotropins (growth hormone) to appear more bulky or to have a better performance. 8,[15][16][17] Numerous side effects, which some of them are life threatening, make AAS and illicit drugs a great public health concern. 18-22 For several decades, determining the predisposing risk factors for AAS and substances abuse have been the main subject of various studies. ...
... 18-22 For several decades, determining the predisposing risk factors for AAS and substances abuse have been the main subject of various studies. 8,10,12,[15][16][17][18][19][20][21][22] Theoretically, psycho-social and demographic factors may influence AAS and substance misuse and some authors have assessed the effect of these parameters on AAS and substances intake in male bodybuilders; 8,12 however, there are a few studies investigating this among female bodybuilders. According to some reports, several parameters such as age, education level, frequency of sport participation, mental health, and body image are probably associated with AAS or substance abuse in male bodybuilders, [8][9][10]12,16,17,23 but this is not fully consistent in the correlated literature. ...
... 8,10,12,[15][16][17][18][19][20][21][22] Theoretically, psycho-social and demographic factors may influence AAS and substance misuse and some authors have assessed the effect of these parameters on AAS and substances intake in male bodybuilders; 8,12 however, there are a few studies investigating this among female bodybuilders. According to some reports, several parameters such as age, education level, frequency of sport participation, mental health, and body image are probably associated with AAS or substance abuse in male bodybuilders, [8][9][10]12,16,17,23 but this is not fully consistent in the correlated literature. ...
Background:
The growing tendency to anabolic-androgenic steroids (AAS) and prohibited substances misuse by female athletes is a new public health concern. Epidemiological studies in this field are necessary to introduce an effective preventive drug control program in gyms. This study directed to evaluate the prevalence of AAS and other banned substances use and assess its association with some psycho-social and also demographic parameters among Iranian female recreational bodybuilders.
Methods:
This study was done from January to March 2017 and 289 recreational female bodybuilders from 41 randomly-selected fitness and sports clubs in different geographic parts of Tehran, Iran, were included. Age, education level, months of sport involvement, frequency of sport participation in a week (hour), body image assessed by Multidimensional Body-Self Relations Questionnaire (MBSRQ), and history of AAS and substances intake as the psycho-socio-demographic parameters were recorded by interviews using questionnaires.
Findings:
Subjects were all recreational female bodybuilders [mean and standard deviation (SD) of age: 26.3 ± 6.3, range: 15-52 years]. Self-report of AAS abuse was recorded in 70 bodybuilders (24.2%). Among prohibited substances, the use of stimulants (amphetamine or methamphetamine) and other illicit drugs was recorded in 10 (3.5%) and 95 (32.9%) athletes, respectively. 112 (38.8%) participants reported somatotropin use. Cigarette smoking, hookah use, and alcohol intake were reported by 42 (14.5%), 162 (56.1%), and 49 (17.0%) female bodybuilders, respectively. Among different evaluated parameters, merely the frequency of sport participation in a week and sport experience was inversely associated with AAS consumption.
Conclusion:
Based on the subjects' self-statement, AAS and substance misuse was surprisingly common in recreational female bodybuilders. Some factors including weekly frequency of sport participation and the duration of sport involvement may influence the prevalence of AAS abuse.
... Human growth hormone is a naturally occurring peptide hormone which maintains body composition, and improves physical performance, cardiovascular health, and wellbeing in humans (Erotokritou-Mulligan, Holt, & Sönksen, 2011;Graham et al., 2009;Graham, Evans, Davies, & Baker, 2008;Olshansky & Perls 2008). It is one of the oldest and popular antiaging treatments in animal models (Al-Regaiey, Masternak, Bonkowski, Liang et al., 2003;Rudman et al., 1990;Sun, Al-Regaiey, Masternak, Wang, & Bartke, 2005) despite concerns for adverse side effects (Ayuk & Sheppard, 2008;Brennan, Kanayama, & Hudson, 2010;Liu et al., 2007) and reviews that supplementation does not significantly increase muscle strength or aerobic capacity in either health subjects (Liu et al., 2008) or nonhuman growth hormone deficient subjects (Ehrnborg & Rosen, 2008;Gibney, Healy, & Sönksen, 2007;Graham et al., 2009). Clinical studies observe its limited properties to promote muscle growth in healthy active subjects with outcomes complicated by issues in targeting appropriate dosage and cardiovascular and metabolic consequences (Berggren et al., 2005;Crist, Peake, Egan, & Waters, 1988;Deyssig, Frisch, Blum, & Waldhör, 1993;Ehrnborg, Ellegård, Bosaeus, Bengtsson, & Rosén, 2005;Wallace et al., 1999;Yarasheski et al., 1992;Yarasheski, Zachweija, Angelopoulos, & Bier, 1993). ...
... Human growth hormone was once abused solely by elite athletes (Salomon, Cuneo, Hesp, & Sönksen, 1989). Illicit use is rising in athletes striving to improve physical performance with demand fuelled by Internet availability of new, cheap and potent synthetic growth hormone releasing hormone analogues (Brennan et al., 2010;Cai et al., 2014). This rise in synthetic peptide drug manufacture, often marketed without prior clinical trials (Henninge, Pepaj, Hullstein, & Hemmersbach, 2010) occurs in correspondence with development of new detection methods in sport (Bidlingmaier & Strasburger, 2010;Saugy et al., 2006;Sackmann-Sala, Ding, Frohman, & Kopchick, 2009;Thomas, Schänzer, Delahaut, & Thevis, 2012). ...
... This rise in synthetic peptide drug manufacture, often marketed without prior clinical trials (Henninge, Pepaj, Hullstein, & Hemmersbach, 2010) occurs in correspondence with development of new detection methods in sport (Bidlingmaier & Strasburger, 2010;Saugy et al., 2006;Sackmann-Sala, Ding, Frohman, & Kopchick, 2009;Thomas, Schänzer, Delahaut, & Thevis, 2012). Illicit use has also displaced into repertoires of poly pharmaceutical and illicit drug use in bodybuilding and weight lifting groups (Baker, Graham, & Davies, 2006;Brennan et al., 2010;Gruber & Pope, 2000;Kanayama, Pope, Cohane, & Hudson, 2003;Rickert, Pawlak-Morello, Sheppard, & Jay, 1992;Skarberg, Nyberg, & Engstrom, 2009). ...
Background:
Communal online folk pharmacology fuels the drive for short cuts in attaining muscle enhancement, fat loss, and youthful skin.
Objectives:
The study used "netnography" to explore female use of CJC-1295, a synthetic growth hormone analogue from the perspectives contained in Internet forum activity.
Methods:
A systematic Internet search was conducted using variation of the term "CJC-1295"; and combined with "forum." Ninety-six hits related to bodybuilding websites where CJC-1295 was mentioned. Following application of exclusion criteria to confine to female use and evidence of forum activity, 9 sites remained. These were searched internally for reference to CJC-1295. Twenty-three discussion threads relating to female use of CJC-1295 formed the end data set, and analyzed using the Empirical Phenomenological Psychological method.
Results:
Forum users appeared well versed and experienced in the poly use of performance and image drug supplementation. Choice to use CJC-1295 centered on weight loss, muscle enhancement, youthful skin, improved sleep, and injury healing. Concerns were described relating to female consequences of use given gender variations in growth hormone pulses affecting estimation of dosage, cycling, and long-term consequences.
Conclusions:
Public health interventions should consider female self-medicating use of synthetic growth hormone within a repertoire of product supplementation, and related adverse health consequences.
... 30 In a study among 231 young male weightlifters in the USA, 12% reported the use of AAS, and 81% met the criteria for current or past AAS dependence. 31 The link between AAS use and weightlifting was also reported in other studies. 27,28,31 With the continuing practice of using AAS among weightlifters, it seems necessary to study and develop programs directed towards reducing AAS use among this group. ...
... 31 The link between AAS use and weightlifting was also reported in other studies. 27,28,31 With the continuing practice of using AAS among weightlifters, it seems necessary to study and develop programs directed towards reducing AAS use among this group. ...
Objectives:
Anabolic-androgenic steroids (AAS) have been used internationally for enhancing physical appearance and performance despite their significant side effects. We sought to identify the prevalence of AAS use and its different risk factors among gym users in Riyadh, Saudi Arabia.
Methods:
A cross-sectional survey was distributed among gym users across 20 gyms in Riyadh. The cluster sampling technique was used to represent the four regions of Riyadh (North, South, East, and West). Univariate and multivariate analyses were performed to identify the factors associated with AAS.
Results:
Out of 482 participants, 29.3% reported using AAS. The mean age of the study participants was 27.2±6.9 years, 61.0% were single, 67.1% were educated, 35.5% were government employees, and 31.1% were students. The use of AAS was more prevalent among gym members who practiced weightlifting (45.5%), were employed in the private sector (35.8%), and aged > 25 years old (53.3%). Multiple logistic regression showed that the most significant factors associated with the use of AAS among gym members were: weightlifting, using supplementary vitamins or minerals, following special diets, knowing individuals who used AAS, and being offered AAS.
Conclusions:
Our study provides clear evidence that the lifetime prevalence of AAS use is high among male gym members in Riyadh with modifiable risk factors. The results could help public health policymakers to take the necessary measures to alleviate the potential negative implications of AAS use at the community level.
... Elite athletes started to abuse AAS since the 1950s (5)and currently, millions of people worldwide use AAS (6)(7)(8)(9)(10)(11). Surprisingly, majority of such people are not among elites or competitive athletes, rather ordinary people who use these drugs merely to lose body fat or to gain more muscle mass (12)(13). Additionally, many of AAS users also abuse other prohibited substances and drugs to look more muscular or to have a better performance (14)(15)(16)(17). Concerns over serious side-effects of AAS abuse such as cardiac, hepatic, neuroendocrine and psychiatric effects has increased over the last decades (18)(19)(20)(21)(22) and now theses drugs are considered as a big threat for public health. ...
... Another important finding in the present study was the association between AAS and substance abuse among male body-builders. This finding is supported by many previous surveys (10,12,13,15,(40)(41)(42). Accordingly, anabolic steroids may be considered as a gateway to illegal substance abuse with more adverse effects and additional addictive properties. ...
Background:
The high prevalence and potential side effects of anabolic-androgenic steroids (AAS) misuse by athletes has made it a major public health concern. Epidemiological studies on the abuse of such drugs are mandatory for developing effective preventive drug control programs in sports community. This study aimed to investigate the prevalence of AAS abuse and their association with some psycho-socio-demographic factors in Iranian male recreational body-builders.
Methods:
Between March and October 2011; 906 recreational male body-builders from 103 randomly selected bodybuilding clubs in Tehran, Iran were participated in this study. Some psycho-socio- demographic factors including age, job, average family income, family size, sport experience (months), weekly duration of the sporting activity (h), purpose of participation in sporting activity, mental health as well as body image (via General Health Questionnaire and Multidimensional Body-Self Relations Questionnaire, respectively), and history of AAS use were obtained by interviews using questionnaires.
Results:
Participants were all recreational male body-builders [mean age (SD): 25.7 (7.1), ranging 14-56 yr]. Self-report of AAS abuse was registered in 150 body-builders (16.6%). Among different psycho-socio-demographic factors, only family income and sport experience were inversely associated with AAS abuse.
Conclusion:
Lifetime prevalence of AAS abuse is relatively high among recreational body-builders based on their self-report. Some psycho-socio-demographic factors including family income and sport experience may influence the prevalence of AAS abuse.
... Однако было много сообщений о его наличии на черном рынке. IGF-I одобрен только для лечения пациентов с первичным тяжелым дефицитом IGF-I или с делецией гена GH, у которых выработались нейтрализующие антитела к GH в дозе 40-120 мкг/кг два раза в день подкожно [12]. ...
Введение: При оказании медицинской помощи спортсменам как профессиональным, так и спортсменам любителям, спортивные врачи и врачи первичной медико-санитарной помощи должны иметь определенный объем антидопинговых знаний. Цель исследования: обзор литературных данных по основным существующим международным стандартам антидопингового обеспечения для спортивных врачей сборных команд и детских спортивных школ, врачей центров спортивной медицины и фитнес-клубов, а также врачей общей практики. Стратегия поиска: Поиск и анализ релевантной информации: нормативно-правовые акты в области регулирования антидопинговой политики, базы данных и поисковые системы: Pubmed, Cochrane Library, Scopus, Google Scholar, eLIBRARY, Cyberleninka. Глубина поска составила20 лет. Результаты: Анализ литературных данных показал, что на сегодняшний день огромное многообразие существующих фармакологических средств в спорте вызывает необходимость их систематизации, изучения механизмов влияния и определения основных принципов использования и является актуальной проблемой, изучаемой на мировом уровне. Результаты анализа также показали необходимость в дальнейшем изучении спортивной фармакологии. Выводы: Врачи и медицинские работники играют важную роль в жизни спортсменов. Крайне необходимы знание и понимание особенностей при оказании медицинской помощи спортсменам. При назначении лекарственных препаратов и биологически активных добавок, необходимо помнить о возможных рисках нарушения антидопинговых правил. Прежде чем назначать какие-либо лекарственные средства спортсмену, важно проверить их на наличие запрещенных субстанций в спорте.
