Self-Reported Use of Anabolic-Androgenic Steroids by Elite Power Lifters

Cardiac Adaptation in Power Athletes: Differential Impact of Judo and Weightlifting

Background: According to the ESC guidelines, sport disciplines are classified in relation to the predominant component (skill, power, mixed and endurance), including a wide range of disciplines with different isometric/isotonic exercises and exercise-induced heart remodeling. The aim of our study was to evaluate differences in morpho-functional cardiac adaptations in power athletes, comparing judokas with weightlifters. Methods: We enrolled 55 Olympic athletes (38 judokas, 17 weightlifters), aged 24.5 ± 3.8 years, 25 (45.4%) of whom were males, and they underwent a pre-participation evaluation, including a physical examination, ECG, transthoracic echocardiogram, and exercise stress test. Results: The judokas presented significant differences in cardiac adaptations, with larger left ventricle (LV) end-diastolic and end-systolic volumes indexed (LVEDVi, p = 0.002 and LVESVi, p = 0.004) and higher LVMass values indexed (p = 0.033), but similar LV wall thicknesses (p = 0.093) and LV ejection fractions (p = 0.981). Also, the left atrium (LA) dimension (p = 0.0002) and volume indexed (p < 0.0001) were higher in the judokas, as were the larger right ventricle (RV) areas. Finally, the judokas showed higher VO2max (p = 0.012), O2 pulse (p = 0.007), VE/O2 LT1 (p = 0.041) and VE/O2 LT2 (p = 0.036) values, with a lower resting heart rate (p = 0.031) and higher exercise capacity (p = 0.011). Conclusions: The judokas showed substantial differences in cardiac morpho-functional adaptations from the weightlifters, and, accordingly, judo should be more properly considered not a pure strength sport but more similar to mixed disciplines of the ESC classification.

Prevalence of anabolic steroid users seeking support from physicians: a systematic review and meta-analysis

OBJECTIVES

To estimate the overall prevalence of androgenic-anabolic steroids (AAS) users seeking support from physicians. Secondary objectives are to compare this prevalence in different locations and among subpopulations of AAS users, and to discuss some of the factors that could have influenced the engagement of AAS users with physicians.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, PsycINFO, Web of Science and SciELO were searched in January 2022.

ELIGIBILITY CRITERIA

Quantitative and qualitative studies reporting the number of AAS users who sought support from physicians, with no restrictions of language or time of publication.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed the quality of studies, including publication bias. A random-effects meta-analysis was performed to estimate the overall prevalence of AAS users seeking support from physicians, followed by pooled prevalence rates by studies' location and the subpopulation of AAS users.

RESULTS

We identified 36 studies published between 1988 and 2021, involving 10 101 AAS users. The estimated overall prevalence of AAS users seeking support from physicians is 37.12% (95% CI 29.71% to 44.52%). Higher prevalence rates were observed in studies from Australia (67.27%; 95% CI 42.29% to 87.25%) and among clients of the needle and syringe exchange programme (54.13%; 95% CI 36.41% to 71.84%). The lowest prevalence was observed among adolescent AAS users (17.27%; 95% CI 4.80% to 29.74%).

CONCLUSION

Our findings suggest that about one-third of AAS users seek support from physicians, with remarkable differences between locations and subpopulations of AAS users. Further studies should investigate the factors influencing the engagement of AAS users with physicians.

PROSPERO REGISTRATION NUMBER

CRD42020177919.

Consequences of Anabolic-Androgenic Steroid Abuse in Males; Sexual and Reproductive Perspective

The real epidemiology and the possible consequences of anabolic-androgenic steroids (AAS) use still represent a very tricky task due to the difficulties in the quantification and detection of these drugs. Chronic use of AAS, frequently combined with other illicit substances, can induce tremendous negative effects on the reproductive system, but it is also associated with an increased overall and cardiovascular mortality risk. In the present review we summarize and discuss the available evidence regarding the negative impact of AAS on the male reproductive system, providing practical suggestions to manage these problems. For this purpose a meta-analysis evaluating the effects of AAS abusers vs. controls on several hormonal, reproductive and metabolic parameters was performed. In addition, in order to overcome possible limitations related to the combined use of different AAS preparations, we also retrospectively re-analyzed data on animal models treated with supraphysiological dosage of testosterone (T), performed in our laboratory. Available data clearly indicated that AAS negatively affect endogenous T production. In addition, increased T and estradiol circulating levels were also observed according to the type of preparations used. The latter leads to an impairment of sperm production and to the development of side effects such as acne, hair loss and gynecomastia. Furthermore, a worse metabolic profile, characterized by reduced high density lipoprotein and increased low density lipoprotein cholesterol levels along with an increased risk of hypertension has been also detected. Finally sexual dysfunctions, often observed upon doping, represent one the most probable unfavorable effects of AAS abuse.

Doping Prevalence in Competitive Sport: Evidence Synthesis with "Best Practice" Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence

BACKGROUND

The prevalence of doping in competitive sport, and the methods for assessing prevalence, remain poorly understood. This reduces the ability of researchers, governments, and sporting organizations to determine the extent of doping behavior and the impacts of anti-doping strategies.

