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Pitsiladis YP, Pigozzi F, Geistlinger M, Kawazoe Lazzoli J, Zahar M, Bachl N, Manonelles Marqueta P, Roberts WO, Braumann KM, De Rose EH, Constantinou D, Ionescu A, Schneider C, Yung PSH, Bigard X. We want healthy athletes and fair competition. Br J Sports Med 2024; 58:760-763. [PMID: 38821542 DOI: 10.1136/bjsports-2024-108581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Yannis P Pitsiladis
- International Federation of Sports Medicine, Lausanne, Switzerland
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong, Hong Kong SAR
| | - Fabio Pigozzi
- International Federation of Sports Medicine, Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michael Geistlinger
- International Federation of Sports Medicine, Lausanne, Switzerland
- Department of International and European Law and Fundaments of Law, University of Salzburg, Salzburg, Austria
| | - José Kawazoe Lazzoli
- International Federation of Sports Medicine, Lausanne, Switzerland
- Biomedical Institute, Fluminense Federal University Medical School, Niterói, Brazil
| | - Maher Zahar
- International Federation of Sports Medicine, Lausanne, Switzerland
- Medical and Informatical Research and Education, Tunis, Tunisia
| | - Norbert Bachl
- International Federation of Sports Medicine, Lausanne, Switzerland
- Institute of Sports Science, University of Vienna, Vienna, Austria
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine, Lausanne, Switzerland
- International Chair of Sports Medicine, Faculty of Medicine, Catholic University of Murcia, Campus de los Jeronimos, Murcia, Spain
| | - William O Roberts
- International Federation of Sports Medicine, Lausanne, Switzerland
- Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | - Klaus-Michael Braumann
- International Federation of Sports Medicine, Lausanne, Switzerland
- Department of Sports and Exercise Medicine, University of Hamburg, Hamburg, Germany
| | | | - Demitri Constantinou
- International Federation of Sports Medicine, Lausanne, Switzerland
- Centre for Exercise Science and Sports Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Anca Ionescu
- International Federation of Sports Medicine, Lausanne, Switzerland
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Christian Schneider
- International Federation of Sports Medicine, Lausanne, Switzerland
- Orthopädiezentrum Theresie, Munich, Germany
| | - Patrick Shu-Hang Yung
- International Federation of Sports Medicine, Lausanne, Switzerland
- The Chinese University of Hong Kong Department of Orthopaedics and Traumatology, Hong Kong, Hong Kong
| | - Xavier Bigard
- International Federation of Sports Medicine, Lausanne, Switzerland
- Union Cycliste Internationale, Aigle, Switzerland
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Scarth M, Hauger LE, Thorsby PM, Leknes S, Hullstein IR, Westlye LT, Bjørnebekk A. Supraphysiological testosterone levels from anabolic steroid use and reduced sensitivity to negative facial expressions in men. Psychopharmacology (Berl) 2024; 241:701-715. [PMID: 37993638 DOI: 10.1007/s00213-023-06497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
RATIONALE Anabolic-androgenic steroids (AAS) are used to improve physical performance and appearance, but have been associated with deficits in social cognitive functioning. Approximately 30% of people who use AAS develop a dependence, increasing the risk for undesired effects. OBJECTIVES To assess the relationship between AAS use (current/previous), AAS dependence, and the ability to recognize emotional facial expressions, and investigate the potential mediating role of hormone levels. METHODS In total 156 male weightlifters, including those with current (n = 45) or previous (n = 34) AAS use and never-using controls (n = 77), completed a facial Emotion Recognition Task (ERT). Participants were presented with faces expressing one out of six emotions (sadness, happiness, fear, anger, disgust, and surprise) and were instructed to indicate which of the six emotions each face displayed. ERT accuracy and response time were recorded and evaluated for association with AAS use status, AAS dependence, and serum reproductive hormone levels. Mediation models were used to evaluate the mediating role of androgens in the relationship between AAS use and ERT performance. RESULTS Compared to never-using controls, men currently using AAS exhibited lower recognition accuracy for facial emotional expressions, particularly anger (Cohen's d = -0.57, pFDR = 0.03) and disgust (d = -0.51, pFDR = 0.05). Those with AAS dependence (n = 47) demonstrated worse recognition of fear relative to men without dependence (d = 0.58, p = 0.03). Recognition of disgust was negatively correlated with serum free testosterone index (FTI); however, FTI did not significantly mediate the association between AAS use and recognition of disgust. CONCLUSIONS Our findings demonstrate impaired facial emotion recognition among men currently using AAS compared to controls. While further studies are needed to investigate potential mechanisms, our analysis did not support a simple mediation effect of serum FTI.