Introduction: In providing medical care to both professional and amateur athletes, sports physicians and primary care physicians must have a certain amount of anti-doping knowledge. Objective: To analyze the literature sources on the current state of the main existing international anti-doping standards: for sports doctors of national teams and children's sports schools, doctors of sports medicine centers and fitness clubs, as well as general practitioners. Search strategy: The search and analysis of relevant information: of regulation of anti-doping policy, databases and search engines: Pubmed, Cochrane Library, Scopus, Google Scholar, eLIBRARY, Cyberleninka. The depth of the survey was 20 years. Results: An analysis of the literature data showed that today the huge variety of existing pharmacological agents in sports needs their systematization, study of the mechanisms of influence and determination of the basic principles of use and is an urgent problem studied at the world level. The results of the analysis also showed the need for further study of sports pharmacology. Conclusion: Physicians and health professionals play an important role in the athlete’s lives. Knowledge and understanding of the specifics when providing medical care to an athlete is imperative. When prescribing drugs and dietary supplements, it is necessary to be aware of the possible risks of anti-doping rule violations. Before prescribing any medication to an athlete, it is important to check it for prohibited substances in sport.
Кіріспе: Кәсіби спортшылар мен әуесқой спортшыларға медициналық көмек көрсету кезінде спорт дәрігерлері де, алғашқы медициналық-санитарлық көмек көрсететін дәрігерлер де допингке қарсы белгілі бір білімге ие болуы керек. Мақсаты: Негізгі допингке қарсы халықаралық стандарттар бойынша: ұлттық командалардың және балалар спорт мектептерінің спорт дәрігерлеріне, спорттық медицина орталықтары мен фитнес клубтарының дәрігерлеріне, сондай-ақ жалпы тәжірибелік дәрігерлерге арналған ғылыми әдебиеттік деректерді шолу болды. Іздеу стратегиясы: Тиісті ақпаратты іздеу және талдау: допингке қарсы саясат ережелері, дерекқорлар және электрондық ғылыми кітапханада: Pubmed, Cochrane Library, Scopus, Google Scholar, eLIBRARY, Cyberleninka. Зерттеудің тереңдігі 20 жыл болды. Нәтижелер: Бұл шолу қазіргі таңда спортта қолданылып жүрген фармакологиялық препараттардың түрлілігі оларды жүйелеуді, әсер ету механизмдерін зерттеуді және қолданудың негізгі принциптерін анықтауды қажет етеді және әлемдік деңгейде зерттелетін өзекті мәселе болып табылатынын көрсетті. Талдау нәтижелері спорттық фармакологияны одан әрі зерттеу қажеттілігін де көрсетті. Қорытынды: Дәрігерлер мен денсаулық сақтау мамандары спортшылардың өмірінде маңызды рөл атқарады. Спортшыларға медициналық көмек көрсетудің ерекшеліктерін білу және түсіну өте маңызды. Дәрілік заттар мен тағамдық қоспаларды тағайындау кезінде допингке қарсы ережелерді бұзудың ықтимал қауіптерін білу қажет. Спортшыға қандай да бір дәрі-дәрмекті тағайындамас бұрын, спортта тыйым салынған заттардың бар-жоғын тексеру маңызды.
... Moreover, among middle-aged and elderly individuals, the pursuit of GH administration aims to augment muscle mass and recapture youthful physical attributes. The pervasiveness of PED misuse extends to the weightlifting community, as evidenced by a survey of 231 weightlifters where 12% admitted to historical and/or current GH or IGF-I usage, with a substantial 80% of these respondents exhibiting indications of prior or ongoing AAS dependence [12]. Another noteworthy addition to PEDs is insulin, frequently adopted by bodybuilders due to its purported anabolic effects, including the vital stimulation of glycogen synthesis for post-exercise muscle recovery. ...
Abdominal hypertrophy syndrome, known as steroid gut, is an uncommon condition affecting bodybuilders and athletes engaged in prolonged usage of growth hormone (GH), insulin, and other anabolic agents. The condition is more commonly known in the professional bodybuilding community as Palumboism, named after David Palumbo, an American bodybuilder. It is characterized by significant enlargement and distension of the abdomen. Precise pathophysiological mechanisms and underlying causes of Palumboism have yet to be fully understood. The primary objective of this study is to conduct a comprehensive literature review of the condition and explore the pathophysiology and possible treatment modalities. We aim to contribute to the existing knowledge of Palumboism and lay the foundation for clinical and surgical management. A literature review was conducted using PubMed and other sources. Specific keywords, such as "palumboism," "bodybuilder gut," "steroid gut," "HGH gut," "insulin gut," "bubble gut," "muscle gut," "abdominal distension," "abdominal organomegaly," "visceral adiposity," "abdominal obesity," "anabolic steroids," and "growth hormone," were employed to retrieve relevant articles. The inclusion criteria focused on studies that investigated the pathophysiology, clinical presentation, and management of Palumboism. A total of 1,222 studies were identified through the search criteria, of which 451 were screened, 33 were assessed for eligibility, and 30 studies were included in the final review. Literature review revealed that no peer-reviewed studies dedicated to Palumboism, underscoring the insufficient research conducted in this area. The available anecdotal data suggest that the prolonged use of high-dose anabolic steroids, particularly human GH and insulin, may contribute to the development of Palumboism. Several potential mechanisms have been proposed, including visceral adiposity, organomegaly, and altered collagen synthesis. Given the dearth of available research on Palumboism, a comprehensive understanding of this condition is yet to be established. Further studies are warranted to elucidate the pathophysiology, establish diagnostic criteria, and explore treatment options for affected individuals.
... The prevalence of PEDs is also cause for concern given the deleterious impact they are known to have on users' physical and mental health (10). Anabolic Androgenic Steroids, for example, have been found to account for 43% of doping offences in grassroots sport, and are associated with serious ill effects on the liver, heart, kidneys, and reproductive systems (11,12). Unfortunately, little is known about the true prevalence of doping in sport (13). ...
Although whistleblowing is thought to represent an effective mechanism for detecting and uncovering doping in sport, it has yet to become a widely adopted practice. Understanding the factors that encourage or discourage whistleblowing is of vital importance for the promotion of this practice and the development of pedagogical material to enhance the likelihood of whistleblowing. The current study employed a qualitative methodology to explore the personal and organisational factors that underpin intentions to blow the whistle or that may lead to engagement in whistleblowing behaviours in sport. Thirty-three competitive athletes across a range of sports took part in a semi-structured interview which sought to explore what they would do should they encounter a doping scenario. Content analysis revealed that whistleblowing is a dynamic process characterised by the interaction of a range of personal and organisational factors in determining the intention to report PED use. These factors included moral reasoning, a desire to keep the matter "in-house", perceived personal costs, institutional attitudes to doping, and social support. Analysis revealed a number of 'intervening events' (Ajzen, 1991), including a perceived lack of organisational protection (e.g., ethical leadership) within some sporting sub-cultures, which present an important obstacle to whistleblowing. The intention to report doping was underpinned by a "fairness loyalty trade-off" which involved athletes choosing to adhere to either fairness norms (which relate to a sense that all people and groups are treated equally) or loyalty norms (which reflect preferential treatment towards an in-group) when deciding whether they would blow the whistle. The promotion of fairness norms that emphasise a group's collective interests might encourage athletes to view whistleblowing as a means of increasing group cohesiveness and effectiveness and thereby increase the likelihood of this practice.
... Stanowi to przyczynę, dla której IGF-1 wykorzystywany jest przez osoby uprawiające sporty, w których siła odgrywa decydującą rolę. Podczas badania przeprowadzanego w latach 2005-2009 w Stanach Zjednoczonych, spośród 231 zakwalifikowanych sztangistów 27 ankietowanych przyznało się do stosowania hGH lub jego bioaktywnej pochodnej jaką jest IGF-1 [22]. Ponadto liczne przypadki naruszenia kodeksu antydopingowego odnotowywano podczas kolarskiego Tour de France czy choćby w amerykańskiej lidze baseballu (MLB) [23]. ...
In addition to its potential use in the treatment of a number of genetic diseases, gene therapy has also opened up the possibility of using genetic advances to artificially enhance the body’s physical abilities, primarily in the case of professional athletes. Genes that can be modified to increase muscle strength and performance include those encoding erythropoietin, endothelial growth factor, myostatin, human growth hormone, insulin-like growth hormone and endorphins. However, gene therapies, and thus genetic doping, in addition to their many diagnostic, prophylactic and therapeutic benefits, may carry negative physiological consequences: from altered blood parameters and cardiovascular disorders, to diabetogenic effects and possible overloading of the body, and a potential link to tumourigenesis. The aim of this article is to assess the possibilities and health risks of using gene therapy
as a form of doping.
... The term 'doping' refers to the use of performance-enhancing substances in non-pharmacologic doses to improve sports performance [111]. Abuse of GH is widespread and has been reported in 27% of young male weightlifters [112], even extending beyond professional contexts [113]. During childhood and adolescence, abuse of GH causes further damage, since the achievement of normal pubertal growth and adult body composition is dependent on the GH/ IGF1 and hypothalamo-pituitary-gonadal axes, but data are scarce [114,115]. ...
Tall stature is defined as height greater than the threshold of more than 2 standard deviations above the average population height for age, sex, and ethnicity. Many studies have described the main aspects of this condition during puberty, but an analysis of the characteristics that the physician should consider in the differential diagnosis of gigantism—tall stature secondary to a pituitary tumour—during the transition age (15–25 years) is still lacking.
A comprehensive search of English-language original articles was conducted in the MEDLINE database (December 2021-March 2022). We selected all studies regarding epidemiology, genetic aspects, and the diagnosis of tall stature and gigantism during the transition age.
Generally, referrals for tall stature are not as frequent as expected because most cases are familial and are usually unreported by parents and patients to endocrinologists. For this reason, lacking such experience of tall stature, familiarity with many rarer overgrowth syndromes is essential. In the transition age, it is important but challenging to distinguish adolescents with high constitutional stature from those with gigantism. Pituitary gigantism is a rare disease in the transition age, but its systemic complications are very relevant for future health. Endocrine evaluation is crucial for identifying conditions that require hormonal treatment so that they can be treated early to improve the quality of life and prevent comorbidities of individual patient in this age range.
The aim of our review is to provide a practical clinical approach to recognise adolescents, potentially affected by gigantism, as early as possible.
... Regular blood tests conducted to monitor hormone levels can detect abnormalities at an early stage and allow for prompt medical intervention. It is important to remember that the use of AAS for therapeutic purposes involves the use of minimal doses, and any individual increases in doses by the patient can contribute to the occurrence of adverse effects [87,88]. There are also extreme cases of combating the side effects of chronic AAS use. ...
Anabolic-androgenic steroids (anabolic-androgenic steroids, AAS) are testosterone-derived compounds whose popularity and use are constantly growing. Chronic use of AAS leads to many hormonal and metabolic disorders in the human body, which often lead to permanent health damage. Changes affect the following systems: cardiovascular, musculoskeletal, reproductive, digestive, and nervous. We decided to collect the existing knowledge in the literature and enrich it with the latest research reports in the field of degenerative effects of AAS on the nervous system. The work aimed to increase public awareness of the dangers and consequences of AAS use and improve it with the latest research on the neurodegenerative effects of AAS. We hope that our work will contribute to raising public awareness and reducing the use of AAS.
... Also, users have the option to stack additional appearance-enhancing medications (e.g., human growth hormone, clenbuterol, insulin). Furthermore, they add medications to mitigate the negative effects of AAS, such as antiestrogens to prevent gynecomastia [11,16,17]. ...
Background
Over the years, the use of anabolic–androgenic steroids (AAS) has become widespread among athletes and bodybuilders. The prevalence of their use has been estimated at around 20 to 50% globally. Unfortunately, many athletes do not have the proper knowledge about the effects of these banned substances Thus, this study aims to qualitatively assess Jordanian gym users’ AAS intentions, perceptions, and safety.
Methods
Twenty male Jordanian anabolic steroid users were interviewed using in-depth interviews as part of a qualitative study evaluating the motivations, perceptions, and safety of AAS among gym users.
Results
The findings of this study indicate that the desire to compete in bodybuilding contests was the primary motivation for participants to use AAS. The study participants mentioned using a combination of oral and injectable medications. Gym coaches and trainers were also identified as an essential source of information for AAS use. A very limited number of AAS users were getting their information from healthcare providers, and most of them have experienced some of these medications side effects but are still willing to continue the use of AAS to get what they need in terms of their physical appearance or for winning competitions.
Conclusion
There is an urgent need for structured awareness campaigns targeting gyms and fitness clubs’ members to increase their knowledge about the side effects and health risks associated with the use of AAS. In addition, sports governing bodies should have stricter measures to tackle this problem and discourage athletes from using such products.
... Figures on its use range from 6% to 7% to up to 16%. 43 The doses reported in weightlifters are 50---75 g/day for nine weeks up to a total of 2,200---8,600 g. 25 It has been prohibited by the WADA since 2003. There is no evidence that it increases muscle mass. ...
Among the substances prohibited by the World Anti-Doping Agency, "peptide hormones, growth factors, related substances, and mimetics" are classified as prohibited both in- and out-of-competition in section S2. This work reviews growth hormone and its releasing peptides, insulin-like growth factor 1 as the main growth factor, insulin, and erythropoietin and other agents that affect erythropoiesis. This review analyzes the prevalence of use among professional athletes and gym clients, the forms of use, dosing, ergogenic effects and effects on physical performance, as well as side effects and anti-doping detection methods.
... Algunas estadísticas señalan que hasta un 5% de los atletas universitarios en EE. UU. la habían consumido alguna vez 7 y puede llegar a ser hasta un 12% en los levantadores de pesas 25 ; en algún grupo de gimnastas supuso el 24% 26 , pero realmente se desconoce la verdadera prevalencia porque se suele adquirir clandestinamente a través de Internet. ...