OBJECTIVES

The primary aim of this subject-wide systematic review was to collate and synthesize evidence on doping prevalence from published scientific papers. Secondary aims involved reviewing the reporting accuracy and data quality as evidence for doping behavior to (1) develop quality and bias assessment criteria to facilitate future systematic reviews; and (2) establish recommendations for reporting future research on doping behavior in competitive sports to facilitate better meta-analyses of doping behavior.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. Articles were included if they contained information on doping prevalence of any kind in competitive sport, regardless of the methodology and without time limit. Through an iterative process, we simultaneously developed a set of assessment criteria; and used these to assess the studies for data quality on doping prevalence, potential bias and reporting.

RESULTS

One-hundred and five studies, published between 1975 and 2019,were included. Doping prevalence rates in competitive sport ranged from 0 to 73% for doping behavior with most falling under 5%. To determine prevalence, 89 studies used self-reported survey data (SRP) and 17 used sample analysis data (SAP) to produce evidence for doping prevalence (one study used both SRP and SAP). In total, studies reporting athletes totaled 102,515 participants, (72.8% men and 27.2% women). Studies surveyed athletes in 35 countries with 26 involving athletes in the United States, while 12 studies examined an international population. Studies also surveyed athletes from most international sport federations and major professional sports and examined international, national, and sub-elite level athletes, including youth, masters, amateur, club, and university level athletes. However, inconsistencies in data reporting prevented meta-analysis for sport, gender, region, or competition level. Qualitative syntheses were possible and provided for study type, gender, and geographical region. The quality assessment of prevalence evidence in the studies identified 20 as "High", 60 as "Moderate", and 25 as "Low." Of the 89 studies using SRP, 17 rated as "High", 52 rated as "Moderate", and 20 rated as "Low." Of the 17 studies using SAP, 3 rated as "High", 9 rated as "Moderate", and 5 rated as "Low." Examining ratings by year suggests that both the quality and quantity of the evidence for doping prevalence in published studies are increasing.

CONCLUSIONS

Current knowledge about doping prevalence in competitive sport relies upon weak and disparate evidence. To address this, we offer a comprehensive set of assessment criteria for studies examining doping behavior data as evidence for doping prevalence. To facilitate future evidence syntheses and meta-analyses, we also put forward "best practice" recommendations and reporting guidelines that will improve evidence quality.

Effect of Training Phase on Physical and Physiological Parameters of Male Powerlifters

Longitudinal research on training and dietary practices of natural powerlifters is limited. This study investigated the effect of phases of training on physical and physiological parameters in male natural powerlifters. Nine participants completed testing at two time points: (i) preparatory phase (~3 months prior to a major competition) and (ii) competition phase (1–2 weeks from a major competition). No significant changes between training phases were found for muscle strength and power. A trend for significance was found for decreased muscle endurance of the lower body (−24.4%, p = 0.08). A significant increase in leg lean mass was found at the competition phase (2.3%, p = 0.04), although no changes for other body composition measures were observed. No change was observed for any health marker except a trend for increased urinary creatinine clearance at the competition phase (12.5%, p = 0.08). A significant reduction in training volume for the lower body (−75.0%, p = 0.04) and a trend for a decrease in total energy intake (−17.0%, p = 0.06) was observed during the competition phase. Despite modifications in training and dietary practices, it appears that muscle performance, body composition, and health status remain relatively stable between training phases in male natural powerlifters.

The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis

PURPOSE

To estimate the global lifetime prevalence rate of anabolic-androgenic steroid (AAS) use and investigate moderators of the prevalence rate.

METHODS

A meta-analysis and meta-regression analysis was performed using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, and Google Scholar among others. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were coded for publication year, region, sample type, age range, sample size, assessment method, and sampling method. Heterogeneity was assessed by the I(2) index and the Q-statistic. Random effect-size modeling was used. Subgroup comparisons were conducted using Bonferroni correction.

RESULTS

The global lifetime prevalence rate obtained was 3.3% (95% confidence interval [CI], 2.8-3.8; I(2) = 99.7, P < .001). The prevalence rate for males, 6.4% (95% CI, 5.3-7.7, I(2) = 99.2, P < .001), was significantly higher (Qbet = 100.1, P < .001) than the rate for females, 1.6% (95% CI, 1.3-1.9, I(2) = 96.8, P < .001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias.

CONCLUSION

Nonmedical AAS use is a serious widespread public health problem.

Increased mortality rate and suicide in Swedish former elite male athletes in power sports

Physical training has been shown to reduce mortality in normal subjects, and athletes have a healthier lifestyle after their active career as compared with normal subjects. Since the 1950s, the use of anabolic androgenic steroids (AAS) has been frequent, especially in power sports. The aim of the present study was to investigate mortality, including causes of death, in former Swedish male elite athletes, active 1960-1979, in wrestling, powerlifting, Olympic lifting, and the throwing events in track and field when the suspicion of former AAS use was high. Results indicate that, during the age period of 20-50 years, there was an excess mortality of around 45%. However, when analyzing the total study period, the mortality was not increased. Mortality from suicide was increased 2-4 times among the former athletes during the period of 30-50 years of age compared with the general population of men. Mortality rate from malignancy was lower among the athletes. As the use of AAS was marked between 1960 and 1979 and was not doping-listed until 1975, it seems probable that the effect of AAS use might play a part in the observed increased mortality and suicide rate. The otherwise healthy lifestyle among the athletes might explain the low malignancy rates.