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Affiliation(s)
- Morgan Scarth
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, 0424, Oslo, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Lisa Evju Hauger
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, 0424, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone laboratory, Department of Medical Biochemistry and Biochemical endocrinology and metabolism research group, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
| | - Siri Leknes
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Ingunn R Hullstein
- Norwegian Doping Control Laboratory, Oslo University Hospital, Oslo, Norway
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Astrid Bjørnebekk
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, 0424, Oslo, Norway
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van de Ven K, Malouff J, McVeigh J. The Association Between the Nonmedical use of Anabolic-Androgenic Steroids and Interpersonal Violence: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:1484-1495. [PMID: 37467456 DOI: 10.1177/15248380231186150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The nonmedical use of anabolic-androgenic steroids (AAS) by athletes and the general population is a public health concern. One particular concern relates to the link between AAS use and violence. Although there is a growing body of research on the association between AAS and violence, results as to what the relationship is seem to be mixed. The aim of this meta-analysis is to improve our understanding of what the current evidence base indicates regarding the relationship between the use of AAS and interpersonal violence. In total, 14 studies with a total of 16 samples met the inclusion criteria, comprising a total sample size of 137,055 participants. The findings show that there is a significant association between AAS use and interpersonal violence (r = .21 [95% confidence intervals (CI): 0.15, 0.27], p < .00001), although small. It is however unclear what the direction of this relationship is as almost all studies failed to demonstrate whether AAS use occurred prior or subsequent to the violent behavior. Risk of bias for most studies was moderate or high. Three potential moderators, AAS use via self-report or testing, interpersonal violence via self-report or criminal records of violent behavior, and proportion of males, were nonsignificant. Although a meta-analytic relationship between AAS use and interpersonal violence was found, it is unclear to what extent AAS causes violent acts. We need to carefully consider the role of mediating factors, and that the relationship between the two could be part of a broader context as opposed to AAS being the cause of violence.
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Affiliation(s)
- Katinka van de Ven
- University of New England, Armidale, NSW, Australia
- University of NSW, Sydney, NSW, Australia
- Human Enhancement Drugs Network, NSW, Australia
| | - John Malouff
- University of New England, Armidale, NSW, Australia
| | - Jim McVeigh
- Manchester Metropolitan University, Manchester, UK
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Mbiydzenyuy NE, Joanna Hemmings SM, Shabangu TW, Qulu-Appiah L. Exploring the influence of stress on aggressive behavior and sexual function: Role of neuromodulator pathways and epigenetics. Heliyon 2024; 10:e27501. [PMID: 38486749 PMCID: PMC10937706 DOI: 10.1016/j.heliyon.2024.e27501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Stress is a complex and multifaceted phenomenon that can significantly influence both aggressive behavior and sexual function. This review explores the intricate relationship between stress, neuromodulator pathways, and epigenetics, shedding light on the various mechanisms that underlie these connections. While the role of stress in both aggression and sexual behavior is well-documented, the mechanisms through which it exerts its effects are multifarious and not yet fully understood. The review begins by delving into the potential influence of stress on the Hypothalamic-Pituitary-Adrenal (HPA) axis, glucocorticoids, and the neuromodulators involved in the stress response. The intricate interplay between these systems, which encompasses the regulation of stress hormones, is central to understanding how stress may contribute to aggressive behavior and sexual function. Several neuromodulator pathways are implicated in both stress and behavior regulation. We explore the roles of norepinephrine, serotonin, oxytocin, and androgens in mediating the effects of stress on aggression and sexual function. It is important to distinguish between general sexual behavior, sexual motivation, and the distinct category of "sexual aggression" as separate constructs, each necessitating specific examination. Additionally, epigenetic mechanisms emerge as crucial factors that link stress to changes in gene expression patterns and, subsequently, to behavior. We then discuss how epigenetic modifications can occur in response to stress exposure, altering the regulation of genes associated with stress, aggression, and sexual function. While numerous studies support the association between epigenetic changes and stress-induced behavior, more research is necessary to establish definitive links. Throughout this exploration, it becomes increasingly clear that the relationship between stress, neuromodulator pathways, and epigenetics is intricate and multifaceted. The review emphasizes the need for further research, particularly in the context of human studies, to provide clinical significance and to validate the existing findings from animal models. By better understanding how stress influences aggressive behavior and sexual function through neuromodulator pathways and epigenetic modifications, this research aims to contribute to the development of innovative protocols of precision medicine and more effective strategies for managing the consequences of stress on human behavior. This may also pave way for further research into risk factors and underlying mechanisms that may associate stress with sexual aggression which finds application not only in neuroscience, but also law, ethics, and the humanities in general.