... Por ejemplo, los trabajos de Bruno 38 o Alén y Rahkila 39 , los cuales no se ha podido recuperar el texto completo, a pesar de contar con la ayuda de la biblioteca de la universidad. Tanto en el artículo de Brennan et al. 40 , como en el de Graham et al. 25 , se habla sobre los efectos adversos tras la utilización de Hormona de Crecimiento (HG), dicha sustancia no se encuentra dentro de la lista de agentes anabolizantes establecida por la AMA, por lo que no se pueden tener en cuenta en esta revisión. En el artículo de Fanton et al. 41 , utilizan conejos como sujeto a estudio, por lo que al tratarse de uno de nuestros criterios de exclusión -uso de animales-queda descartado. ...
Objetivo: Revisar la documentación científica sobre los efectos adversos de los agentes anabolizantes en las personas adultas que practican deporte. Método: Estudio descriptivo transversal y análisis crítico de los trabajos recuperados mediante revisión sistemática. Los datos se obtuvieron de la consulta directa y acceso, vía Internet, a las siguientes bases de datos bibliográficas del ámbito de las ciencias de la salud: MEDLINE (vía PubMed), The Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science y PsycINFO hasta octubre de 2017. Se consideró adecuado el uso de los Descriptores «Sports», «Anabolic Agents/Adverse effects», utilizando los filtros: «Clinical Trial», «Comparative Study», «Humans» y «Adult:19+years». Resultados:De las 108 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron para la revisión 15 artículos. En los listados bibliográficos se encontró 1 trabajo. Al evaluar la calidad de los artículos seleccionados para la revisión mediante el cuestionario CONSORT, las puntuaciones oscilaron entre 11,5 y 15,5 sobre una puntuación máxima de 25. Conclusiones: Los trabajos revisados presentaban una obsolescencia superior a lo esperado en el área de las ciencias de la salud. Los artículos estaban redactados preferentemente en inglés. Se observó, en la revisión, que los EAA presentaban efectos adversos, sobre todo a nivel cardiovascular, conductual y aparición de efectos secundarios asociados al consumo de anabolizantes. Si bien, existen discrepancias entre la magnitud de los mismos a nivel cardiovascular y su potencial daño.
... The breadth of symptoms of interest in the included studies was very narrow. Whilst there is research to suggest that recreational weightlifters or bodybuilders are at increased risk of using AAS or other banned performance enhancing substances [16,58,59] it is notable that we only came across two case reports that documented the potential implication for a diagnosable mental illness in relation to the use of banned substances [28,29]. Given the endemic doping in this sport that is reported elsewhere [60], this suggests there is the need for more peer-reviewed research to better understand the potential mental health factors related to the use of banned substances. ...
Introduction: The mental health of elite athletes is a growing area of research however there remains a paucity of data to support evidence-based screening and prevention programmes as well as holistic yet targeted care. Olympic Weightlifting has long been associated in the media with the use of banned substances at an elite level however little is known about the mental health impact that this might represent and what the wider mental health needs of this group might be. Methods: A systematic search of PsychINFO, MEDLINE, EMCARE, EMBASE and CINAHL databases was conducted from inception up until January 2022. Peer reviewed studies of any methodology looking at mental illness or symptoms amongst current elite level Olympic weightlifters were eligible for inclusion. Results: Four articles met all inclusion criteria. Two cross-sectional studies looked at depression and anxiety and two case studies reported psychosis following long-term use of Mephentermine. Results seemed to broadly align with research looking at elite athletes in other sports however it was not possible to compare results between the two cross-sectional studies due to methodological differences. Conclusion: There is very little published research in this area and it is of varying methodological quality. A narrow subset of mental health symptoms were investigated and most of the data were based on self-reported symptoms rather than diagnostic data. Further research is needed to explore the mental health burden in this group and to inform appropriate support programmes.
... Systemic hypertension is promoted via the activation of renin-angiotensin-aldosterone-system (RAAS) advancing oxidative stress as well as sodium and water retention that are stimulated by HGH. Elevated blood pressure have had correlations with the severity of acromegaly cardiopathy [16,17]. ...
Background
Human growth hormone (HGH) is a categorized as a performance-enhancing substance. HGH has been abused by athletes for doping purposes.
Case presentation
We present a first lethal case of HGH acute toxicity. A young-agitated-athlete with a history of somatropin for the past 2-year, who had hallucinations referred to the emergency department reporting to have abused of 300 mg subcutaneous injections of HGH. He was tachycardic with mild hypertension. Lab data revealed hypernatremia (157 mEq/L), hyperkalemia (5.3 mEq/L), high LDH (1448 U/L), and CPK (2620 U/L), in favor of rhabdomyolysis. Routine drug screening tests were negative for all substances. He was intubated due to low O2 saturation and progressive loss of consciousness. After several episodes of hyperthermia, hypertension, and possibly pulmonary embolism, he died subsequent to somatropin overdose.
Conclusions
Complications of HGH misuse can be life-threatening and athletes should be warned of its deleterious effects.
... The formation of specific degradation products of peptide hormones during (subcutaneous) administration, and hence the possible detection of the particular fragments in human serum, is a promising approach to identify the misuse of several peptides currently prohibited for performance enhancement in sports, including peptides with anabolic properties such as human growth hormone (hGH) and its main mediator, insulin-like growth factor-I (IGF-I) [17]. The misuse of hGH has frequently been reported for both professional and recreational sports, presumably due to its anabolic and lipolytic effects, as well as the potentially complicated detection in doping controls, considering its natural occurrence in the human body [18][19][20][21]. hGH, also known as somatropin, is a peptide hormone composed of 191 amino acids, and it mainly acts by stimulating the biosynthesis and secretion of IGF-I (primary structures in Figure 1) [22][23][24]. ...
Studying the metabolism of prohibited substances is an essential element in anti-doping research in order to facilitate and improve detectability. Whilst pharmacokinetic studies on healthy volunteers are valuable, they are often difficult, not least due to safety reasons and ethical constraints, especially concerning peptidic substances, which must be administered parenterally. Hence, there is a growing need for suitable in vitro models and sophisticated analytical strategies to investigate the metabolism of protein- and peptide-derived drugs. These include human growth hormone (hGH) and its main mediator insulin-like growth factor-I (IGF-I), both prohibited in professional sports for their anabolic and lipolytic effects, while challenging in their detection, as they occur naturally in the human body.Within this study, the in vitro metabolism of hGH and IGF-I was investigated using a stable-isotope-labelled reporter ion screening strategy (IRIS). A combination of liquid chromatography, high-resolution mass spectrometry, and characteristic immonium ions generated by internal dissociation of the stable-isotope-labelled peptidic metabolites enabled the detection of specific fragments. Several degradation products for hGH and IGF-I were identified within this study. These metabolites, potentially even indicative for subcutaneous administration of the drugs, could serve as promising targets for the detection of hGH and IGF-I misuse in future anti-doping applications.
... androgens [18,19] and growth hormones [20]. However, the abuse of OCPs for these aforementioned purposes has never been reported in the literature. ...
Background
Oral contraceptive pills (OCPs) are considered one of the most important birth control methods globally. However, these pills were designed for female administration rather than males. This study was designed to investigate patterns of OCPs use and abuse among Jordanian males, according to the community pharmacists’ observations.
Method
A mixed-method explanatory sequential study was conducted using an online self-administered survey, followed by semi-structured in-depth interviews for registered pharmacists, assistant pharmacists and pharmacy interns. The interviews were utilized using a conceptual framework. Inductive thematic analysis and descriptive/regression analyses were completed using Nvivo and SPSS, respectively.
Results
A total of 158 questionnaire responses and 22 interviews were included in our analysis. Around half (48.4%) of the questionnaire responses confirmed that males could use OCPs for hair growth enhancement, muscle gain and acne treatment 12.7%, 31.7% and 4.4%, respectively. Through the interviews, the participating pharmacists highlighted that males use OCPs mostly for bodybuilding purposes, according to recommendations by their coaches at the gym. The most abused OCPs containing estrogen (Ethinyl estradiol) and progestins (Drospirenone or Levonorgestrel).
Conclusion
This study provided insight into unexpected uses of OCPs by males in Jordan. Community pharmacists have a crucial role in the management of OCPs use and abuse. However, restricted regulations and monitoring must be released and implemented on the community to limit such practices.
... The doses of HGH reported in this study were concerningly higher than what has been published earlier [19,20]. The difference in the doses might be partly due to the fact that in the US (where the previous studies have been conducted), the abused HGH is sometimes prescribed by a clinical practitioner for off-label use [20], and ▶ Some of the participants reported the style of steroid cycling mostly referred to as "Blast & Cruise". ...
Doping-untested strength-sport athletes (powerlifters, strongmen, armlifters, etc.,) are infamous for their doping use, but their exact doping regimens are not known. The purpose of this study was to provide a reasonable portrait of doping history in this specific athlete group for medical practitioners. Seventy-five athletes were selected by netnography of the social media community around the Finnish doping-untested strength-sport federations on the basis of their activity in doping-related discussions, and the athletes were invited to answer a detailed doping-related anonymous survey. Fifty respondents completed the survey. 100% of the respondents reported use of anabolic androgenic steroids, 66% reported use of stimulants, and 80% use of non-steroidal anabolic substances. The doses of both testosterone products and human growth hormone were notably larger than reported in previous studies of gym users (mostly non-competitive athletes). The subjects reported simultaneous use of an average 5.66 illegal substances, and lifetime use of 16.78 illegal substances. The doses of illicit drugs, as well as polypharmacy, among competitive doping-untested strength-sport athletes are higher than previously reported among recreational gym users, and side effects are likely in this specific population.
... A study from Germany found that 10 (0.4%) of 2,319 adolescents reported use of GH in the previous year, administered for its putative performance-enhancing properties (54). In another study of 231 male weightlifters (18 to 40 years old), 27 individuals (12%) reported nonprescription use of GH and/or IGF-1, often in association with anabolic steroids or opioids (55). In a study of 180 men who attended an outpatient clinic for users of anabolic steroids in the Netherlands, 36% reported GH use (22). ...
Over the past few decades, there has been an unprecedented rise in off-label use and misuse of testosterone, growth hormone, thyroid hormone, and adrenal supplements. Testosterone therapy is often promoted to men for the treatment of low energy, lower libido, erectile dysfunction, and other symptoms. Growth hormone is used in attempts to improve athletic performance in athletes and to attenuate aging in older adults. Thyroid hormone and/or thyroid supplements or boosters are taken to treat fatigue, obesity, depression, cognitive impairment, impaired physical performance, and infertility. Adrenal supplements are used to treat common nonspecific symptoms due to “adrenal fatigue,” an entity that has not been recognized as a legitimate medical diagnosis. Several factors have contributed to the surge in off-label use and misuse of these hormones and supplements: direct-to-consumer advertising, websites claiming to provide legitimate medical information, and for-profit facilities promoting therapies for men's health and anti-aging. The off-label use and misuse of hormones and supplements in individuals without an established endocrine diagnosis carries known and unknown risks. For example, the risks of growth hormone abuse in athletes and older adults are unknown due to a paucity of studies and because those who abuse this hormone often take supraphysiologic doses in sporadic intervals. In addition to the health risks, off-label use of these hormones and supplements generates billions of dollars of unnecessary costs to patients and to the overall health-care system. It is important that patients honestly disclose to their providers off-label hormone use, as it may affect their health and treatment plan. General medical practitioners and adult endocrinologists should be able to begin a discussion with their patients regarding the unfavorable balance between the risks and benefits associated with off-label use of testosterone, growth hormone, thyroid hormone, and adrenal supplements.
Abbreviations: DHEA = dehydroepiandrosterone; FDA = U.S. Food and Drug Administration; GH = growth hormone; IGF-1 = insulin-like growth factor 1; LT3 = L-triiodothyronine; LT4 = levothyroxine; T3 = total triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone
... Users may also add other appearance-performance-enhancing drugs to the stack (e.g., human growth hormone, clenbuterol, insulin, etc.), as well as drugs to counteract the side effects of AAS, such as anti-estrogens to prevent DOI: 10.1159/000505978 gynecomastia. Discussion of these other classes of drugs can be found elsewhere [8,[14][15][16]. Although AAS and these other drugs are illegal without a prescription in most developed Western countries, the drugs are readily available through local underground drug dealers and through numerous Internet sites. ...
... The use of hGH in adults is limited to wasting syndrome due to AIDS and hGH deficiency. hGH has been known to be abused in bodybuilder and athlete populations for various reasons, including increasing red blood cell production, muscle mass, and overall athletic performance [70]. ...
Objective:
Growth hormone (GH) and GH-related signaling molecules play an important role in nociception and development of chronic pain. This review aims to examine the potential molecular mechanisms through which GH-related signaling modulates sensory hypersensitivity in rodents, the clinical pharmacology of GH, and the clinical evidence of GH treatment for several common pain syndromes.
Methods:
A search was conducted using the PUBMED/MEDLINE database, Scopus, and the Cochrane library for all reports published in English on GH in pain management from inception through May 2018. A critical review was performed on the mechanisms of GH-related signaling and the pharmacology of GH. The levels of clinical evidence and implications for recommendations of all of the included studies were graded.
Results:
The search yielded 379 articles, of which 201 articles were deemed irrelevant by reading the titles. There were 53 reports deemed relevant after reading abstracts. All of these 53 articles were retrieved for the analysis and discussion.