Judging cheaters: is substance misuse viewed similarly in the athletic and academic domains?

The present study examines how individuals judge others who use performance-enhancing drugs in two different domains--the athletic domain and the academic domain. Approximately 1,200 males in their freshman year of college completed a questionnaire that included two scenarios. One scenario described an athlete who misused anabolic steroids to help him succeed at a sporting event. The other described a college student who misused Adderall to help him succeed on his midterm exams. Participants rated the extent to which they thought the target had cheated and the extent to which they felt the substances were necessary for success. Results showed participants believed the athlete was more of a cheater than the student, and this difference got larger as past prescription stimulant misuse increased. Results also demonstrated that participants felt Adderall was more necessary than anabolic steroids for bringing about success. Contributions to the literature on zero-sum and non-zero-sum domains are discussed. Implications for future research and efforts to prevent substance misuse are described.

Psychological drivers in doping: the life-cycle model of performance enhancement

BACKGROUND

Performance enhancement (PE) is a natural and essential ingredient of competitive sport. Except for nutritional supplement contamination, accidental use of doping is highly unlikely. It requires deliberation, planning and commitment; and is influenced by a host of protective and risk factors.

HYPOTHESIS

In the course of their career, athletes constantly set goals and make choices regarding the way these goals can be achieved. The cycle of choice - goal commitment - execution - feedback on goal attainment - goal evaluation/adjustment has numerous exit points, each providing an opportunity for behaviour change, which may or may not be related to the use of prohibited methods. The interplay between facilitating and inhibiting systemic and personality factors, constantly influenced by situational factors could result in an outcome vector of 'doping attitudes', which combines with subjective norms to influence intentions to choose prohibited PE methods. These influences also vary from one stage of athlete development to the next, making some athletes more vulnerable to engaging in doping practices than others, and more vulnerable at certain time periods - and not others.

TESTING THE HYPOTHESIS

Model-testing requires a series of carefully planned and coordinated studies. Correlational studies can establish relationships where the directionality is not-known or not important. Experimental studies with the manipulation of doping expectancies and risk factors can be used to demonstrate causality and evaluate potential intervention strategies. The final model can be tested via a behavioural simulation, with outcomes compared to those expected from literature precedence or used as a simulated computer game for empirical data collection.

IMPLICATIONS

A hypothesized life-cycle model of PE identifies vulnerability factors across the stages of athlete development with the view of informing the design of anti-doping assessment and intervention. The model suggests that, instead of focusing on the actual engagement in prohibited PE practices, deterrence strategies are likely to be more effective if they target the influencing factors at the appropriate stage and identify groups of athletes and their respective career stages, which pose particular risks of engagement in doping practices. This enables a more effective intervention approach by targeting specific risk factors and expectancies.

Corticosteroid- and Anabolic Steroid—Induced Mental Status Disturbances

Corticosteroids and anabolic steroids can induce remarkably similar presentations in the mental status changes that they precipitate. Most individuals demonstrate affect and mood changes consistent with patients diagnosed with either bipolar or unipolar affective disorder. In addition, affective changes can be accompanied by delusions in the minority of subjects. Presentation of the drug-induced disorder is dose dependent. Patients experiencing corticosteroid-induced mental status changes are commonly ingesting the equivalent of approximately 60 mg/d of prednisone orally with the symptoms appearing in most patients within a week of starting the drug. In addition, women are more likely to experience these mental status changes. Subjects abusing anabolic steroids generally do not exhibit any mental status changes until a dose equivalent to intramuscular testosterone 600 mg/wk has been reached. Unlike corticosteroids, high-dose exposure of anabolic steroids is accompanied by increased aggressive behavior that is problematic from not only a medical but also a legal standpoint.

Some rewarding effects of androgens may be mediated by actions of its 5alpha-reduced metabolite 3alpha-androstanediol

The abuse of anabolic-androgenic steroids (AS) is a growing problem; however, the effects and mechanisms underlying their addictive effects are not well understood. Research findings regarding androgen abuse in people and hedonic effects of androgens in laboratory rats are reviewed. Androgens, like other steroids, can have traditional actions via cognate intracellular steroid receptors, as well as other substrates. Our recent results indicate that testosterone (T) metabolites may have actions in part via gamma-aminobutyric acid (GABA)(A)/benzodiazepine receptor complexes (GBRs) and/or dopaminergic neurons in the nucleus accumbens, to mediate T's positive hedonic states. This may provide the basis for positive reinforcing effects of androgen seeking and use behavior. Following a comprehensive review of the background literature, our findings are presented that have explored the extent to which metabolites of T mediate euphorogenic effects of androgens by acting in the nucleus accumbens. Then results regarding whether GBRs are necessary substrates for androgens' positive hedonic effects are discussed. Lastly, research that addresses if dopaminergic neurons in the nucleus accumbens are necessary for these effects of androgens are discussed. This review provides a comprehensive examination of the hedonic properties and abuse/addiction potential of androgens and the putative mechanisms underlying these effects.