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Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Basic Science Department, School of Medicine, Copperbelt University, P.O Box 71191, Ndola, Zambia
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Sian Megan Joanna Hemmings
- Division of Molecular Biology & Human Genetics, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Thando W. Shabangu
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Lihle Qulu-Appiah
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
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Lieberman HR, Caldwell JA, Vartanian O, Carmichael OT, Karl JP, Berryman CE, Gadde KM, Niro PJ, Harris MN, Rood JC, Pasiakos SM. Effects of testosterone enanthate on aggression, risk-taking, competition, mood, and other cognitive domains during 28 days of severe energy deprivation. Psychopharmacology (Berl) 2024; 241:461-478. [PMID: 38038817 PMCID: PMC10884082 DOI: 10.1007/s00213-023-06502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
RATIONALE Behavioral effects of testosterone depend on dose, acute versus sustained formulation, duration of administration, personality, genetics, and endogenous levels of testosterone. There are also considerable differences between effects of endogenous and exogenous testosterone. OBJECTIVES This study was the secondary behavioral arm of a registered clinical trial designed to determine if testosterone protects against loss of lean body mass and lower-body muscle function induced by a severe energy deficit typical of sustained military operations. METHODS Behavioral effects of repeated doses of testosterone on healthy young men whose testosterone was reduced by severe energy deficit were examined. This was a double-blind, placebo-controlled, between-group study. Effects of four weekly intramuscular injections of testosterone enanthate (200 mg/week, N = 24) or matching placebo (N = 26) were evaluated. Determination of sample size was based on changes in lean body mass. Tasks assessing aggression, risk-taking, competition, social cognition, vigilance, memory, executive function, and mood were repeatedly administered. RESULTS During a period of artificially induced, low testosterone levels, consistent behavioral effects of administration of exogenous testosterone were not observed. CONCLUSIONS Exogeneous testosterone enanthate (200 mg/week) during severe energy restriction did not reliably alter the measures of cognition. Study limitations include the relatively small sample size compared to many studies of acute testosterone administration. The findings are specific to healthy males experiencing severe energy deficit and should not be generalized to effects of other doses, formulations, or acute administration of endogenous testosterone or studies conducted with larger samples using tests of cognitive function designed to detect specific effects of testosterone.
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Affiliation(s)
- Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA.
- University of Toronto, Toronto, ON, Canada.
| | - John A Caldwell
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
- Laulima Government Solutions, Frederick, MD, USA
| | - Oshin Vartanian
- University of Toronto, Toronto, ON, Canada
- Defence Research and Development Canada, Toronto, ON, Canada
| | - Owen T Carmichael
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - J Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
| | - Claire E Berryman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kishore M Gadde
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Philip J Niro
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
| | - Melissa N Harris
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Jennifer C Rood
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
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Tyborowska A, Volman I, Niermann HCM, Dapprich AL, Smeekens S, Cillessen AHN, Toni I, Roelofs K. Developmental shift in testosterone influence on prefrontal emotion control. Dev Sci 2024; 27:e13415. [PMID: 37341037 DOI: 10.1111/desc.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/22/2023]
Abstract
A paradox of testosterone effects is seen in adolescents versus adults in social emotional approach-avoidance behavior. During adolescence, high testosterone levels are associated with increased anterior prefrontal (aPFC) involvement in emotion control, whereas during adulthood this neuro-endocrine relation is reversed. Rodent work shows that, during puberty, testosterone transitions from a neuro-developmental to a social-sexual activating hormone. In this study, we explored whether this functional transition is also present in human adolescents and young adults. Using a prospective longitudinal design, we investigated the role of testosterone on neural control of social emotional behavior during the transitions from middle to late adolescence and into young adulthood. Seventy-one individuals (tested at ages 14, 17, and 20 years) performed an fMRI-adapted approach-avoidance (AA) task involving automatic and controlled actions in response to social emotional stimuli. In line with predictions from animal models, the effect of testosterone on aPFC engagement decreased between middle and late adolescence, and shifted into an activational role by young adulthood-impeding neural control of emotions. This change in testosterone function was accompanied by increased testosterone-modulated amygdala reactivity. These findings qualify the testosterone-dependent maturation of the prefrontal-amygdala circuit supporting emotion control during the transition from middle adolescence into young adulthood.