Conclusions:
Dysfunction of the GH/insulin-like growth factor 1 (IGF-1)/ghrelin axis was linked to hyperalgesia and several common clinical pain syndromes. Low levels of GH and IGF-1 were linked to pain hypersensitivity, whereas ghrelin appeared to provide analgesic effects. Pretreatment of GH reversed mechanical and thermal hypersensitivity in an animal model of inflammatory pain. Clinical trials support GH treatment in a subgroup of patients with fibromyalgia syndrome (level of evidence: 1B+) or chronic lower back pain syndrome (level of evidence: 2C+).
... Esse hormônio é uma droga bastante cara, sendo usada inicialmente por atletas de elite, no entanto, com as facilidades da internet, a obtenção desta se tornou algo banal [38]. ...
O presente estudo visa analisar alguns pontos importantes sobre o uso de esteroides anabólico-androgênicos e o hormônio do crescimento, além de mostrar sua história dentro dos esportes de alto nível. Para a presente revisão, foram interpretados 42 artigos, todos internacionais, disponíveis na base dedados Pubmed.Palavras-chave: esteroides anabólico-androgênicos, hormônio do crescimento, esportes, alto nível.
... In order to complement anabolic effects, approximately one-fourth of AAS users administer human growth hormone (hGH), insulin-like growth factor-1 (IGF-1) or insulin [10,13]; however, these extensive pharmacological regimens increase the risk of adverse effects [3]. Furthermore, several other performance enhancing agents are combined with steroids; clenbuterol, amphetamine, and some hormones as thyroxine, to stimulate body fat burning; diuretics (e. g., furosemide, thiazides) to improve muscle definition or to reduce body weight, erythropoietins to increase the ability of training and accelerate the recovery after hard competitions. ...
Introduction. Anabolic androgenic steroids, such as testosterone and its synthetic analogue, nandrolone, have clear clinical indications. However, their abuse is practiced to enhance physical performance in professional, recreational and non-professional athletes; outside of sports, their nonmedical use is associated with different social groups (criminal activities, substance abuse). Polypharmacy. Testosterone and its synthetic analogues are also used for nonmedical purposes, mainly administered in supraphysiological doses in cycles lasting a few weeks. In order to potentiate the anabolic properties and control the adverse effects, the users also administer other pharmacological agents. Thus, growth hormone and insulin are complement to anabolic steroids; clenbuterol, amphetamine and thyroid hormones stimulate body fat loss; diuretics reduce the body weight and improve muscle definition; and erythropoietin increases the training capacity and accelerates the recovery after hard competitions. To control adverse effects, cardiovascular drugs, central nervous system depressants, central nervous system stimulants, human chorionic gonadotropin, sexual enhancement drugs, estrogen antagonists, analgesics/opioids, nonsteroidal anti-inflammatory drugs and others, are administered. Probenecid, finasteride and diuretics mask the administration of other doping agents. Additionally, during the last two decades, attention has increasingly been focused on the relationship between the use of anabolic androgenic steroids and psychoactive substances (alcohol, cannabis, amphetamines, cocaine, hallucinogens). Conclusion. Supraphysiological doses and polypharmacy additionally increase the risk of adverse effects, including withdrawal syndrome; therefore, prevention of nonmedical use of anabolic androgenic steroids should be a public health priority.
... Гормон роста человека уже более 50 лет используется для коррекции нарушений всех видов обмена веществ [17,39,53], а с 1980х годов в клинической прак тике используется рекомбинантный гормон роста человека [39]. Он обладает комплекс ным свойством: оказывает анаболическое действие [24], стимулирует βклетки подже лудочной железы, играет значительную роль в функционировании иммунной системы за счет влияния на пролиферацию тимоцитов и стимулирует цитотоксическую активность натуральных киллеров и пролиферацию лим фоцитов [81]. Гормон роста выполняет сти MedicoBiological and SocioPsychological Problems of Safety in Emergency Situations. ...
... In addition to AASs, other hormones with potential anabolic activity like human growth hormone (hGH), insulin and insulin-like growth factor-1 (IGF-1) may be abused by the athletes. Recently, the widespread abuse of stimulant agents such as Clenbuterol (an α-adrenergic agonist), amphetamine deriva-tives, ephedrine, pseudoephedrine and caffeine has been documented among athletes (1,(3)(4)(5). ...
There are some reports, particularly case studies about adverse effects of performance-enhancing drugs on the renal function. However, there is very limited information about performance-enhancing drugs effects on the renal function. Therefore, the aim of this study was to use a simple screening test to evaluate side effects of performance-enhancing drugs on the kidney among bodybuilding athletes in the south of Iran, Bushehr.
... Indeed, PEDs can cause severe physical (e.g., Johnson, 2012) and mental health illnesses (e.g., Lindqvist et al., 2013), due to the large quantities in which PEDs are consumed to gain a performance enhancing effect (Bird, Goebel, Burke, & Greaves, 2016). For example, AAS, which accounts for 43% of doping offenses in grassroots sport (Brennan, Kanayama, Hudson, & Pope, 2011), is associated with damage to the liver, heart, kidneys, and reproductive systems. Worryingly, these illnesses may be irreversible and can ultimately lead to premature death (Bird et al., 2016). ...
The use of performance enhancing drugs, also known as doping, can represent a serious threat to an athlete's psychological and physical health and contravenes the spirit of sport. Scholars identified attitudes towards doping as a crucial factor that indirectly influences doping behaviors. Further, prominent theoretical frameworks that are designed to explain why athletes dope state that personality traits shape doping attitudes. To date, however, scholars are yet to examine the relationship between attitudes towards doping and personality traits such as the Dark Triad. The purpose of this study was to explore the relationship between the Dark Triad and doping attitudes amongst a sample of competitive athletes. Two hundred and eighty-five athletes completed a measure of the Dark Triad and attitudes towards doping. Machiavellianism, psychopathy, and narcissism all correlated positively with attitudes towards doping. Machiavellianism and psychopathy explained 29% of the variance in attitudes towards doping, whereas narcissism did not independently contribute to the variance in doping attitudes. These results reveal that athletes who score highly on the Dark Triad may be more likely to dope and therefore might need targeted anti-doping education and long-term monitoring to reduce their risk of taking banned substances.
... L'utilisation des produits anabolisants réservés initialement aux sportifs professionnels s'est étendue à la population générale. C'est le cas de l'hormone de croissance humaine (human Growth Hormone ou hGH), initialement utilisée par les athlètes en compétition, dont l'utilisation s'est étendue aux sportifs amateurs grâce à la facilité d'achat par Internet, et le faible coût des nouveaux analogues de l'hormone de libération de l'hormone de croissance (Growth Hormone Releasing Hormone ou GHRH) [3][4][5]. La GHRH est un peptide de 44 acides aminés produit par l'hypothalamus stimulant la production d'hGH par l'hypophyse, laquelle est responsable d'effets anabolisants. L'amélioration des performances sportives potentiellement engendrées par la hGH a poussé l'agence mondiale anti-dopage à interdire son utilisation, ainsi que celle de la GHRH et leurs analogues. ...
Résumé
Objectif
La fabrication et la vente illégale de peptides recombinants deviennent de plus en plus facile et fréquente. Nous rapportons ici le cas d’une poudre blanche étiquetée comme étant du CJC-1295, un dérivé d’un analogue peptidique synthétique de la GHRH, analysée afin d’en déterminer la composition réelle.
Méthode
Un échantillon de poudre a été analysé sur un système CL-SM/SMHR de type Q-Exactive (Thermo, États-Unis). L’instrument fonctionnait en mode data-dependent (full scan suivi d’une fragmentation des ions d’abondance significative) à une résolution de 70 000 avec une ionisation de type electrospray fonctionnant en mode positif.
Résultats
Le chromatogramme a montré que la poudre était pure. L’analyse spectrale a mis en évidence 5 ions multichargés. L’ion monoisotopique le plus abondant était le m/z 674,1855 (z = 5) correspondant à une masse de 3365,8885 Da. La masse observée correspondait à l’analogue peptidique de la GHRH de 29 acides aminés contenu dans le CJC-1295 (3365,8930 Da) avec une erreur de masse de 1,3 ppm. Cet analogue peptidique n’était pas conjugué contrairement à celui présent dans le CJC-1295.
Conclusion
L’interprétation du spectre SMHR associé à la connaissance de la structure de la molécule nous a permis d’identifier l’analogue peptidique contenu normalement dans le CJC-1295, sans pour autant être du CJC-1295 dans lequel cet analogue est couplé à un complexe qui en prolonge la demi-vie. Il s’agit à notre connaissance de la première saisie de ce produit en France.
... In addition to AASs, other hormones with potential anabolic activity like human growth hormone (hGH), insulin and insulin-like growth factor-1 (IGF-1) may be abused by the athletes. Recently, the widespread abuse of stimulant agents such as Clenbuterol (an α-adrenergic agonist), amphetamine derivatives, ephedrine, pseudoephedrine and caffeine has been documented among athletes (1,(3)(4)(5). ...
Background:
Several reports have implied progressive increase of performance-enhancing drug (PED) use among Iranian athletes. More importantly, most of the previous research in the Iranian population had mainly focused on the anabolic steroid abuse, and ignored other agents.
Objectives:
The aim of this study was to investigate the prevalence and characteristics of PED use among bodybuilding athletes in Bushehr, south of Iran.
Methods:
Four hundred and fifty three male bodybuilding athletes were recruited from Bushehr gyms between February and May of 2015. Men were eligible to participate in the survey if they had regularly participated in the strength-training exercise (minimum of 1 year and 4 hour/week). Data were collected via a face-to-face interview. The survey consisted of three separate parts including demographic data, exercise pattern and PED use.
Results:
According to this study, 234 (51.7%) of bodybuilding athletes had used PEDs. The PED users reported an average of 3.80 ± 4.52 agents' use in their programs and they had used PEDs for the average of 3.24 ± 3.99 years. The most prevalent agents which had been abused by the athletes were anabolic steroids (used by 185 athletes (79.4% of athletes). Furthermore, 110 (47%) of athletes reported stimulant agents' use during their routines. The most prevalent motivation for using PEDs was increasing muscle mass that was reported by 164 (70.1%) of PED users. In addition, sexual and dermatologic effects were the most prevalent adverse effects reported by the PED user athletes (114 (49.4%) and 103 (44.2%), respectively).
Conclusions:
This study showed the high rate of PED use among recreational and professional Iranian bodybuilding athletes that can expose them to the serious side effects of these agents.
... Acromegaly, fluid retention, and endocrine disorders have been associated with high levels of HGH, but increased use of HGH is not known to cause psychosis or violence. 7,13,14 Reports of aggression due to the use of anabolic steroids are common in the medical literature, but we found only five case reports describing homicidality during the active use of these drugs. 4,15,16 The use of L-dopa and dopamine precursors can precipitate agitation, psychosis, hypersexuality, and compulsive and addictive behaviors. ...
The authors examine the role that unregulated dietary supplements may have had in a young man who presented with psychotic and homicidal ideations.
Comprehensive and up to date, this textbook on children’s sport and exercise medicine features research and practical experience of internationally recognized scientists and clinicians that informs and challenges readers. Four sections—Exercise Science, Exercise Medicine, Sport Science, and Sport Medicine—provide a critical, balanced, and thorough examination of each subject, and each chapter provides cross-references, bulleted summaries, and extensive reference lists. Exercise Science covers growth, biological maturation and development, and examines physiological responses to exercise in relation to chronological age, biological maturation, and sex. It analyses kinetic responses at exercise onset, scrutinizes responses to exercise during thermal stress, and evaluates how the sensations arising from exercise are detected and interpreted during youth. Exercise Medicine explores physical activity and fitness and critically reviews their role in young people’s health. It discusses assessment, promotion, and genetics of physical activity, and physical activity in relation to cardiovascular health, bone health, health behaviours, diabetes, asthma, congenital conditions, and physical/mental disability. Sport Science analyses youth sport, identifies challenges facing the young athlete, and discusses the physiological monitoring of the elite young athlete. It explores molecular exercise physiology and the potential role of genetics. It examines the evidence underpinning aerobic, high-intensity, resistance, speed, and agility training programmes, as well as effects of intensive or over-training during growth and maturation. Sport Medicine reviews the epidemiology, prevention, diagnosis, and management of injuries in physical education, contact sports, and non-contact sports. It also covers disordered eating, eating disorders, dietary supplementation, performance-enhancing drugs, and the protection of young athletes.
Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) are increasingly recognised for their role in cardiovascular (CV) physiology. The GH-IGF-1 axis plays an essential role in the development of the CV system as well as in the complex molecular network that regulates cardiac and endothelial structure and function. A considerable correlation between GH levels and CV mortality exists even among individuals in the general population without a notable deviation in the GHIGF- 1 axis functioning. In addition, over the last decades, evidence has demonstrated that pathologic conditions involving the GH-IGF-1 axis, as seen in GH excess to GH deficiency, are associated with an increased risk for CV morbidity and mortality. A significant part of that risk can be attributed to several accompanying comorbidities. In both conditions, disease control is associated with a consistent improvement of CV risk factors, reduction of CV mortality, and achievement of standardised mortality ratio similar to that of the general population. Data on the prevalence of peripheral arterial disease in patients with acromegaly or growth hormone deficiency and the effects of GH and IGF-1 levels on the disease progression is limited. In this review, we will consider the pivotal role of the GH-IGF-1 axis on CV system function, as well as the far-reaching consequences that arise when disorders within this axis occur, particularly in relation to the atherosclerosis process.