Predictors of Future Anabolic Androgenic Steroid Use

PURPOSE

To prospectively study the stability of anabolic androgenic steroid (AAS) use and predictors of AAS use, and to investigate whether AAS use alters the risk of later emotional and behavioral problems.

METHODS

Survey of a national sample of Norwegian high school students (age 15-19) in 1994 followed up in 1999 (N = 2924). Measures of frequent alcohol intoxication (50+ times per 12 months), cannabis use (12 months), hard drug use (12 months), being offered cannabis, eating problems, conduct problems, sexual debut before age 15, BMI, involvement in power sports, perceived physical appearance, and satisfaction with body parts were obtained.

RESULTS

Life-time prevalence of AAS use were 1.9 and 0.8% in the follow-up period. Multivariate logistic regression revealed that future AAS use was predicted by young age, male gender, previous AAS use, involvement in power sports, and frequent alcohol intoxication. AAS use did not predict future emotional or behavioral problems other than reducing the risk of future frequent alcohol intoxication.

CONCLUSION

Frequent alcohol intoxication and involvement in power sports appear to predict future AAS use. At the population level there was little stability in individual AAS use from adolescence to early adulthood. No detrimental effects of AAS use could be detected in this study, but low statistical power limits this conclusion.

Plasticity in anterior hypothalamic vasopressin correlates with aggression during anabolic-androgenic steroid withdrawal in hamsters

In hamsters, adolescent anabolic-androgenic steroid (AAS) exposure facilitates offensive aggression, in part by altering the development and activity of anterior hypothalamic arginine vasopressin (AH-AVP). This study assessed whether these effects were lasting by examining aggression and AH-AVP during AAS withdrawal. Adolescent hamsters administered AAS were tested as adults for aggression at 1, 4, 11, 18, or 25 days of withdrawal, sacrificed the following day, and examined for AH-AVP afferent innervation using immunohistochemistry. Through Day 12 of withdrawal, aggression and AVP were significantly higher in AAS-treated hamsters than in controls. These differences were no longer observable by Day 19 of withdrawal, at which point the behavior and neurobiology of AAS-treated hamsters reverted to that observed in controls. These data indicate that adolescent AAS exposure has short-term, reversible effects on both aggression and AH-AVP, correlating AH-AVP with the aggressive/nonaggressive behavioral phenotype during AAS withdrawal.

Predicting intentions for long-term anabolic-androgenic steroid use among men: A covariance structure model

Long-term use of anabolic-androgenic steroids (AASs) is associated with both positive and negative effects. The authors examined possible mechanisms by which these effects contribute to AAS satisfaction and predict intentions for future AAS use. Five hundred male AAS users completed an interactive Web-based instrument assessing the psychological and physical effects of AAS use. Covariance structure modeling was used to evaluate both direct and indirect effects of AAS consequences on satisfaction with AASs and intentions for future AAS use. Results suggest that gain in muscle mass and psychological benefits from AAS use uniquely contributed to both AAS satisfaction and intentions for future use. Side effects from AAS use also uniquely contributed to AAS satisfaction, but ancillary drug use was found to partially mediate this relationship, suggesting that the satisfaction of experienced AAS users is enhanced by their mastery of side effects through the use of ancillary drugs. The final model explained 29% of the variance in intentions for future AAS use. Mechanisms for sustained AAS use and implications for intervention and prevention strategies are discussed.

Current perspectives on anabolic steroids

Steroids are used outside the realm of competitive athletics in Australia among a wide variety of groups with different motivations and goals. This paper provides an overview of the reasons for use; rates of usage; physical and psychological side effects; and sources of steroids. Issues associated with injecting steroids; their current legal status; and drug education and prevention programmes are reviewed briefly. Research involving identified sub-populations is needed to determine user profiles and prevalence rates of users and potential users. Studies of Australian users are also needed to obtain baseline information on areas of potential harm associated with steroids use, e.g. aggressive behaviour, needle-sharing behaviour, physical side effects and potential for dependency. It is concluded that future deterrence strategies should focus more on demand reduction, rather than supply.

Drug Use in Sports: A Veritable Arena for Pharmacists

OBJECTIVE

To describe opportunities and obligations for pharmacists regarding doping control in sports, and to present information and resources on drugs and dietary supplements that are popular among athletes for performance enhancement.

DATA SOURCES

Sports medicine journals and articles in English obtained from Medline (1966 through June 2003) using the search terms doping in sports, drugs in sports, dietary supplements, sports, amphetamine, stimulants, ephedrine, ephedra, caffeine, anabolic steroids, human growth hormone, erythropoietin, darbepoetin, androstenedione, dehydroepiandrosterone, and creatine. Information was also obtained from sports-governing agencies, such as the National Collegiate Athletic Association and the International Olympic Committee.

STUDY SELECTION

Studies and reports that were credible and scientifically sound that evaluated the ergogenic effects of drugs and dietary supplements.

DATA EXTRACTION

By the author.