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Affiliation(s)
- Anna Tyborowska
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Inge Volman
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Hannah C M Niermann
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Anna L Dapprich
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Sanny Smeekens
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
- Pro Persona, Nijmegen, Netherlands
| | | | - Ivan Toni
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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Chegeni R, Pallesen S, Weldemariam H, Sagoe D. Systematic reviews and meta-analyses on androgen administration in humans: an umbrella review. Curr Opin Endocrinol Diabetes Obes 2023; 30:300-308. [PMID: 37603031 DOI: 10.1097/med.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
PURPOSE OF REVIEW The present umbrella review systematically searches and synthesizes recent (2021-2023) systematic reviews and meta-analyses (SRMA) on androgen administration in humans. RECENT FINDINGS Results from 19 SRMA are synthesized. Four themes were identified: market for androgens, prevalence of androgen abuse, psychological effects of androgens, and clinical/therapeutic effects of androgens. One of three androgens on the illicit market are fake or substandard. Whereas one of three androgen users experiences dependence and various serious disorders, only one of three androgen users seeks physician support. Additionally, androgen administration increases self-reported aggression in healthy male individuals, and abuse positively correlates with interpersonal violence. Furthermore, androgen therapy is beneficial in treating persons suffering from various chronic diseases. SUMMARY In this umbrella review, we identified 19 SRMA on androgen use and abuse. Results show a high prevalence of fake androgens on the illicit market, a high prevalence of androgen abuse and dependence, and that a huge proportion of androgen users tend to avoid seeking support from clinicians. Also, androgen administration increases self-reported aggression among healthy male, and there is a positive correlation between androgen abuse and violent behavior. Finally, androgens have multiple therapeutic effects on various pathology.
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Affiliation(s)
- Razieh Chegeni
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
| | - Ståle Pallesen
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Hailemariam Weldemariam
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Dominic Sagoe
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Nyssanbayeva K, Abdulla V, Semenova Y, Bakasheva M, Sagoe D, Glushkova N. Characteristics of the Online Market for Anabolic-Androgenic Steroids in Central Asia: A Netnographic Analysis. Subst Use Misuse 2023; 59:10-19. [PMID: 37724019 DOI: 10.1080/10826084.2023.2257317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background: With the online proliferation of illegal substances, the Internet offers a wide variety of information on the acquisition and intake of anabolic-androgenic steroids (AAS) and other performance and image enhancing drugs. This study focuses on investigating the characteristics of the online AAS market in Central Asia. OBJECTIVES The primary objectives of this study were to investigate the accessibility and features of the online market for AAS in Central Asia. To achieve this, we employed a netnographic approach for a systematic exploration of websites advertising and selling AAS. The study aimed to conduct a comprehensive analysis of several key aspects, including the variety of AAS products offered, the quality of health advice provided the level of product availability, the procedures involved in making purchases, and the pricing structures within this market. RESULTS Twenty-one websites supplying AAS in Central Asia met our inclusion criteria. Using content analysis, data were gathered on AAS offerings, quality of health advice provided, availability, purchase process, and prices. Data were synthesized using descriptive statistics. Results indicate that AAS are easily accessible for purchase without valid medical prescription in the Central Asia online market. Most websites advertised the aesthetic and ergogenic benefits of AAS use without indicating the potential complications and adverse effects. CONCLUSIONS Public health efforts to mitigate AAS use in Central Asia should consider both the online accessibility of AAS and the lack of accompanying information on potential complications as well as adverse effects associated with their use. Efforts must be intensified to curtail the proliferation of AAS and related misleading information on the Central Asian online market.
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Affiliation(s)
- Kulman Nyssanbayeva
- Department of Public Health and Social Sciences, Kazakhstan Medical University (KSPH), Almaty, Kazakhstan
| | - Venera Abdulla
- Department of Public Health and Social Sciences, Kazakhstan Medical University (KSPH), Almaty, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Maira Bakasheva
- Kazakhstan National Anti-Doping Organization, Almaty, Kazakhstan
| | - Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Natalya Glushkova
- Department of Epidemiology, Biostatistics and Evidence, Al-Farabi Kazakh National University Based Medicine, Almaty, Kazakhstan
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Piatkowski TM, Neumann DL, Dunn M. 'My mind pretty much went to mush': A qualitative exploration of trenbolone in the performance and image enhancing drug community. Drug Alcohol Rev 2023; 42:1566-1576. [PMID: 36992616 DOI: 10.1111/dar.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/13/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION There are a variety of harms associated with anabolic-androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users. METHOD As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16). RESULTS Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS-using peers and family members of users reported the readily observable effect of trenbolone. DISCUSSION AND CONCLUSIONS Users should be cognisant of the potential for significant harms and health-care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users.