Purpose of review: To investigate the prevalence and correlates of androgen dependence among users. A meta-analysis, meta-regression analysis, and qualitative synthesis were conducted based on a systematic literature search in Google Scholar, ISO Web of Science, PsycNET, and PubMed. Recent findings:
Twenty-six studies were included in the review and 18 studies (N = 1782) in the statistical analysis. The overall lifetime androgen dependence prevalence was 34.4% [95% confidence interval (CI): 27.8–41.7, Q = 113.1, I2 = 85.0, P < 0.001]. Although males (36.1%, P < 0.001) and females (37.0%, P = 0.188) did not differ (Q = 0.0, P = 0.930) in dependence prevalence, controlling for other study characteristics, higher study male sample proportion was related to higher dependence prevalence. Combined interview and questionnaire assessments showed higher prevalence compared to interviews only. Publications from 1990–1999 generated higher prevalence compared to 2000–2009 and 2010–2023 publications. Dependents were associated with a wide array of demographic inequalities, and biophysical, cognitive, emotional, and psychosocial problems.
Summary: One of three persons who initiate androgen use experiences dependence along with various serious disorders. Androgen use and dependence should be considered an important public health issue requiring targeted health interventions.
Purpose of review:
To investigate the prevalence and correlates of androgen dependence among users. A meta-analysis, meta-regression analysis, and qualitative synthesis were conducted based on a systematic literature search in Google Scholar, ISO Web of Science, PsycNET, and PubMed.
Recent findings:
Twenty-six studies were included in the review and 18 studies (N = 1782) in the statistical analysis. The overall lifetime androgen dependence prevalence was 34.4% [95% confidence interval (CI): 27.8-41.7, Q = 113.1, I2 = 85.0, P < 0.001]. Although males (36.1%, P < 0.001) and females (37.0%, P = 0.188) did not differ (Q = 0.0, P = 0.930) in dependence prevalence, controlling for other study characteristics, higher study male sample proportion was related to higher dependence prevalence. Combined interview and questionnaire assessments showed higher prevalence compared to interviews only. Publications from 1990-1999 generated higher prevalence compared to 2000-2009 and 2010-2023 publications. Dependents were associated with a wide array of demographic inequalities, and biophysical, cognitive, emotional, and psychosocial problems.
Summary:
One of three persons who initiate androgen use experiences dependence along with various serious disorders. Androgen use and dependence should be considered an important public health issue requiring targeted health interventions.
Nandrolone, an anabolic androgenic steroid, is included in the prohibited list of the World Anti‐Doping Agency. Drugs of abuse activate brain dopamine neurons and nandrolone has been suspected of inducing dependence. Accordingly, possible critical periods for the effects of nandrolone on muscular strength and dopaminergic activity have been investigated, including the effects of chronically administered nandrolone alone and on morphine‐induced increases in dopamine efflux in the nucleus accumbens. Six‐ or 10‐week‐old male Sprague‐Dawley rats were used. Treatment with nandrolone was initiated in adolescent (6‐week‐old) and young adult (10‐week‐old) rats. Nandrolone (5.0 mg/kg s.c.) or sesame oil vehicle was given once daily, on six consecutive days per week, for 3 weeks and then once per day for 4 consecutive days. Nandrolone enhanced the developmental increase in grip strength of 6‐ but not 10‐week‐old rats, without altering the developmental increase in body weight of either age group. Using in vivo microdialysis in freely moving 6‐week‐old rats given nandrolone for 4 weeks, basal accumbal dopamine efflux was unaltered, while the increase in dopamine efflux induced by acute administration of morphine (1.0 mg/kg s.c.) was reduced. The present study provides in vivo evidence that adolescence constitutes a critical period during which repeated administration of nandrolone enhances increases in muscular strength without influencing increases in body weight. Though repeated administration of nandrolone during this period of adolescence did not stimulate in vivo mesolimbic dopaminergic activity, it disrupted stimulation by an opioid, the drug class that is most commonly co‐abused with nandrolone. This article is protected by copyright. All rights reserved
Performance-enhancing drug (PED) use is a known and increasingly recognized maladaptive behavior among athletes of all ages and levels of competition. The underlying reasons for use are diverse and may include attempting to gain a selective advantage, to recover from injury, or to optimize cosmetic appearance. The veil of secrecy and stigma regarding PED use challenges the careful study of use behavior patterns, but there is an emerging body of evidence linking PED use to the presence and development of mental health disorders. In order to counteract PED use in the interest of athlete safety and fair play, most governing sports bodies have imposed escalating penalties, including performance bans, for multiple-time PED offenders. It is important for the treating provider to become familiar with PED use and use patterns in order to have an educated discussion with the at-risk athlete.
The sport of competitive bodybuilding requires an intense regimen of weightlifting and dieting, often aided with muscle-building or fat-burning drugs, and culminating in an on-stage posing competition. Despite these rigorous demands, competitive bodybuilding is popular, with thousands of competitions performed annually around the world. Although many studies have addressed the psychological features of various sports and the athletes who compete in them, few have examined the psychological aspects of bodybuilding. Even fewer studies have specifically examined competitive bodybuilders, as opposed to the much larger group of "recreational" bodybuilders who do not compete. The limited available literature suggests that competitive bodybuilders may show an increased risk for four categories of psychopathology: muscle dysmorphia, eating disorders, abuse of appearance- and performance-enhancing drugs, and exercise dependence. However, in each of these categories, one must carefully distinguish between the planned and dedicated behaviors required for success in the sport, as opposed to frankly pathological behaviors that impair social or occupational function, cause subjective distress, or lead to adverse health consequences. Future work should attempt to better assess the nature and prevalence of these conditions among competitive bodybuilders, with perhaps greatest attention to the issue of drug use.
Objetivo:
Revisar la documentación científica sobre los efectos adversos de los agentes anabolizantes en las personas adultas que practican deporte.
Método:
Estudio descriptivo transversal y análisis crítico de los trabajos recuperados mediante revisión sistemática. Los datos se obtuvieron de la consulta directa y acceso, vía Internet, a las siguientes bases de datos bibliográficas del ámbito de las ciencias de la salud: MEDLINE (vía PubMed), The Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science y PsycINFO hasta octubre de 2017. Se consideró adecuado el uso de los Descriptores «Sports», «Anabolic Agents/Adverse effects», utilizando los filtros: «Clinical Trial», «Comparative Study», «Humans» y «Adult:19+years».
Resultados:
De las 108 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron para la revisión 15 artículos. En los listados bibliográficos se encontró 1 trabajo. Al evaluar la calidad de los artículos seleccionados para la revisión mediante el cuestionario CONSORT, las puntuaciones oscilaron entre 11,5 y 15,5 sobre una puntuación máxima de 25.
Conclusiones:
Los trabajos revisados presentaban una obsolescencia superior a lo esperado en el área de las ciencias de la salud. Los artículos estaban redactados preferentemente en inglés. Se observó, en la revisión, que los EAA presentaban efectos adversos, sobre todo a nivel cardiovascular, conductual y aparición de efectos secundarios asociados al consumo de anabolizantes. Si bien, existen discrepancias entre la magnitud de los mismos a nivel cardiovascular y su potencial daño.
Sport psychiatry can be seen as a new and rapidly developing global field, due not only to the growing popularity of sports in the general population but also to the highly challenging environments in a professional setting. Mental health problems like brain trauma, depression, suicide, doping, physical trauma and abuse, and also sport-specific problems like the female athletic triad or overtraining are risks endangering the physical and psychological benefits that can be expected from sport and exercise. Working with individual athletes or teams requires special knowledge and skills but also awareness of ethical challenges encountered especially in high-performance sports.
Context:
Recombinant human growth hormone (rHGH) has become a target of abuse in the sporting world. Conversely, sports medicine clinicians may encounter athletes using rHGH to achieve normalcy in the context of growth hormone (GH) deficiency.
Evidence acquisition:
Medline and PubMed databases were queried using the following keywords: GH, GH physiology, GH deficiency, acromegaly, GH athlete, GH sports, GH athletic performance, and GH deficiency concussion. Articles focusing on GH physiology, deficiency, excess, and its effects in both deficient and healthy patients were included.
Study design:
Clinical review.
Level of evidence:
Level 3.
Results:
GH is a naturally occurring hormone with important roles in human physiology. Patients with GH deficiency (GHD) present variably, and GHD has numerous etiologies. rHGH treatment has substantial therapeutic benefits for patients with GHD. The benefits of rHGH treatment in otherwise-healthy adults are uncertain. GH excess may cause health problems such as acromegaly. Professional, collegiate, and international sports leagues and associations have banned rHGH use to maintain athlete health, safety, and fair play. Athletes misusing GH may face prolonged suspensions from competition. Implementing GH abuse testing is challenging, but new methods, such as the biomarker testing procedure, are being finalized.
Conclusion:
rHGH is not only an important therapeutic agent for GH-deficient patients but also a target of abuse in competitive athletics. Its benefits in a healthy, adult population are uncertain. A safe exercise and competition plan, developed with a physician knowledgeable of GH use, physiology, and abuse potential, should be of benefit to a longitudinal clinician-patient relationship.
Hormones with anabolic properties such as growth hormone (GH), insulin-like growth factor-1 (IGF-I), and insulin are commonly abused among professional and recreational athletes to enhance physical ability. Performance enhancing drugs (PEDs) such as these are also commonly used by recreational athletes to improve body aesthetics. The perception of increased muscle mass due to supraphysiologic hormone supplementation, or doping, is widespread among PED users despite a paucity of evidence-based data in humans. Even still, athletes will continue to abuse PEDs in hopes of replicating anecdotal results. It is important to educate the general public and potential treating physicians of the risks of PED use, including the dangers of polypharmacy and substance dependence. It will also be important for the research community to address the common challenges associated with studying PED use such as the ethical considerations of PED administration, the general reticence of the PED-using community to volunteer information, and the constant need to improve or create new detection methods as athletes continually attempt to circumvent current methods. This review highlights the anabolic mechanisms and suggestive data implicating GH, IGF-I, and insulin for use as PEDs, the specific detection methods with cutoff ranges that may be utilized to diagnose abuse of each substance, and their respective side effects.
The use of androgens, frequently referred to as anabolic-androgenic steroids (AAS), has grown into a worldwide substance abuse problem over the last several decades. Testosterone was isolated in the 1930s, and numerous synthetic androgens were quickly developed thereafter. Athletes soon discovered the dramatic anabolic effects of these hormones, and AAS spread rapidly through elite athletics and bodybuilding from the 1950s through the 1970s. However it was not until the 1980s that widespread AAS use emerged from the elite athletic world and into the general population. Today, the great majority of AAS users are not competitive athletes, but instead are typically young to middle-aged men who use these drugs primarily for personal appearance. AAS abuse has now become particularly prevalent in regions such as Scandinavia, the United States, Brazil, and British Commonwealth countries, but remains rare in countries such as China, Korea, and Japan – a pattern that reflects cultural differences in attitudes towards male muscularity.
Background
Doping substances are those thought to increase athletic performance, enhance image, or overcome the effects of ageing. This study aims to evaluate the profiles of people and the reasons for importing substances appearing on the World Anti-Doping Agency Prohibited List into Switzerland, which is illegal under Swiss law.
Methods
A survey was conducted among people intending to illegally import doping substances in 2013 and 2014. A questionnaire with 29 items was developed, aiming to collect importers’ socio-demographic information, data on their sports practices, import characteristics, import motivations, product quality awareness and knowledge of the Swiss Sports Law. In total, 491 questionnaires were sent to doping product importers, with 147 (30%) responding.
Results
Gender analysis showed a higher percentage of importation of doping products resulted by men (81%) than by women (18%). Swiss doping product importers were physically active people, but not competing athletes. Men preferentially imported anabolic androgenic steroids and supplements. They admitted that the motivation to import the products was to increase muscle size and improve athletic performance. Women mainly imported products with the intention of losing weight. Apart from supplements, which were imported for performance enhancing reasons, doping products were imported into Switzerland principally for image enhancing reasons.
Conclusion
In Switzerland, doping substance misuse is not limited to regulated sport, it is present in the general population and therefore may become a public health issue.
The concept of doping behaviour was initially developed to better understand the way performance enhancing drugs are used, in elite sports and beyond, throughout society (Laure, 1997). If the ability to identify doping behaviour is certainly interesting in itself, especially when it is related to health or social problems, the hypothesis we advocate here is that such behaviour may itself constitute a useful indicator of performance pressure. We indeed believe that the very concept of doping behaviour and subsequent studies of it could prove highly useful to anyone whose aim is to devise better targeted public health policies and campaigns dealing with enhancing drugs, including in narrower contexts like occupational medicine. If a strong causal link can be demonstrated between performance pressure and doping behaviour, this could then lead to policies that focus on the causes rather than on the effects of doping behaviour, probably with greater effectiveness, and maybe also with more justice and compassion towards the consumers.
Anabolic androgenic steroids (AAS) are substances that mimic the hormone testosterone, and primarily act via the androgen receptor. In addition to their physiological effect on muscle tissue and growth, research from the last decade has shown that AAS have a pronounced impact on the central nervous system. A large number of studies have demonstrated that AAS affect the mesolimbic reward system in the brain. However, whether the direct effects of AAS on endorphins, dopamine, serotonin and GABA etc. and on the corresponding and related systems lead to dependence needs to be further elucidated. According to recent studies, the prevalence of AAS dependence among AAS users has been estimated to be approximately 30%, and polysubstance use, of both pharmaceutical drugs and narcotics, within this group is common. The present review primarily discusses AAS in the context of addiction and dependence, and further addresses the issue of using multiple substances, i.e. stimulants and opiates in combination with AAS. In addition, aspects of the treatment of AAS dependence, the connection between AAS abuse and cognition, and AAS-induced neurotoxicity are presented. Currently, performance enhancing drugs are frequently used in combination with AAS. Therefore, a large section on growth hormone and insulin-like growth factor is also included.