DATA SYNTHESIS

Pharmacists can participate in doping control programs in a number of ways. Pharmacists also have an obligation when counseling, advising, and treating athletes to help them avoid banned substances. Athletes use a host of drugs for their performance-enhancing effects, many of which are banned by major sports-governing bodies. Myriad dietary supplements are marketed to athletes, claiming to have ergogenic effects. Some of these popular supplements have proven performance-enhancing effects, while others do not. Adverse effects of these drugs and dietary supplements are discussed.

CONCLUSION

A variety of drugs and dietary supplements have proven performance-enhancing effects in athletes. However, many of these substances have adverse effects and are banned by various sports-governing organizations. Pharmacists can play a key role in participating in doping control programs, and can prevent athletes from inadvertently consuming a banned substance.

Effects of Androgenic-Anabolic Steroids in Athletes

Androgenic-anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone. They can exert strong effects on the human body that may be beneficial for athletic performance. A review of the literature revealed that most laboratory studies did not investigate the actual doses of AAS currently abused in the field. Therefore, those studies may not reflect the actual (adverse) effects of steroids. The available scientific literature describes that short-term administration of these drugs by athletes can increase strength and bodyweight. Strength gains of about 5-20% of the initial strength and increments of 2-5 kg bodyweight, that may be attributed to an increase of the lean body mass, have been observed. A reduction of fat mass does not seem to occur. Although AAS administration may affect erythropoiesis and blood haemoglobin concentrations, no effect on endurance performance was observed. Little data about the effects of AAS on metabolic responses during exercise training and recovery are available and, therefore, do not allow firm conclusions. The main untoward effects of short- and long-term AAS abuse that male athletes most often self-report are an increase in sexual drive, the occurrence of acne vulgaris, increased body hair and increment of aggressive behaviour. AAS administration will disturb the regular endogenous production of testosterone and gonadotrophins that may persist for months after drug withdrawal. Cardiovascular risk factors may undergo deleterious alterations, including elevation of blood pressure and depression of serum high-density lipoprotein (HDL)-, HDL2- and HDL3-cholesterol levels. In echocardiographic studies in male athletes, AAS did not seem to affect cardiac structure and function, although in animal studies these drugs have been observed to exert hazardous effects on heart structure and function. In studies of athletes, AAS were not found to damage the liver. Psyche and behaviour seem to be strongly affected by AAS. Generally, AAS seem to induce increments of aggression and hostility. Mood disturbances (e.g. depression, [hypo-]mania, psychotic features) are likely to be dose and drug dependent. AAS dependence or withdrawal effects (such as depression) seem to occur only in a small number of AAS users. Dissatisfaction with the body and low self-esteem may lead to the so-called 'reverse anorexia syndrome' that predisposes to the start of AAS use. Many other adverse effects have been associated with AAS misuse, including disturbance of endocrine and immune function, alterations of sebaceous system and skin, changes of haemostatic system and urogenital tract. One has to keep in mind that the scientific data may underestimate the actual untoward effects because of the relatively low doses administered in those studies, since they do not approximate doses used by illicit steroid users. The mechanism of action of AAS may differ between compounds because of variations in the steroid molecule and affinity to androgen receptors. Several pathways of action have been recognised. The enzyme 5-alpha-reductase seems to play an important role by converting AAS into dihydrotestosterone (androstanolone) that acts in the cell nucleus of target organs, such as male accessory glands, skin and prostate. Other mechanisms comprises mediation by the enzyme aromatase that converts AAS in female sex hormones (estradiol and estrone), antagonistic action to estrogens and a competitive antagonism to the glucocorticoid receptors. Furthermore, AAS stimulate erythropoietin synthesis and red cell production as well as bone formation but counteract bone breakdown. The effects on the cardiovascular system are proposed to be mediated by the occurrence of AAS-induced atherosclerosis (due to unfavourable influence on serum lipids and lipoproteins), thrombosis, vasospasm or direct injury to vessel walls, or may be ascribed to a combination of the different mechanisms. AAS-induced increment of muscle tissue can be attributed to hypertrophy and the formation of new muscle fibres, in which key roles are played by satellite cell number and ultrastructure, androgen receptors and myonuclei.

Glutamic acid decarboxylase (GAD65) immunoreactivity in brains of aggressive, adolescent anabolic steroid-treated hamsters

Chronic anabolic-androgenic steroid (AAS) treatment during adolescence facilitates offensive aggression in male Syrian hamsters (Mesocricetus auratus). The current study assessed whether adolescent AAS exposure influenced the immunohistochemical localization of glutamic acid decarboxylase (GAD65), the rate-limiting enzyme in the synthesis of gamma-aminobutyric acid (GABA), in areas of hamster brain implicated in aggressive behavior. Hamsters were administered high dose AAS throughout adolescence, scored for offensive aggression, and then examined for differences in GAD65 puncta to regions of the hamster brain important for aggression. When compared with control animals, aggressive AAS-treated hamsters showed significant increases in the area covered by GAD65 immunoreactive puncta in several of these aggression regions, including the anterior hypothalamus, ventrolateral hypothalamus, and medial amygdala. Conversely, aggressive AAS-treated hamsters showed a significant decrease in GAD65-ir puncta in the lateral septum when compared with oil-treated controls. However, no differences in GAD65 puncta were found in other aggression areas, such as the bed nucleus of the stria terminalis and central amygdala. Together, these results support a role for altered GAD65 synthesis and function in adolescent AAS-facilitated offensive aggression.