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Affiliation(s)
| | - David L Neumann
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Matthew Dunn
- School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Australia
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Parent MC, Johnson NL. Anabolic Steroid Use and Intimate Partner Violence Among Sexual Minority Men. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6676-6694. [PMID: 36401518 DOI: 10.1177/08862605221137704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study examined the relationship between intimate partner violence (IPV) and use of anabolic-androgenic steroids (AAS), in a relationship context, among men who have sex with men (MSM). The sample was collected online via Prolific.co and consisted of 491 MSM. Data were analyzed using structural equation modeling. While accounting for the influence of factors known to be linked to IPV (adverse childhood experiences and alcohol use), the use of AAS in a relationship context was uniquely linked to greater perpetration of IPV. AAS use was not uniquely linked to IPV victimization. Findings from this study contribute to literature on IPV among MSM by including a group-specific risk factor (AAS use) in modeling risk for IPV. Limitations, implications, and future directions for research are discussed.
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Human enhancement drugs and Armed Forces: an overview of some key ethical considerations of creating 'Super-Soldiers'. New Bioeth 2022:10.1007/s40592-022-00170-8. [PMID: 36550228 DOI: 10.1007/s40592-022-00170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is a long history and growing evidence base that the use of drugs, such as anabolic-androgenic steroids, to enhance human performance is common amongst armed forces, including in Australia. We should not be surprised that this might have occurred for it has long been predicted by observers. It is a commonplace of many recent discussion of the future of warfare and future military technology to proclaim the imminent arrival of Super Soldiers, whose capacities are modified via drugs, digital technology and genetic engineering, in ways that increase their performance exponentially. This is what some observers have referred to as the "Gladiator Model" wherein the aim is to create soldiers able to perform feats of which ordinary citizens are not capable. One key aspect of this "gladiator project" is the use of illicit drugs to enhance performance. Could we use drugs, such as steroids or amphetamines, to enhance performance? Should we use such drugs? In this paper we explore the ethics of creating Super Soldiers, and raise issues of consent, coercion and the extent to which such use is permitted or condemned by just war theory. We conclude that much will depend on the extent to which such use is harmful to the soldiers themselves and this is still an open question.
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Rogne A, Hassel B. Improvement of attention deficit/hyperactivity disorder (ADHD) in three adult men during testosterone treatment: a case series. J Med Case Rep 2022; 16:425. [DOI: 10.1186/s13256-022-03651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Attention deficit/hyperactivity disorder (ADHD) entails inattention, impulsivity, and restlessness at a disabling level. The pharmacological treatment of ADHD rests on the use of centrally acting stimulants, such as methylphenidate and D-amphetamine. In some patients, these drugs cause side effects that preclude their use.
Case presentation
We present three adult male, Caucasian, ADHD patients (24, 37, and 43 years old) whose ADHD symptoms improved during treatment with testosterone. The first patient experienced loss of libido during treatment with methylphenidate; for this, he was offered a trial of testosterone. Unexpectedly, his ADHD symptoms improved with testosterone treatment, and this effect continued with testosterone as monotherapy. The two other patients, who also had side effects from centrally acting stimulants, received testosterone monotherapy with similar results. The effect has now continued for 4.5–5 years at the same doses: 10–60 mg testosterone/day, administered as a skin gel. Prior to testosterone treatment, the patients had serum levels of testosterone in the low–normal range: 12–16 nmol/L (age-specific reference range: 10.4–32.6 nmol/L). The testosterone/sex hormone-binding globulin ratio was low in two patients (0.32 and 0.34; age-specific reference range: 0.38–1.1), suggesting low free serum levels of testosterone. Serum testosterone levels and testosterone/sex hormone-binding globulin ratios increased with testosterone treatment in all patients, but remained within reference values.
Conclusion
These cases suggest that a moderately reduced serum level of free testosterone may contribute to the ADHD symptoms of some adult male ADHD patients, and that testosterone treatment may be of value for these patients.
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Scarth M, Jørstad ML, Reierstad A, Klonteig S, Torgersen S, Hullstein IR, Bjørnebekk A. Psychopathology among anabolic-androgenic steroid using and non-using female athletes in Norway. J Psychiatr Res 2022; 155:295-301. [PMID: 36170757 DOI: 10.1016/j.jpsychires.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
Anabolic-androgenic steroids (AAS) are primarily used to improve physical appearance and increase lean muscle mass. Due to their masculinizing properties, the majority of people using AAS are men; however, AAS use among females may increase with changing body ideals trending towards a more muscular appearance. AAS use among males have been associated with risk-taking behavior, and increased prevalence of personality disorders and psychopathology. As a result of low perceived prevalence and stigma among females who use AAS, the relationship between AAS use and psychopathology in this population is not well-known. AAS using women (n = 16) and weight-lifting controls (WLC) (n = 16) completed questionnaires regarding AAS use, health and training information. Psychopathology was evaluated using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Group differences on demographic variables and scores on MCMI-III scales were evaluated with Mann-Whitney U tests. The clinical cut-off was then applied to all MCMI-III scales and groups were compared using Fisher's exact test. AAS consumers demonstrated significantly greater psychopathology than WLC on several scales. Externalizing personality disorder scales were elevated among those who use AAS relative to controls, such as borderline (p < 0.001), antisocial (p = 0.007) and sadistic (p = 0.002), and in addition depressive (p = 0.012), negativistic (p = 0.001) and masochistic (p = 0.029) personality disorders scales. Furthermore, all clinical syndromes were elevated among AAS consumers. AAS consumers thus demonstrated multi-pathology, and 56% (n = 9) of the group met the clinical criteria for six or more disorders. Females who use AAS experience in general increased levels of psychopathology compared to WLC. Clinicians should be aware of these traits and the challenges they present in providing care to this population.