One of the most common-sought after goals in athletic performance is attaining and maintaining muscle mass. From protein to creatine, arginine to human growth hormone, how is one to determine what really works, what is legitimate, and what is merely another gimmick in the supplement industry? Coupling the array of supplements with the unique performance needs of an athlete creates an infinite amount of possible combinations. How do you know what is the right combination for successfully building the desired amount of muscle mass, maintaining an “optimal” body composition, and (during periods when additional body mass is desired) ensuring lean mass is gained over fat mass? It is with great time, research, and a foundation laid for us by our predecessors in the field of sports nutrition that we write this chapter on muscle building and optimizing lean body mass. By the end of this chapter you should be able to:
Describe the muscle building process
Define and determine net protein balance
Describe how genetics play a role in muscle growth
Know the recommended amounts of protein for gaining muscle
Know the suggested protein: carbohydrate ratio for optimal muscle hypertrophy
Define nutrient timing and its role in muscle hypertrophy
Explain the difference between whey, casein, egg, soy, and vegan protein supplements
Explain why and when supplementing with BCAAs are important to muscle growth
Explain the major hormones that play a role in muscle growth
Explain the potential benefits and drawbacks of anabolic steroids
Define the role of IGF in muscle growth
Describe the creatine-phosphate system and why creatine is used for muscle hypertrophy
Explain why supplements that promote the production of nitric oxide are used by athletes
Explain how resistance training stimulates muscle hypertrophy
Injecting use of image and performance-enhancing drugs (IPED) in the general population is a public health concern. A wide and varied range of IPED are now easily accessible to all through the online market. A comprehensive literature review was undertaken according to Critical Appraisal Skills Programme (CASP) guidelines for systematic review, to identify the relevant literature. No date restrictions were placed on the database search in the case of human growth hormone melanotan I and II, and oil and cosmetic injectables. In the case of anabolic androgenic steroids search dates were restricted to January 2014–2015. Publications not in English and with a lack of specificity to the topic were excluded. The review yielded 133 relevant quantitative and qualitative papers, clinical trials, clinical case presentations and editorials/reports. Findings were examined/reviewed under emergent themes which identified/measured extent of use, user profiling, sourcing, product endorsement, risk behaviours and health outcomes in users. Motivation for IPED use may be grounded in appearance, pursuit of health and youth, and body image disturbance. IPED users can practice moderated use, with pathological use linked to high-risk behaviours, which may be normalised within IPED communities. Many IPED trajectories and pathways of use are not scientifically documented. Much of this information may be available online in IPED specific discussion forums, an underutilised setting for research, where uncensored discourse takes place among users. This review underscores the need for future internet and clinical research to investigate prevalence and patterns of injecting use, and to map health outcomes in IPED users. This paper provides community-based clinical practice and health promotion services with a detailed examination and analysis of the injecting use of IPED, highlighting the patterns of this public health issue. It serves to disseminate updated publication information to health and social policy makers and those in health service practice who are involved in harm reduction intervention.
The nontherapeutic use of prescription medicines by individuals involved in sport is increasing. Anabolic-androgenic steroids (AAS) are the most widely abused drug. Much of our knowledge of the psychological and physiological effects of human growth hormone (hGH) and insulin has been learned from deficiency states. As a consequence of the Internet revolution, previously unobtainable and expensive designer drugs, particularly recombinant human growth hormone (rhGH) and insulin, have become freely available at ridiculously discounted prices from countries such as China and are being abused. These drugs have various physiological and psychological effects and medical personnel must become aware that such prescription medicine abuse appears to be used not only for performance and cosmetic reasons, but as a consequence of psychological pre-morbidity.
Anabolic-androgenic steroids (AAS) were the first identified doping agents that have ergogenic effects and are being used to increase muscle mass and strength in adult males. Consequently, athletes are still using them to increase physical performance and bodybuilders are using them to improve size and cosmetic appearance. The prevalence of AAS use has risen dramatically over the last two decades and filtered into all aspects of society. Support for AAS users has increased, but not by the medical profession, who will not accept that AAS use dependency is a psychiatric condition. The adverse effects and potential dangers of AAS use have been well documented. AAS are used in sport by individuals who have acquired knowledge of the half-lives of specific drugs and the dosages and cycles required to avoid detection. Conversely, they are used by bodybuilders in extreme dosages with the intention of gaining muscle mass and size, with little or no regard for the consequences. Polypharmacy by self-prescription is prevalent in this sector. Most recently, AAS use has filtered through to ‘recreational street drug’ users and is the largest growth of drugs in this subdivision. They are taken to counteract the anorexic and cachectic effects of the illegal psychotropic street drugs. Screening procedures for AAS in World Anti-Doping Agency accredited laboratories are comprehensive and sensitive and are based mainly on gas chromatography-mass spectrometry, although liquid chromatography-mass spectrometry is becoming increasingly more valuable. The use of carbon isotope mass spectrometry is also of increasing importance in the detection of natural androgen administration, particularly to detect testosterone administration. There is a degree of contentiousness in the scenario of AAS drug use, both within and outside sport. AAS and associated doping agents are not illegal per se. Possession is not an offence, despite contravening sporting regulations and moral codes. Until AAS are classified in the same capacity as street drugs in the UK, where possession becomes a criminal offence, they will continue to attract those who want to win at any cost. The knowledge acquired by such work can only assist in the education of individuals who use such doping agents, with a view to minimizing health risks and hopefully once again create a level playing field in sport.
Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure.
We performed 2D tissue-Doppler and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n=12) and otherwise similar AAS nonusers (n=7). AAS users (median [quartile 1, quartile 3] cumulative lifetime AAS exposure, 468 [169, 520] weeks) closely resembled nonusers in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups; however, AAS users had significantly lower LV ejection fraction (50.6% [48.4, 53.6] versus 59.1% [58.0%, 61.7%]; P=0.003 by two-tailed Wilcoxon rank sum test), longitudinal strain (16.9% [14.0%, 19.0%] versus 21.0% [20.2%, 22.9%]; P=0.004), and radial strain (38.3% [28.5%, 43.7%] versus 50.1% [44.3%, 61.8%]; P=0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (>or=55%). AAS users also demonstrated decreased diastolic function compared to nonusers as evidenced by a markedly lower early peak tissue velocity (7.4 [6.8, 7.9] cm/s versus 9.9 [8.3, 10.5] cm/s; P=0.005) and early-to-late diastolic filling ratio (0.93 [0.88, 1.39] versus 1.80 [1.48, 2.00]; P=0.003).
Cardiac dysfunction in long-term AAS users appears to be more severe than previously reported and may be sufficient to increase the risk of heart failure.
It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of its effects; 3) reasons for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n = 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31% of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and nonusers of HGH.
GH is an agent widely used in sport to improve physical performance and has been proposed as adjunctive therapy in several clinical conditions. However, its short-term effects on the normal human heart are poorly understood. Sixty young normal volunteers (30 males and 30 females) were enrolled in a multicenter, double-blind, placebo-controlled study. All subjects were randomized to receive GH (0.03 or 0.06 mg/kg.d) or placebo. A complete Doppler-echocardiographic examination was performed at baseline and after 4 wk of treatment. Low-dose GH did not significantly affect echocardiographic parameters. In contrast, high-dose GH increased left ventricular mass index by 12% (P < 0.05). The type of growth response was concentric, because left ventricular wall thickness but not diameter increased, leading to a 10% increase of relative wall thickness. These structural changes were associated with functional changes, including a significant increase in cardiac index and a decrease in peripheral vascular resistance; diastolic function was not altered. Fractional shortening and systemic blood pressure were unchanged in the two treatment groups. In conclusion, administration of GH for 4 wk at doses that simulate GH abuse in sport caused a high cardiac output state associated with concentric left ventricular remodeling.
Readers may question the interpretation of findings in clinical trials when multiple outcome measures are used without adjustment of the p-value. This question arises because of the increased risk of Type I errors (findings of false "significance") when multiple simultaneous hypotheses are tested at set p-values. The primary aim of this study was to estimate the need to make appropriate p-value adjustments in clinical trials to compensate for a possible increased risk in committing Type I errors when multiple outcome measures are used.
The classicists believe that the chance of finding at least one test statistically significant due to chance and incorrectly declaring a difference increases as the number of comparisons increases. The rationalists have the following objections to that theory: 1) P-value adjustments are calculated based on how many tests are to be considered, and that number has been defined arbitrarily and variably; 2) P-value adjustments reduce the chance of making type I errors, but they increase the chance of making type II errors or needing to increase the sample size.
Readers should balance a study's statistical significance with the magnitude of effect, the quality of the study and with findings from other studies. Researchers facing multiple outcome measures might want to either select a primary outcome measure or use a global assessment measure, rather than adjusting the p-value.
Several experimental and clinical studies have indicate that the heart is an end-organ of GH action. Patients with either childhood- or adulthood-onset GH deficiency (GHD) have abnormalities of cardiac structure and function, such as reduced cardiac mass, impaired diastolic filling and reduced left ventricular response at peak exercise. These cardiovascular abnormalities can be reversed, at least partially, after GH replacement therapy. On the other hand, the chronic overproduction of GH and IGF-I in acromegaly leads to the development of a specific cardiomyopathy. Concentric cardiac hypertrophy occurs in more than two-thirds of patients at diagnosis and is commonly associated with diastolic dysfunction. In later stages, impaired systolic function ending in heart failure can occur if GH/IGF-I excess is not controlled. Additionally, acromegalic cardiomyopathy is complicated by abnormalities of cardiac rhythm and cardiac valves. Successful control of acromegaly is accompanied by a decrease of the left ventricular mass and improvement of cardiac function. These beneficial effects appear earlier in young patients with short disease duration than in elderly patients. In conclusion, GH and IGF-I play a main role in the regulation of cardiac development and performance.
Goal-directed measures to prevent doping and drug abuse in sports requires empirical data. In this connection, a cross-sectional analysis was carried out in 2004. The purpose of the study, on the one hand, was to register reliable data of the current situation in Thuringia, and, on the other hand it was to give information on possible interventional steps with scientific support. Within three months, 2319 adolescents from 16 Thuringian schools (5 regular schools, 4 secondary schools, 3 sport schools and 4 vocational schools) were surveyed. Three hundred and forty-six (15.1 %) students out of 2287 students (26 students without a statement) indicated use of prohibited substances from the WADA list in the previous year: 16 (0.7 %) anabolic-androgenic steroids (AAS), 10 (0.4 %) growth hormones, 56 (2.4 %) stimulants, 305 (13.2 %) cannabis, 2 (0.1 %) diuretics, 52 (2.2 %) cocaine/heroin and 6 (0.3 %) erythropoeitin. Moreover, nonathletes (N = 490) reported a substance use that was approximately 5.0 % higher than that of recreational athletes (N = 1254) and nearly three times higher than that of competitive athletes (497). All three groups (nonathletes, recreational athletes and competitive athletes) performed poorly on a knowledge test regarding doping in general with an average below 60 % in each case. Another main aspect of the study was to determine factors influencing substance use in sports. Besides the doping specific knowledge (beta = 0.06, p < 0.05), age contributed (beta = 0.09, p < 0.05), as well as anti-doping attitude (beta = -0.34, p < 0.05), to the resulting variance. Gender, however, played no role. The findings of the study point towards the need for improvement of specific knowledge of doping among students and that their attitude towards doping must be altered. The goal in this case is to test the effectiveness of appropriate scientific intervention.
The purpose of this study was to identify the prevalence of abuse of certain prescription medicines (POM) amongst health club attendees. The non-therapeutic use of such medicines has previously been considered to be restricted to the professional athlete.
In the summer of 2005, health club users in the South Wales area were given questionnaires and asked to return them in a stamped, addressed envelope. Anonymity of the respondents was assured.
From the distribution of 210 questionnaires, the response rate was 69.5% (146 questionnaires). The mean age of the sample was 33.6+/-6.7 years (range 15-72 years). Anabolic-androgenic steroid (AAS) use is prominent amongst recreational gym users in this regional sample, with 70% (102 individuals) reporting AAS use, 65.8% (96 individuals) of whom were currently still using. Some 7% of respondents (10 individuals) were female and they also reported taking medication. This research demonstrated an enormous increase in the use of growth hormone (24%), insulin (14%), and tamoxifen (22%), with smaller increases in other drugs.
Drug users were from all levels of society and reported various physiological and psychological side effects from their use. The present study indicated that the most used medicine/drug from less than reputable sources was still AAS but that, as a consequence of the internet revolution, they were being caught up by the more expensive designer drugs, particularly growth hormone. Physicians and medical personnel must become aware that the use of AAS and other prescription medicines is on the increase and appears to be predominantly used for cosmetic reasons.