Repeated anabolic-androgenic steroid treatment during adolescence increases vasopressin V(1A) receptor binding in Syrian hamsters: correlation with offensive aggression

Repeated anabolic-androgenic steroid treatment during adolescence increases hypothalamic vasopressin and facilitates offensive aggression in male Syrian hamsters (Mesocricetus auratus). The current study investigated whether anabolic-androgenic steroid exposure during this developmental period influenced vasopressin V(1A) receptor binding activity in the hypothalamus and several other brain areas implicated in aggressive behavior in hamsters. To test this, adolescent male hamsters were administered anabolic steroids or sesame oil throughout adolescence, tested for offensive aggression, and examined for differences in vasopressin V(1A) receptor binding using in situ autoradiography. When compared with control animals, aggressive, adolescent anabolic steroid-treated hamsters showed significant increases (20-200%) in the intensity of vasopressin V(1A) receptor labeling in several aggression areas, including the ventrolateral hypothalamus, bed nucleus of the stria terminalis, and lateral septum. However, no significant differences in vasopressin V(1A) receptor labeling were found in other brain regions implicated in aggressive responding, most notably the lateral zone from the medial preoptic area to anterior hypothalamus and the corticomedial amygdala. These data suggest that adolescent anabolic steroid exposure may facilitate offensive aggression by increasing vasopressin V(1A) receptor binding in several key areas of the hamster brain.

Anabolic steroids: a review for the clinician

The number of athletes self-administering ergogenic pharmacological agents to increase their competitive edge continues to be a problem. Most athletes using anabolic steroids (AS) have acquired a crude pharmacological database regarding these drugs. Their opinions regarding steroids have been derived from their subjective experiences and anecdotal information. For this reason, traditional warnings regarding the lack of efficacy and potential dangers of steroid misuse are disregarded. A common widely held opinion among bodybuilders is that the anabolic steroid experts are the athletic gurus who for years have utilised themselves as the experimental participants and then dispensed their empirical findings. This review will address the common anabolic steroid misconceptions held by many of today's athletes by providing an evaluation of the scientific literature related to AS in athletic performance.

Anabolic-androgenic steroid use among high school football players

Eight-hundred seventy-three Indiana high school football players were surveyed to investigate the use of anabolic-androgenic steroids (AAS). Subjects were varsity football players that were randomly selected from 27 high schools throughout Indiana. Out of a possible 1,325 subjects, 873 or 66% participated in the study. Subjects completed a 50 item questionnaire that measured demographic information, perceived use of AAS, reasons for use, and how AAS are taken. The results indicate that 6.3% of Indiana high school football players were current or former AAS users. The average age at time of first use of AAS was 14 years and 15% began taking before the age of ten. Almost half of respondents indicated they could obtain AAS if they so desired, and that other athletes, physicians, and coaches were listed as sources for AAS. Athletic trainers can play a vital role in disseminating accurate information about AAS abuse, including the long-term adverse health risks. These messages should begin with students and athletes as early as the fourth and fifth grades and delivered as often as possible throughout the school years.

Qualitative description of the prevalence and use of anabolic androgenic steroids by United States powerlifters

Powerlifters have been suspected to be a population wherein use of anabolic androgenic steroids is prevalent (Yesalis, Herrick, & Buckley, 1988). To access commentary from these athletes on issues related to these drugs and the effectiveness of doping controls, a survey was developed. From 28 U.S. Powerlifting Team members who competed internationally since 1988, 26 were contacted by mail, and 15 questionnaires were returned. The questionnaire solicited yes/no responses and qualitative descriptions about current and previous use of anabolic androgenic steroids in powerlifting. Analysis indicated that ten U.S. Powerlifting Team members admitted to using these drugs, and five athletes admitted to beating the International Olympic Committee's doping control procedures. Reported use of anabolic androgenic steroids by these athletes was consistent with data presented by Yesalis, et al. and illustrated continued discrepancy between admitted use of these drugs prior to or during national and international events and the lack of reported positive test data. Discussion focused on the value of this study to elicit in an athlete's own words commentary specific to the use of anabolic androgenic steroids and the need for more effective doping controls.

Examining athletes' attitudes toward using anabolic steroids and their knowledge of the possible effects

One goal of contemporary sports leaders is to eradicate the use of banned drugs in competitive sport. A common approach to achieving this outcome is to provide athletes with adequate education about the effects of drug use. Ostensibly, educational programs about the deleterious effects of using anabolic steroids are thought to discourage their intake. Thus, the purpose of this study was to examine the relationships between the athletes' knowledge about the long-term effects of anabolic steroids and their attitudes toward this type of drug. Multiple regression analyses indicated relatively low R2's and correlations between the various components of subjects' knowledge and their attitude toward steroid ingestion. This suggests that educational programs for athletes about taking anabolic steroids may have limited value in terms of creating appropriate, responsible attitudes toward this illegal, unethical, and medically questionable practice.