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Affiliation(s)
- Morgan Scarth
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway.
| | - Marie Lindvik Jørstad
- Anabolic Androgenic Steroid Research Group, National Advisory Unit on SUD Treatment, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Sandra Klonteig
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ingunn R Hullstein
- Norwegian Doping Control Laboratory, Oslo University Hospital, Oslo, Norway
| | - Astrid Bjørnebekk
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Dobs AS, Campbell KJ. An Individualized Approach to Managing Testosterone Therapy in the Primary Care Setting. Int J Gen Med 2022; 15:7719-7733. [PMID: 36238539 PMCID: PMC9552794 DOI: 10.2147/ijgm.s364189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
The incidence of testosterone deficiency and the use of testosterone therapy have increased in recent years, and currently the majority of testosterone prescriptions in the United States and Canada are written by primary care physicians. Meanwhile, the range of available testosterone therapy formulations has widened to include buccal tablets, intramuscular injections, transdermal gels, intranasal gel, subcutaneous injections, oral capsules, and subdermal pellets, each with unique pharmacokinetic and clinical characteristics. Despite the growing use of testosterone therapy and its overall efficacy and safety as demonstrated in clinical trials, concerns exist about the potential impact of testosterone therapy on spermatogenesis and fertility, development of prostate cancer, and risk of polycythemia and cardiovascular events. In addition, ongoing research aims to better characterize the effects of testosterone therapy in specific populations, such as patients aged 65 years and older, patients with obesity and type 2 diabetes, and transgender patients. The range of treatment options and the diversity of patients' goals, preferences, comorbidities, and risk factors necessitate an individualized approach to testosterone therapy that considers each patient's clinical needs alongside the distinct features of different testosterone formulations.
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Affiliation(s)
- Adrian Sandra Dobs
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Correspondence: Adrian Sandra Dobs, The Johns Hopkins University School of Medicine Division of Endocrinology, Diabetes and Metabolism, 1830 Monument Street, Suite 328, Baltimore, MD, 21287, USA, Tel +1-410-955-3663, Fax +1-410-367-2042, Email
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Barone B, Napolitano L, Abate M, Cirillo L, Reccia P, Passaro F, Turco C, Morra S, Mastrangelo F, Scarpato A, Amicuzi U, Morgera V, Romano L, Calace FP, Pandolfo SD, De Luca L, Aveta A, Sicignano E, Trivellato M, Spena G, D’Alterio C, Fusco GM, Vitale R, Arcaniolo D, Crocetto F. The Role of Testosterone in the Elderly: What Do We Know? Int J Mol Sci 2022; 23:3535. [DOI: doi.org/10.3390/ijms23073535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Testosterone is the most important hormone in male health. Aging is characterized by testosterone deficiency due to decreasing testosterone levels associated with low testicular production, genetic factors, adiposity, and illness. Low testosterone levels in men are associated with sexual dysfunction (low sexual desire, erectile dysfunction), reduced skeletal muscle mass and strength, decreased bone mineral density, increased cardiovascular risk and alterations of the glycometabolic profile. Testosterone replacement therapy (TRT) shows several therapeutic effects while maintaining a good safety profile in hypogonadal men. TRT restores normal levels of serum testosterone in men, increasing libido and energy level and producing beneficial effects on bone density, strength and muscle as well as yielding cardioprotective effects. Nevertheless, TRT could be contraindicated in men with untreated prostate cancer, although poor findings are reported in the literature. In addition, different potential side effects, such as polycythemia, cardiac events and obstructive sleep apnea, should be monitored. The aim of our review is to provide an updated background regarding the pros and cons of TRT, evaluating its role and its clinical applicability in different domains.