The syndrome of adult GH deficiency and the effects of GH replacement therapy provide a useful model with which to study the effects of the GH/IGF-I axis on exercise physiology. Measures of exercise performance including maximal oxygen uptake and ventilatory threshold are impaired in adult GH deficiency and improved by GH replacement, probably through some combination of increased oxygen delivery to exercising muscle, increased fatty acid availability with glycogen sparing, increased muscle strength, improved body composition, and improved thermoregulation. In normal subjects, in addition to the long-term effects of GH/IGF-I status, there is evidence that the acute GH response to exercise is important in regulating substrate metabolism after exercise. Administration of supraphysiological doses of GH to athletes increases fatty acid availability and reduces oxidative protein loss, particularly during exercise, and increases lean body mass. Despite a lack of evidence that these metabolic effects translate to improved performance, GH abuse by athletes is widespread. Tests to detect GH abuse have been developed based on measurement in serum of 1) indirect markers of GH action, and 2) the relative proportions of the two major naturally occurring isoforms (20 and 22kDa) of GH. There is evidence that exercise performance and strength are improved by administration of GH and testosterone in combination to elderly subjects. The potential benefits of GH in these situations must be weighed against potential adverse effects.
Growth Hormone (GH) is an important and powerful metabolic hormone that is secreted in a pulsatile pattern from cells in the anterior pituitary, influenced by several normal and pathophysiological conditions. Human GH was first isolated in the 1950s and human derived cadaveric GH was initially used to treat patients with GH deficiency. However, synthetic recombinant GH has been widely available since the mid-1980s and the advent of this recombinant GH boosted the abuse of GH as a doping agent. Doping with GH is a well-known problem among elite athletes and among people training at gyms, but is forbidden for both medical and ethical reasons. It is mainly the anabolic and, to some extent, the lipolytic effects of GH that is valued by its users. Even though GH's rumour as an effective ergogenic drug among athletes, the effectiveness of GH as a single doping agent has been questioned during the last few years. There is a lack of scientific evidence that GH in supraphysiological doses has additional effects on muscle exercise performance other than those obtained from optimised training and diet itself. However, there might be synergistic effects if GH is combined with, for example, anabolic steroids, and GH seems to have positive effect on collagen synthesis. Regardless of whether or not GH doping is effective, there is a need for a reliable test method to detect GH doping. Several issues have made the development of a method for detecting GH doping complicated but a method has been presented and used in the Olympics in Athens and Turin. A problem with the method used, is the short time span (24-36 hours) from the last GH administration during which the test effectively can reveal doping. Therefore, out-of-competition testing will be crucial.However, work with different approaches to develop an alternative, reliable test is ongoing.
Anabolic-androgenic steroids (AAS) were the first identified doping agents that have ergogenic effects and are being used to increase muscle mass and strength in adult males. Consequently, athletes are still using them to increase physical performance and bodybuilders are using them to improve size and cosmetic appearance. The prevalence of AAS use has risen dramatically over the last two decades and filtered into all aspects of society. Support for AAS users has increased, but not by the medical profession, who will not accept that AAS use dependency is a psychiatric condition. The adverse effects and potential dangers of AAS use have been well documented. AAS are used in sport by individuals who have acquired knowledge of the half-lives of specific drugs and the dosages and cycles required to avoid detection. Conversely, they are used by bodybuilders in extreme dosages with the intention of gaining muscle mass and size, with little or no regard for the consequences. Polypharmacy by self-prescription is prevalent in this sector. Most recently, AAS use has filtered through to 'recreational street drug' users and is the largest growth of drugs in this subdivision. They are taken to counteract the anorexic and cachectic effects of the illegal psychotropic street drugs. Screening procedures for AAS in World Anti-Doping Agency accredited laboratories are comprehensive and sensitive and are based mainly on gas chromatography-mass spectrometry, although liquid chromatography-mass spectrometry is becoming increasingly more valuable. The use of carbon isotope mass spectrometry is also of increasing importance in the detection of natural androgen administration, particularly to detect testosterone administration. There is a degree of contentiousness in the scenario of AAS drug use, both within and outside sport. AAS and associated doping agents are not illegal per se. Possession is not an offence, despite contravening sporting regulations and moral codes. Until AAS are classified in the same capacity as street drugs in the UK, where possession becomes a criminal offence, they will continue to attract those who want to win at any cost. The knowledge acquired by such work can only assist in the education of individuals who use such doping agents, with a view to minimizing health risks and hopefully once again create a level playing field in sport.
The sympathetic nervous system allows us to increase our cardiac output rapidly—an effect we all appreciate when we run up stairs. The stimulatory effects of sympathetic nerves (which produce the neurotransmitter norepinephrine) are balanced by the parasympathetic nervous system, which produces
Athletes have enjoyed almost a thirty year amnesty of rhGH abuse, which they consider has contributed to the winning of medals and the breaking of world records. Such a reprieve is almost at an end, since WADA have identified a method to detect rhGH abuse. Or have they? The anecdotal word "on the street" is that rhGH is still undetectable and athletes believe that the benefits, at the dosages they administer, far outweigh the risks! Scientists are aware that in a hormone deficiency condition, replacement can halt and in certain situations reverse some of the adverse effects. Growth hormone deficiency can lead to a loss of skeletal muscle mass and an increase in abdomino-visceral obesity, which is reversed on replacement with rhGH. Since the availability of GH, athletes have been trying to extrapolate these effects from the deficiency state to the healthy corpus and increase their sporting prowess. Past confessions from athletes, such as Ben Johnson, Kelly White, Tim Montgomery, Marion Jones and currently Dwain Chambers have demonstrated that they are prepared to tread the very fine lines that separate the "men from the boys". Rewards are so great, that anonymous surveys have identified that athletes will risk ill health, if they believe they can cheat, win and not get caught. The question that still needs to be answered is, "does growth hormone enhance performance"? Recent research suggests that it could. There is also a suspicion that in "cycled" low supraphysiological doses, it is no where near as harmful as WADA claim it to be.
Anabolic-androgenic steroid (AAS) dependence has been a recognized syndrome for some 20 years, but remains poorly understood.
We evaluated three groups of experienced male weightlifters: (1) men reporting no history of AAS use (N=72); (2) nondependent AAS users reporting no history of AAS dependence (N=42); and (3) men meeting adapted DSM-IV criteria for current or past AAS dependence (N=20). We assessed demographic indices, lifetime history of psychiatric disorders by the Structured Clinical Interview for DSM-IV, variables related to AAS use, and results from drug tests of urine and hair.
Nondependent AAS users showed no significant differences from AAS nonusers on any variable assessed. Dependent AAS users, however, differed substantially from both other groups on many measures. Notably, they reported a more frequent history of conduct disorder than nondependent AAS users (odds ratio [95% CI]: 8.0 [1.7, 38.0]) or AAS nonusers (13.1 [2.8, 60.4]) and a much higher lifetime prevalence of opioid abuse and dependence than either comparison group (odds ratios 6.3 [1.2, 34.5] and 18.6 [3.0, 116.8], respectively).
Men with AAS dependence, unlike nondependent AAS users or AAS nonusers, showed a distinctive pattern of comorbid psychopathology, overlapping with that of individuals with other forms of substance dependence. AAS dependence showed a particularly strong association with opioid dependence - an observation that recalls recent animal data suggesting similarities in AAS and opioid brain reward mechanisms. Individuals with AAS dependence and individuals with "classical" substance dependence may possibly harbor similar underlying biological and neuropsychological vulnerabilities.
The aim of this study was to explore and describe total drug use among anabolic-androgenic steroid (AAS) users and the reasons given for the use of these drugs. The study was based on semi-structured interviews and questionnaires involving 32 patients who were attending an addiction centre in Orebro, Sweden, for AAS use. The results indicated that a history of polysubstance use among the patients was frequent. Over half were using drugs of abuse and also taking various other pharmaceuticals. Almost half of the patients took human growth hormones, and almost half of the interviewed persons were drinking alcohol to a hazardous or harmful extent. The most common reason given for taking AAS and other hormones was to increase muscle mass and strength, but some participants also used insulin as a means of losing fat. Cannabis was used to improve sleep, heroin to decrease pain and amphetamine to increase endurance and burn fat. Our data suggest that most of the current AAS users who have been admitted to a treatment programme are multiple drug users with polysubstance dependence. The study stresses the importance of carefully examining total drug use as part of the assessment regimen for this group.
The nontherapeutic use of prescription medicines by individuals involved in sport is increasing. Anabolic-androgenic steroids (AAS) are the most widely abused drug. Much of our knowledge of the psychological and physiological effects of human growth hormone (hGH) and insulin has been learned from deficiency states. As a consequence of the Internet revolution, previously unobtainable and expensive designer drugs, particularly recombinant human growth hormone (rhGH) and insulin, have become freely available at ridiculously discounted prices from countries such as China and are being abused. These drugs have various physiological and psychological effects and medical personnel must become aware that such prescription medicine abuse appears to be used not only for performance and cosmetic reasons, but as a consequence of psychological pre-morbidity.
Pulmonary function was assessed in 11 patients with acromegaly, 8 of whom were previously treated by external pituitary irradiation. None of the patients had any overt respiratory ailment. Ventilatory function tests were normal in all patients and all had normal total lung capacity ranging from 75 to 123% (mean, 98.18 +/- 4.69%). Eight of ten patients (80%) had hypoxemia with a partial pressure of oxygen in arterial blood ranging between 58 and 90 mmHg (mean, 76.0 +/- 4.2). Calculated alveolar-arterial differences for oxygen ranged between 5.25 and 46.0 (mean, 26.0 +/- 4.7). In 4 of 5 patients in whom lung perfusion scans were performed, perfusion defects were found. There was a significant correlations (p < 0.05) between the presence of hypoxemia and the known duration of acromegaly, but not with the present growth hormone levels or previous therapy. The results indicate that pneumomegaly is not common in acromegaly. However, most patients have some degree of hypoxemia present usually as subclinical disease and it is probably due to a ventilation-perfusion derangement, which is probably a direct effect of the prolonged oversecretion of growth hormone.
We calculated fat-free mass index (FFMI) in a sample of 157 male athletes, comprising 83 users of anabolic-androgenic steroids and 74 nonusers. FFMI is defined by the formula (fat-free body mass in kg) x (height in meters)-2. We then added a slight correction of 6.3 x (1.80 m - height) to normalize these values to the height of a 1.8-m man. The normalized FFMI values of athletes who had not used steroids extended up to a well-defined limit of 25.0. Similarly, a sample of 20 Mr. America winners from the presteroid era (1939-1959), for whom we estimated the normalized FFMI, had a mean FFMI of 25.4. By contrast, the FFMI of many of the steroid users in our sample easily exceeded 25.0, and that of some even exceeded 30. Thus, although these findings must be regarded as preliminary, it appears that FFMI may represent a useful initial measure to screen for possible steroid abuse, especially in athletic, medical, or forensic situations in which individuals may attempt to deny such behavior.
Subcellular mechanisms support the notion of an intrinsic pituitary defect in acromegaly, with elevated growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels that affect the cardiovascular and respiratory system, as well as neoplastic cell proliferative activity. Surgery, even with external-beam irradiation adjuvant therapy, is only successful in less than 60% of patients, and there are side effects. Normalization of GH levels may improve survival rates. Octreotide has revolutionized patient management, normalizing GH and IGF-1 levels in up to 60%, ameliorating soft-tissue abnormalities and reducing tumor size in up to 50%, and attenuating GH levels in more than 90% of patients. Issues concerning the role of octreotide, as well as clarifying precise outcome measures, still need to be resolved.
To identify unsupervised anabolic steroid regimens used by athletes.
100 athletes attending four gymnasia were surveyed using an anonymous self administered questionnaire.
Anabolic steroid doses ranged from 250 to 3200 mg per week and users combined different drugs to achieve these doses. Injectable and oral preparations were used in cycles lasting four to 12 weeks. Eighty six per cent of users admitted to the regular use of drugs other than steroids for various reasons, including additional anabolic effects, the minimisation of steroid related side effects, and withdrawal symptoms. Acne, striae, and gynaecomastia were the most commonly reported subjective side effects.
Multiple steroids are combined in megadoses and self administered in a cyclical fashion. Polypharmacy is practised by over 80% of steroid users. Skeletal muscle hypertrophy along with acne, striae, and gynaecomastia are frequent physical signs associated with steroid use.
Patients with acromegaly have a reduced life expectancy, with the accepted causes for premature death being vascular and respiratory disease. Increased mortality from malignant disease has also been reported. We, therefore, performed a multicenter retrospective cohort study of 1362 patients with acromegaly and investigated the relationships of mortality and cancer incidence with GH levels, duration of disease, and age at diagnosis. The overall cancer incidence rate [standardized incidence ratio, 0.76; 95% confidence interval (CI), 0.60-0.95] was lower than that in the general population of the United Kingdom, and there was no significant increase in site-specific cancer incidence rates. The overall cancer mortality rate was not increased, but the colon cancer mortality rate (standardized mortality ratio, 2.47; 95% CI, 1.31-4.22) was higher than expected. Mortality rates due to colon cancer, all malignant disease, cardiovascular disease and overall mortality were increased with higher posttreatment GH levels (P for trends, <0.02, <0.05, <0.02, and <0.0001). The overall mortality rate in patients with acromegaly with posttreatment GH levels less than 2.5 ng/mL (5 mU/L) was comparable to that in the general population of the United Kingdom (standardized mortality ratio, 1.10; 95% CI, 0.89-1.35). We conclude that high posttreatment GH levels are associated with an increased overall mortality rate and increased mortality rates due to colon cancer, cardiovascular disease, and all malignant disease. Posttreatment GH levels less than 2.5 ng/mL (5 mU/L) result in an overall mortality rate similar to that in the general population.
Although numerous studies have documented the psychiatric and physiological effects of anabolic-androgenic steroids (AAS) in males, virtually no studies have investigated the effects of illicit AAS use in women.