Adolescent anabolic steroid use and aggressive behavior in golden hamsters

In the present study, the ability of high-dose androgens, namely AAS, administered during adolescence to facilitate aggressive behavior in experimental animals was examined. Data from these studies show clearly that exposure to high doses of multiple AAS during adolescent development can predispose animals to intense bouts of aggressive behavior during young adulthood. Specifically, young adult hamsters treated with high doses of AAS throughout adolescence were more likely to attack and bite intruders placed in their home cage than sesame oil (vehicle)-treated control animals. Further, AAS-treated animals displayed a higher intensity of attack during the test period, exhibiting greater than four times the number of attacks/bites of control animals. Given the recent reports of increased incidence of AAS abuse in the adolescent population and the documented stimulatory effects of AAS on aggressive behavior, the study of the behavioral and neurobiological effects of prolonged exposure to AAS during critical phases of development such as adolescence warrants further investigation.

Social physique anxiety, body esteem, and social anxiety in bodybuilders and self-reported anabolic steroid users

Social physique anxiety, upper body esteem, social anxiety, and body dissatisfaction were examined among self-reported anabolic steroid (AS)-using bodybuilders, non-using bodybuilders, athletically active exercisers, and non-exercising individuals. Results indicate that: (a) the AS-using bodybuilder group had significantly lower levels of social physique anxiety than non-user groups, (b) AS-using bodybuilders have significantly higher upper body strength ratings than do non-users (non-using bodybuilders, athletically active exercisers, and non-exercisers), and (c) no differences among groups on a measure of social anxiety. Implications for further research and intervention are discussed in terms of the differences between anabolic steroids and other substances of abuse.

Anabolic-androgenic steroids. Current issues

The use of drugs to enhance physical performance has been observed for thousands of years. Today, individuals continue to use a variety of substances, including anabolic-androgenic steroids, in the hope of enhancing their performance and appearance. Rumours persist regarding the incidence of the nonmedical use of anabolic steroids by athletes and nonathletes: however, true estimates are now available based on the results of systematic surveys. Although the vast majority of the athletic community accepts that anabolic steroids enhance performance and appearance, the extent to which this occurs and the factors influencing such effects remain incompletely understood and documented. Refinement of our knowledge of the ergogenic effects of anabolic steroids is not without merit; however, the existing scientific evidence coupled with an overwhelming number of anecdotal accounts argues against devoting significant resources to this area of investigation at present. The short term health effects of anabolic steroids have been increasingly studied and reviewed, and while anabolic steroid use has been associated with several adverse and even fatal effects, the incidence of serious effects thus far reported has been extremely low. The long term effects of anabolic steroid use are generally unknown. Unfortunately, the lack of scientific information on long term health effects has impeded, if not precluded, the formation of effective health education and drug abuse prevention strategies. Consequently, efforts should be expanded in the areas of prevention and education.

Weight training. A potential confounding factor in examining the psychological and behavioural effects of anabolic-androgenic steroids

Psychological and behavioural changes are associated with anabolic-androgenic steroid (AAS) use. Changes in personality, moods and self-esteem following weight training have also been reported. The fact that nearly all AAS users are also dedicated weight trainers has often been overlooked in studies examining the relationship between AAS use and behavioural change. A triad may exist between AAS use, weight training and behavioural change (including dependence). It is also possible that changes frequently attributed to AAS use may also reflect changes resulting from the concurrent use of other substances such as alcohol, and from dietary manipulation including food supplements. Weight training and related practices should be considered potential confounding factors in future studies designed to examine the psychological and behavioural effects of AAS.

Intramuscular Abscess

In brief A 24-year-old man had been reusing needles to inject anabolic-androgenic steroids intramuscularly and developed a thigh abscess. He was treated with intravenous antibiotics, and the abscess was surgically drained. The case highlights the danger of intramuscular steroid injection and of reusing needles.

Current perspectives on anabolic-androgenic steroid abuse

For the past 40 years anabolic-androgenic steroids have been used by a wide variety of athletes with the hope of improving their training, endurance and performance. Proponents of their use claim that the drugs increase muscle strength and mass, endurance, decrease recovery time between workouts and improve physique. Critics claim that these beneficial effects are due primarily to expectancy and other factors associated with training; many doctors also claim that their use is actually quite dangerous. Regardless of their efficacy, the use and abuse of anabolic-androgenic steroids has escalated such that in 1990 the US Congress enacted the Anabolic Steroids Control Act requiring that anabolic steroids be added to Schedule III of the Controlled Substances Act. This action placed compounds such as testosterone cipionate and nandrolone decanoate in the company of various opioid drugs, amphetamines and barbiturates. As chair of the American Society for Pharmacology and Experimental Therapeutics' Committee on Substance Abuse, Scott Lukas advocates continued research on the effectiveness, toxicity and natural history of anabolic-androgenic steroid abuse.

Psychological treatment of anabolic-androgenic steroid-dependent individuals

Anabolic-androgenic steroids (AAS) are synthetic derivatives of the sex hormone testosterone. Anabolic refers to the "growth-promoting" effect while androgenic refers to the "masculinizing" effect. It is becoming more evident that nonathletes as well as athletes are abusing AAS. Although the abuse of alcohol and other drugs contribute significantly to current chemical use problems in American society, AAS abuse is one of the fastest growing "new drug" problems facing secondary and higher education institutes of learning. The purpose of this discussion is to present working hypotheses regarding the psychological treatment of AAS dependent individuals. The treatment approach presented incorporates the approaches used with eating disorders, substance abuse/dependence, and narcissistic personality disorders. This paper considers some of the preliminary considerations for the first phase of treatment, some pitfalls to avoid, and therapist characteristics, as well as treatment modalities that might be helpful in the treatment of AAS-dependent individuals.