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The Role of Testosterone in the Elderly: What Do We Know? Int J Mol Sci 2022; 23:ijms23073535. [PMID: PMID: 35408895 PMCID: PMC8998588 DOI: 10.3390/ijms23073535] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Testosterone is the most important hormone in male health. Aging is characterized by testosterone deficiency due to decreasing testosterone levels associated with low testicular production, genetic factors, adiposity, and illness. Low testosterone levels in men are associated with sexual dysfunction (low sexual desire, erectile dysfunction), reduced skeletal muscle mass and strength, decreased bone mineral density, increased cardiovascular risk and alterations of the glycometabolic profile. Testosterone replacement therapy (TRT) shows several therapeutic effects while maintaining a good safety profile in hypogonadal men. TRT restores normal levels of serum testosterone in men, increasing libido and energy level and producing beneficial effects on bone density, strength and muscle as well as yielding cardioprotective effects. Nevertheless, TRT could be contraindicated in men with untreated prostate cancer, although poor findings are reported in the literature. In addition, different potential side effects, such as polycythemia, cardiac events and obstructive sleep apnea, should be monitored. The aim of our review is to provide an updated background regarding the pros and cons of TRT, evaluating its role and its clinical applicability in different domains.
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Severity of anabolic steroid dependence, executive function, and personality traits in substance use disorder patients in Norway. Drug Alcohol Depend 2022; 231:109275. [PMID: 35030506 DOI: 10.1016/j.drugalcdep.2022.109275] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. OBJECTIVE To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). METHODS Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. RESULTS Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. CONCLUSION Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.
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Sagoe D, Johnsen B, Lindblad B, Normann TAJ, Skogvoll V, Heierdal M, Lauritzen F. A Mixed-Method Evaluation of a Prison Anti-doping Intervention: The Hercules Prison Program. Front Sports Act Living 2022; 3:779218. [PMID: 35005620 PMCID: PMC8732770 DOI: 10.3389/fspor.2021.779218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
The Norwegian Offender Mental Health and Addiction study denotes the need for physical activity and anti-doping interventions in Norwegian prisons. We developed and evaluated the efficacy of such intervention—the Hercules prison program. The program combines theoretical anti-doping lessons with practical strength training. The study adopts a mixed-methods approach (pretest-posttest design) comprising a longitudinal survey, observation, informal conversations, and in-depth interviews. Survey respondents were 104 male prisoners aged 18–56 (M = 34.81, SD = 9.34) years from seven Norwegian prisons. Of these, 52 provided both baseline and posttest responses. Participants completed questionnaires including demographic, doping use, and psychophysical items/measures. At the end of the intervention, in-depth interviews were conducted with 11 of the survey respondents. The survey data were analyzed using descriptive statistics, as well as independent and paired samples t-tests. The qualitative data were analyzed using Interpretative Phenomenological Analysis. A total of 7.5% and 33.3% of participants were current and former AAS users respectively, whereas 86.1% personally knew at least one current or former AAS user. Consistent with our expectation, there were increases in self-rated physical strength (t = −4.1, p < 0.001, d = 0.46) and strength training self-efficacy (t = −8.33, p < 0.001, d = 1.36), and a decrease in moral disengagement in doping (t = −4.05, p < 0.001, d = 0.52) from baseline to posttest. These findings are supported by the qualitative data. Notable success factors are relationship-building, instructors' expertise and acceptability, and gatekeepers' navigation and co-creation. The program provides valuable evidence of the potential benefits of combining anti-doping education with practical strength training in doping prevention in correctional settings.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Berit Johnsen
- University College of Norwegian Correctional Service (Kriminalomsorgens Høgskole og Utdanningssenter KRUS), Lillestrøm, Norway
| | - Bo Lindblad
- Department of Prevention and Public Health, Anti-doping Norway, Oslo, Norway
| | - Tom Are Jensen Normann
- University College of Norwegian Correctional Service (Kriminalomsorgens Høgskole og Utdanningssenter KRUS), Lillestrøm, Norway
| | - Vidar Skogvoll
- University College of Norwegian Correctional Service (Kriminalomsorgens Høgskole og Utdanningssenter KRUS), Lillestrøm, Norway
| | - Morten Heierdal
- Department of Prevention and Public Health, Anti-doping Norway, Oslo, Norway
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Abstract
PURPOSE OF REVIEW To systematically review and meta-synthesize current (2019-2021) literature on aggression and criminality in androgen abusers. Results from 13 empirical human studies are discussed. RECENT FINDINGS Some androgen abusers engage in aggressive and criminal behavior. Here, results show positive effects and associations between the administration of androgens and aggression, and descriptions of various patterns and kinds of aggression and criminality in androgen abusers. Still, this positive relationship seems to be mediated by various factors, such as cognition, neurobiology, personality, polypharmacy, and study methods. SUMMARY The current literature on aggression and criminality in androgen abusers shows methodical diversity and underlines the need to synthesize the current evidence in order to draw overall conclusions as well as identify relevant and important knowledge gaps. On the basis of a systematic literature search, we identified 13 studies and categorized them by methodology. Of the 13 studies, 4 were meta-analyses and systematic reviews, 1 was a randomized controlled trial, 4 were cross-sectional studies, and 4 constituted case reports. Evidence on the relationship between androgen abuse and involvement in aggressive behavior seems to be mediated by cognition, neurobiology, personality, and polypharmacy as well as methodical factors, such as study design, aggression severity, type of measurement, and temporal proximity. Implications for practice and future research are presented.