We performed psychiatric and medical evaluations of 75 dedicated women athletes, recruited by advertisement primarily from gymnasiums in the Boston, Mass., area.
Twenty-five (33%) of the women reported current or past AAS use. Users were more muscular than nonusers and reported use of many other 'ergogenic' (performance-enhancing) drugs in addition to AAS. Some described a frank syndrome of ergogenic polysubstance dependence, often with significant morbidity. Fourteen (56%) of the users reported hypomanic symptoms during AAS use and 10 (40%) reported depressive symptoms during AAS withdrawal, but none met full DSM-IV criteria for a hypomanic or major depressive episode. Nineteen (76%) users reported at least one adverse medical effect associated with AAS use. Perhaps the most interesting findings were several unusual psychiatric syndromes reported by both the AAS users and nonusers. These included rigid dietary practices (which we have termed 'eating disorder, bodybuilder type'), nontraditional gender roles and chronic dissatisfaction and preoccupation with their physiques (a syndrome which we have termed 'muscle dysmorphia').
Dedicated women athletes exhibit not only AAS abuse, but use of many other ergogenic drugs, sometimes associated with significant morbidity. In addition, these athletes frequently display several psychiatric syndromes which have not previously been well described.
Anabolic-androgenic steroid (AAS) use represents a major public health problem in the United States, but the risk factors for this form of drug use are little studied. We evaluated 48 men who had used AAS for at least 2 months and 45 men who had never used AAS, using a verbal interview and a battery of questionnaires covering hypothesized demographic, familial, and psychosocial risk factors for AAS use. All subjects in both groups were experienced weightlifters; thus, differences between groups were likely to be associated specifically with AAS use, rather than with weightlifting in general. The AAS users and non-users generally described similar childhood and family experiences, but users reported significantly poorer relationships with their fathers and greater childhood conduct disorder than non-users. At the time that they first started lifting weights, AAS users and non-users were similar in their perceived physical, social, and sexual status, but users were significantly less confident about their body appearance. AAS users displayed much higher rates of other illicit substance use, abuse, or dependence than non-users, with use of other illicit substances almost always preceding first use of AAS. These findings suggest that AAS use may be most likely to occur in men with high levels of antisocial traits and low levels of body esteem.
Acromegalics have been reported to be at an increased risk of colorectal neoplasm. However, the magnitude of the risk is still controversial and the mechanism has not been fully investigated. In this study, we attempted to determine the magnitude of the association between acromegaly and colorectal lesions after taking into account age, gender, smoking status, and treatment status. In addition, we assessed the relationship between colorectal lesions and serum growth hormone (GH) levels in acromegalics.
We conducted a case-control study by using 19 consecutive untreated patients (male:female = 11:8) who were newly diagnosed with acromegaly between 1990 and 2000. All patients underwent colonoscopy and received a histological diagnosis of colorectal lesions. Prevalence of hyperplastic polyp, adenoma, and carcinoma were compared with the prevalence in 76 controls matched for gender, age, and smoking status. Serum GH levels were compared between acromegalic patients with and without each type of colorectal lesion.
The prevalence of hyperplastic polyp, adenoma, and carcinoma were significantly higher in the acromegalic patients compared to the controls (p < 0.05, odds ratios; 8.3, 4.2, and 9.8, respectively). In acromegalics, the presence of hyperplastic polyps and carcinomas were significantly associated with higher serum GH levels after adjusting for the other lesions and age (p < 0.05).
After controlling for age, gender, smoking status, and treatment status, acromegaly was associated with significantly higher prevalence of colorectal hyperplastic polyp, adenoma, and carcinoma. High serum GH levels may be associated with the presence of hyperplastic polyp and carcinoma.
Acromegaly is characterised by excessive levels of circulating growth hormone and its tissue mediator, insulin-like growth factor (IGF)-I. Prior to effective treatment and lowering of growth hormone and IGF-I, the majority of patients with the disease died by the age of 60 years, largely due to diabetes mellitus, cardiovascular and cerebrovascular diseases. More recently, it has become apparent that patients with acromegaly may also have an increased prevalence of colorectal adenomas and cancer. This may be due to elevated IGF-I, which is implicated in the development of sporadic colorectal cancer, and environmental factors, such as the bile acid deoxycholic acid, the levels of which are also increased in acromegaly. There is some evidence to suggest that breast and prostatic malignancies might also be increased in acromegaly. However, these associations have been based mostly on small epidemiological surveys and circumstantial evidence. Large-scale epidemiological studies are required to clarify this issue.
Acromegaly is characterized by an increased cardiovascular morbidity and mortality. In fact, growth hormone and insulin-like growth factor-I excess induces a specific cardiomyopathy. The heart is involved from the very early stages of the disease in which the hyperkinetic syndrome (high heart rate and increased systolic output) takes place. Frequently, if the disease is untreated for many years or unsuccessfully treated, concentric biventricular hypertrophy and diastolic dysfunction can develop and, at least, lead to diastolic congestive heart failure. Rhythm disturbances and valve dysfunction are also frequently described in acromegaly. The coexistence of other complications, such as diabetes and arterial hypertension, can induce the worsening of acromegalic cardiomyopathy. Control of acromegaly by surgery or pharmacotherapy could improve cardiovascular morbidity thanks to decreasing left ventricular mass and reducing cardiac dysfunction. In conclusion, an early diagnosis and a careful evaluation of cardiac function, morphology and activity seem to be mandatory in acromegaly.
This article focuses on in vivo data from tests performed in normal subjects and in patients who had abnormal growth hormone (GH) status. Experimental data in human subjects demonstrate that GH acutely inhibits glucose disposal in skeletal muscle. At the same time GH stimulates the turnover and oxidation of free fatty acid (FFA), and experimental evidence suggests a causal link between elevated FFA levels and insulin resistance in skeletal muscle. Observational data in GH-deficient adults do not indicate that GH replacement is associated with significant impairment of glucose tolerance, but it is recommended that overdosing be avoided and glycemic control be monitored.
To determine whether 6 days recombinant human growth hormone (rhGH) administration, in an abstinent anabolic-androgenic steroid (AAS) using group had any respiratory, endurance exercise and biochemical effects compared with an abstinent AAS control group.
Male subjects (n=48) were randomly divided, using a single blind procedure into two groups: (1) control group (C) n=24, means+/-SD, age 32+/-11 years; height 1.8+/-0.06 m; (2) rhGH using group (0.019 mg kg(-1) day(-1)) (GH) n=24, means+/-SD, age 32+/-9 years; height 1.8+/-0.07 m. Anthropometry, respiratory muscle function and endurance exercise were investigated. Respiratory measurements examined, were forced expiratory volume in one second, forced vital capacity, maximum inspiratory pressure and maximum expiratory pressure. Endurance exercise was assessed by measuring peak oxygen uptake (VO(2)peak). Biochemical analysis included; haemoglobin, packed cell volume, glucose, sodium, urea, creatinine, total protein, albumin, testosterone and insulin like growth factor-I (IGF-I).
Forced expiratory volume in one second/forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure, and IGF-I significantly increased compared with the control group (all P<0.05). Body mass index, fat free mass index, peak oxygen uptake, maximum inspiratory pressure, maximum expiratory pressure, IGF-I and serum sodium significantly increased, whilst body fat, total protein and albumin, significantly decreased within the GH group (all P<0.017).
The findings of this study indicated that short-term high dose rhGH increased aerobic performance and respiratory muscle strength in former AAS users.
The increased mortality associated with acromegaly was first demonstrated in early epidemiological studies. Since the seminal paper by Wright et al. in 1970, nearly 20 studies have analyzed mortality rates in over 5,000 patients with acromegaly. Overall standardized mortality rates are approximately two times higher than in the general population, relating to an average reduction in life expectancy of around 10 years. The excess deaths are due predominantly to cardiovascular, cerebrovascular and respiratory disease. Malignancy deaths have been high in some studies but not others; in the largest series looking at cancer mortality in acromegaly, overall cancer deaths were not increased, but colon cancer mortality was higher than expected. In 1993, Bates et al. first demonstrated that outcome was related to the latest measurable growth hormone (GH), and treatment to reduce GH levels led to improved outcomes. Other factors predicting poor outcome include the presence of hypertension and diabetes. On the basis of current evidence, a latest GH of less than 2-2.5 mug/L is a better predictor of good outcome than a normal insulin-like growth factor-1 (IGF-1), possibly due to discrepancy between GH and IGF-1 at low GH levels. There is some evidence to suggest a more stringent GH cut-off (less than 1 mug/L) may yield additional benefit but further studies are required to investigate any added risk of increased mortality from hypopituitarism. Radiotherapy has been linked specifically to cerebrovascular mortality and its use in patients with acromegaly must involve a careful risk-benefit analysis in each case.
GH and IGF-I affect cardiac structure and performance. In the general population, low IGF-I has been associated with higher prevalence of ischaemic heart disease and mortality. Both in GH deficiency (GHD) and excess life expectancy has been reported to be reduced because of cardiovascular disease.
To review the role of the GH-IGF-I system on the cardiovascular system.
Recent epidemiological evidence suggests that serum IGF-I levels in the low-normal range are associated with increased risk of acute myocardial infarction, ischaemic heart disease, coronary and carotid artery atherosclerosis and stroke. This confirms previous findings in patients with acromegaly or with GH-deficiency showing cardiovascular impairment. Patients with either childhood- or adulthood-onset GHD have cardiovascular abnormalities such as reduced cardiac mass, diastolic filling and left ventricular response at peak exercise, increased intima-media thickness and endothelial dysfunction. These abnormalities can be reversed, at least partially, after GH replacement therapy. In contrast, in acromegaly chronic GH and IGF-I excess causes a specific cardiomyopathy: concentric cardiac hypertrophy (in more than two-thirds of the patients at diagnosis) associated to diastolic dysfunction is the most common finding. In later stages, impaired systolic function ending in heart failure can occur, if GH/IGF-I excess is not controlled. Abnormalities of cardiac rhythm and of cardiac valves can also occur. Successful control of acromegaly is accompanied by decrease of the left ventricular mass and improvement of cardiac function.
The cardiovascular system is a target organ for GH and IGF-I. Subtle dysfunction in the GH-IGF-I axis are correlated with increased prevalence of ischaemic heart disease. Acromegaly and GHD are associated with several abnormalities of the cardiovascular system and control of GH/IGF-I secretion reverses (or at least stops) cardiovascular abnormalities.
Recombinant human growth hormone (rhGH) as opposed to cadaver pituitary GH is misused for physical improvement. Six days' rhGH administration, in abstinent anabolic-androgenic steroid dependents, was compared with controls.
Male subjects (n = 48) were randomly divided into two groups: (1): control group (C), n = 24, mean +/- SD, age 32 +/- 11 years, height 1.8 +/- 0.06 m; (2): rhGH-using group (0.058 IU.kg(-1).day(-1)) (GH), n = 24, mean +/- SD, age 32 +/- 9 years, height 1.8 +/- 0.07 m. Physiological measurements included anthropometry, strength, power and peak oxygen uptake (VO(2) peak). Biochemical measurements included haemoglobin, packed cell volume, glucose, sodium, potassium, urea, creatinine, total protein, albumin, thyroid function, testosterone, prolactin, cortisol, GH and insulin-like growth factor-I (IGF-I).
Strength, peak power output and IGF-I significantly increased and total protein, albumin and free tetra-iodothyronine significantly decreased compared to controls (p < 0.05) and within the GH group (p < 0.017). Fat-free mass index and VO(2) peak significantly increased, while body fat and thyroid-stimulating hormone significantly decreased within the GH group (p < 0.017).
Short-term rhGH increased strength and power. Of therapeutic value is the possibility that muscle bulk and strength could be increased in patients with muscle-wasting conditions.
The problem of anabolic-androgenic steroid (AAS) abuse has recently generated widespread public and media attention. Most AAS abusers, however, are not elite athletes like those portrayed in the media, and many are not competitive athletes at all. This larger but less visible population of ordinary AAS users began to emerge in about 1980. The senior members of this population are now entering middle age; they represent the leading wave of a new type of aging former substance abusers, with specific medical and psychiatric risks.
We reviewed the evolving literature on long-term psychiatric and medical consequences of AAS abuse.
Long-term use of supraphysiologic doses of AAS may cause irreversible cardiovascular toxicity, especially atherosclerotic effects and cardiomyopathy. In other organ systems, evidence of persistent toxicity is more modest, and interestingly, there is little evidence for an increased risk of prostate cancer. High concentrations of AAS, comparable to those likely sustained by many AAS abusers, produce apoptotic effects on various cell types, including neuronal cells--raising the specter of possibly irreversible neuropsychiatric toxicity. Finally, AAS abuse appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood syndromes, and progression to other forms of substance abuse. However, the prevalence and severity of these various effects remains poorly understood.
As the first large wave of former AAS users now moves into middle age, it will be important to obtain more systematic data on the long-term psychiatric and medical consequences of this form of substance abuse.
Steroid use in Cardiff: A problem for whom? J Perform-Enhancing Drugs
- Pates R Barry
Pates R, Barry C. Steroid use in Cardiff: A problem for whom? J Perform-Enhancing Drugs. 1996;1:92–97.
Molecular Nutri-tion; 2009. 5. EC21 global B2B marketplace
- Llewellyn W Anabolics
Llewellyn W. Anabolics, 9th edn. Jupiter, Florida: Molecular Nutri-tion; 2009. 5. EC21 global B2B marketplace. Available at: http://www.ec21. com/ec-market/Growth hormone.html. Accessed October 18, 2010.