Performance-enhancing aids in sport: health consequences and nutritional alternatives

The use of anabolic-androgenic steroids is epidemic in the sporting world, and the recent recognition of their pervasive use by recreational and adolescent athletes has made the abuse of these drugs a public health concern. A critical review of the literature supports the doctrine that anabolic-androgenic steroids can improve muscular performance if certain criteria are met, but some of the health risks associated with their use may be irreversible, and life-threatening. Furthermore, polydrug abuse, restrictive diets, and dehydrating practices may potentiate the health risks associated with weight training and steroid use. Recent investigations of nutritional and training alternatives to anabolic-androgenic steroids are promising. To help lure athletes from drug abuse, the pursuit of new areas of research and education should be priorities in the campaign against the abuse of anabolic steroids.

Drug testing of athletes

Drug testing policies have been enacted affecting a large number of athletes. Complex, wide-ranging technical questions are raised by drug testing programs designed for athletes. Issues are also raised concerning the structural elements commonly included in a substance abuse policy affecting athletes. The selection of particular athletes for testing, random drug testing, consent forms, constructing a list of banned substances, the handling, collecting and transporting of testing samples, and selected flaws and limitations affecting the drug testing process are among the topics covered in this article.

Recent developments in the toxicology of anabolic steroids

Anabolic steroids are extensively abused as ergogenic aids by athletes (and others). A number of features of anabolic steroid use and toxicology have been recently reviewed in the Journal, and a large body of data has accumulated concerning their toxic nature. The lipoprotein profile induced by anabolic steroids carries a markedly adverse cardiovascular risk. Glucose metabolism is significantly altered and includes peripheral insulin resistance, hyperinsulinaemia and attenuated responses to glucagon. Hypertension has been noted. Psychiatric and psychological alterations are major toxicities of anabolic steroids, and probably constitute the major mechanism of their action. Hepatic neoplasia occurs in the setting of abuse of this class of drugs, and may be related to their use, although there is no convincing evidence that other malignancies are induced in athletes who abuse them. Gross disturbance of reproductive function occurs in both sexes: hypogonadal states are common and prolonged. The anabolic steroids are toxic drugs with both long and short term effects. Their abuse by athletes is to be decried, particularly in view of the frequent and prolonged use by the young.

Strength training in children and adolescents

Strength is the ability to exert muscular force against resistance. It is a fundamental requirement of most daily physical activities of children and of adults. Strength training is the use of progressive resistance exercise methods specifically to increase strength. Strength training for children and adolescents is not without risk. Proven medical concerns relate to back, shoulder, and other joint injuries and to hypertension and related diseases. However, the rate of injury is probably rather low, comparable to many youthful activities that are considered safe. Also, the incidence and severity of injury can probably be minimized by adherence to the guidelines presented. Children may be expected to become stronger with appropriate training. Increased strength can enhance their performance in those athletic activities in which strength, power, or speed are required. It may reduce the incidence and severity of overuse injury in sport. However, it cannot reasonably be expected to protect against serious, acute injury in sport.

Effect of an anabolic steroid education program on knowledge and attitudes of high school football players

Six varsity high school football teams were assessed by confidential questionnaire regarding anabolic steroids, before and 2 weeks after an education intervention. The education program used the American College of Sports Medicine's position on the "use of anabolic androgenic steroids in sports." Two teams received a lecture and a four-page handout, two teams were given the handout only, and two teams were controls. Self-report of current use was 1.1% but 38.8% claimed availability of these agents. Although increased awareness of the adverse effects of anabolic steroid was found after the education program, no differences in attitudes toward the use of anabolic steroids occurred as compared to controls. Strategies designed to dissuade adolescent athletes from considering these drugs need to be developed.

Winning and Performance-Enhancing Drugs-Our Dual Addiction

Athletes still use performance-enhancing drugs despite stiffer laws, education programs, and society's pervasive antidrug sentiment. In this commentary a drug use expert says it's not the athletes' fault-it's ours.

Anabolic steroids--a review of the clinical toxicology and diagnostic screening

Anabolic steroids have been used by athletes since the 1950s to increase size and strength in order to improve their performance. The abuse of these substances has since expanded to include junior high and high school male and female athletes and non-athletes. The anabolic and androgenic effects of these agents, when taken in the doses needed to produce increases in size and strength, result in significant serious adverse effects involving the skin, liver, cardiovascular, musculoskeletal, endocrine and reproductive systems. Some of these effects are irreversible. It is essential that clinical toxicologists, emergency room physicians and psychiatrists are familiar with the physical and psychological effects, as well as the changes in laboratory parameters, that typically occur from chronic use of anabolic steroids. The toxicities and representative clinical profiles of steroid users are presented, and the methods available for diagnostic screening using psychological testing and urine analysis are also reviewed.