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Affiliation(s)
- Razieh Chegeni
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Optentia, The Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
| | - Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the recent evidence regarding the effects of exogenous androgens on the brain. Understanding these effects is of high importance, as the consequences of androgens on the reproductive and endocrine system are well documented, while fewer studies have focused on the neural and cerebral consequences of androgen use. RECENT FINDINGS Supraphysiological doses of androgens have been shown to contribute to neurodegeneration, decreased brain-derived neurotrophic factor, increased inflammation and decreased neuronal density in animal studies, which may correspond to changes in mood, cognition and aggression. Findings from human studies suggest that similar behavioural and cognitive deficits may occur as a result of prolonged use of androgens. Additional evidence suggests that androgen use, particularly in high doses, may contribute to brain ageing and cerebrovascular problems. SUMMARY Findings from recent human and animal studies indicate that androgen use likely contributes to brain alterations, which may cause the frequently observed deficits in cognitive and emotional functioning. Although exogenous testosterone in appropriate doses for therapeutic purposes likely have some neurobiological benefits for certain populations, supraphysiological doses may cause multiple mental and physical health problems, indicating a need for additional large-scale studies in humans.
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Affiliation(s)
- Morgan Scarth
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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McVeigh J, Hearne E, Boardley I, Bates G, Hope V, Ralphs R, Van Hout MC. Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network. Harm Reduct J 2021; 18:107. [PMID: 34657627 PMCID: PMC8522223 DOI: 10.1186/s12954-021-00550-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. METHODS A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years. RESULTS In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period. CONCLUSION There is a need for the development of effectiveness evaluations of current interventions and any future service provision for people using image and performance enhancing drugs. While there have been no studies of this nature to date, this review illustrates the rich data that has been gathered through diverse methodologies, that will assist in the development of future effectiveness evaluations.
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Affiliation(s)
- Jim McVeigh
- Substance Use & Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Manchester, UK.
| | - Evelyn Hearne
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Ian Boardley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Geoff Bates
- Institute for Policy Research, University of Bath, Bath, UK
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Rob Ralphs
- Substance Use & Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Manchester, UK
| | - Marie Claire Van Hout
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Chegeni R, Notelaers G, Pallesen S, Sagoe D. Aggression and Psychological Distress in Male and Female Anabolic-Androgenic Steroid Users: A Multigroup Latent Class Analysis. Front Psychiatry 2021; 12:629428. [PMID: 34149470 PMCID: PMC8211877 DOI: 10.3389/fpsyt.2021.629428] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022] Open
Abstract
The relationship between anabolic-androgenic steroid (AAS) use and aggression and psychological distress requires further elucidation. No previous study has examined whether the latent patterns of aggression and psychological distress are the same in male and female AAS users. Multigroup latent class analysis (MLCA) can be used to classify individuals into groups based on their responses on a set of variables, and to investigate measurement invariance across subgroups. We therefore conducted a MLCA to identify discrete subgroups of aggression and psychological distress in AAS users, and used measurement invariance to examine whether the identified subgroups can be applied to both sexes. We also examined the relationship between sex and subgroup belongingness. The sample comprised 206 AAS users (females = 58.30%) aged 14-56 (mean = 26.86, SD = 7.12) years. They completed questionnaires assessing demographics, AAS use, aggression, and psychological distress. Based on the MLCA, five subgroups were identified: high aggression moderate distress users (HAMoD: 07.63%), moderate aggression distress users (18.64%), moderate direct aggression-mild indirect aggression moderate distress users (22.95%), mild direct aggression-moderate indirect aggression-distress users (11.71%), and low aggression mild distress users (LAMiD: 39.06%). Although a homogenous five-class solution was the best model for both sexes, sex was significantly associated with the probability of subgroup membership. In particular, members of the HAMoD subgroup were more likely to be male whereas members of the LAMiD subgroup were more likely to be female. Our study provides novel empirical evidence of the idiosyncratic patterns of aggression and psychological distress among male and female AAS users.
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Affiliation(s)
- Razieh Chegeni
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Guy Notelaers
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Optentia, The Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
| | - Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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