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Kritzer MF, Adler A, Locklear M. Androgen effects on mesoprefrontal dopamine systems in the adult male brain. Neuroscience 2024:S0306-4522(24)00306-3. [PMID: 38977069 DOI: 10.1016/j.neuroscience.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
Epidemiological data show that males are more often and/or more severely affected by symptoms of prefrontal cortical dysfunction in schizophrenia, Parkinson's disease and other disorders in which dopamine circuits associated with the prefrontal cortex are dysregulated. This review focuses on research showing that these dopamine circuits are powerfully regulated by androgens. It begins with a brief overview of the sex differences that distinguish prefrontal function in health and prefrontal dysfunction or decline in aging and/or neuropsychiatric disease. This review article then spotlights data from human subjects and animal models that specifically identify androgens as potent modulators of prefrontal cortical operations and of closely related, functionally critical measures of prefrontal dopamine level or tone. Candidate mechanisms by which androgens dynamically control mesoprefrontal dopamine systems and impact prefrontal states of hypo- and hyper-dopaminergia in aging and disease are then considered. This is followed by discussion of a working model that identifies a key locus for androgen modulation of mesoprefrontal dopamine systems as residing within the prefrontal cortex itself. The last sections of this review critically consider the ways in which the organization and regulation of mesoprefrontal dopamine circuits differ in the adult male and female brain, and highlights gaps where more research is needed.
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Affiliation(s)
- Mary F Kritzer
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY 11794-5230, United States.
| | - Alexander Adler
- Department of Oncology and Immuno-Oncology, Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, United States
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Wood RI, Chen MY, Snow E. Chronic high-dose testosterone impairs economic decision making, but has no effect on memory in male rats. Behav Processes 2024; 218:105044. [PMID: 38679343 PMCID: PMC11111344 DOI: 10.1016/j.beproc.2024.105044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
The goal is to understand consequences of anabolic-androgenic steroid (AAS) abuse on cognitive function, using rats as a model. Economic decision making was evaluated in an operant test of effort value discounting, where subjects choose between 2 levers that deliver large and small rewards differing in maximum value and reward contrast. The hypothesis is that chronic high-dose testosterone increases preference for large rewards. Male rats were treated chronically with testosterone (7.5 mg/kg) or vehicle. Initially, all rats preferred the large reward lever when large and small rewards remained fixed at 3 and 1 sugar pellets, respectively. When different reward values were introduced, and with increasing response requirements, testosterone-treated rats made fewer responses for the large reward, and increased omissions. They earned fewer rewards overall. To determine if testosterone impairs memory, rats were tested for recognition memory with the novel object recognition and social transmission of food preference tasks, and for spatial memory with the radial arm maze and Morris water maze. There was not effect of chronic high-dose testosterone on any memory task. These results suggest that testosterone shifts economic decision making towards larger rewards even when they are disadvantageous, but does not alter memory in rats.
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Affiliation(s)
- Ruth I Wood
- Department of Integrative Anatomical Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, United States.
| | - Michael Y Chen
- Department of Integrative Anatomical Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, United States
| | - Elizabeth Snow
- Department of Integrative Anatomical Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, United States
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Zelleroth S, Stam F, Nylander E, Kjellgren E, Gising J, Larhed M, Grönbladh A, Hallberg M. The decanoate esters of nandrolone, testosterone, and trenbolone induce steroid specific memory impairment and somatic effects in the male rat. Horm Behav 2024; 161:105501. [PMID: 38368844 DOI: 10.1016/j.yhbeh.2024.105501] [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: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
Long-term use of anabolic androgenic steroids (AAS) in supratherapeutic doses is associated with severe adverse effects, including physical, mental, and behavioral alterations. When used for recreational purposes several AAS are often combined, and in scientific studies of the physiological impact of AAS either a single compound or a cocktail of several steroids is often used. Because of this, steroid-specific effects have been difficult to define and are not fully elucidated. The present study used male Wistar rats to evaluate potential somatic and behavioral effects of three different AAS; the decanoate esters of nandrolone, testosterone, and trenbolone. The rats were exposed to 15 mg/kg of nandrolone decanoate, testosterone decanoate, or trenbolone decanoate every third day for 24 days. Body weight gain and organ weights (thymus, liver, kidney, testis, and heart) were measured together with the corticosterone plasma levels. Behavioral effects were studied in the novel object recognition-test (NOR-test) and the multivariate concentric square field-test (MCSF-test). The results conclude that nandrolone decanoate, but neither testosterone decanoate nor trenbolone decanoate, caused impaired recognition memory in the NOR-test, indicating an altered cognitive function. The behavioral profile and stress hormone level of the rats were not affected by the AAS treatments. Furthermore, the study revealed diverse AAS-induced somatic effects i.e., reduced body weight development and changes in organ weights. Of the three AAS included in the study, nandrolone decanoate was identified to cause the most prominent impact on the male rat, as it affected body weight development, the weights of multiple organs, and caused an impaired memory function.
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Affiliation(s)
- Sofia Zelleroth
- The Beijer Laboratory, Department of Pharmaceutical Biosciences, Neuropharmacology and Addiction Research, SE-751 24, Uppsala University, Sweden.
| | - Frida Stam
- The Beijer Laboratory, Department of Pharmaceutical Biosciences, Neuropharmacology and Addiction Research, SE-751 24, Uppsala University, Sweden.
| | - Erik Nylander
- The Beijer Laboratory, Department of Pharmaceutical Biosciences, Neuropharmacology and Addiction Research, SE-751 24, Uppsala University, Sweden.
| | - Ellinor Kjellgren
- The Beijer Laboratory, Department of Pharmaceutical Biosciences, Neuropharmacology and Addiction Research, SE-751 24, Uppsala University, Sweden
| | - Johan Gising
- The Beijer Laboratory, Science for Life Laboratory, Department of Medicinal Chemistry, SE-751 23, Uppsala University, Sweden.
| | - Mats Larhed
- The Beijer Laboratory, Science for Life Laboratory, Department of Medicinal Chemistry, SE-751 23, Uppsala University, Sweden.
| | - Alfhild Grönbladh
- The Beijer Laboratory, Department of Pharmaceutical Biosciences, Neuropharmacology and Addiction Research, SE-751 24, Uppsala University, Sweden.
| | - Mathias Hallberg
- The Beijer Laboratory, Department of Pharmaceutical Biosciences, Neuropharmacology and Addiction Research, SE-751 24, Uppsala University, Sweden.
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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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Skauen JE, Pallesen S, Bjørnebekk A, Chegeni R, Syvertsen A, Petróczi A, Sagoe D. Prevalence and correlates of androgen dependence: a meta-analysis, meta-regression analysis and qualitative synthesis. Curr Opin Endocrinol Diabetes Obes 2023; 30:309-323. [PMID: 37410490 DOI: 10.1097/med.0000000000000822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW To investigate the prevalence and correlates of androgen dependence among users. A meta-analysis, meta-regression analysis, and qualitative synthesis were conducted based on a systematic literature search in Google Scholar, ISO Web of Science, PsycNET, and PubMed. RECENT FINDINGS Twenty-six studies were included in the review and 18 studies ( N = 1782) in the statistical analysis. The overall lifetime androgen dependence prevalence was 34.4% [95% confidence interval (CI): 27.8-41.7, Q = 113.1, I2 = 85.0, P < 0.001]. Although males (36.1%, P < 0.001) and females (37.0%, P = 0.188) did not differ ( Q = 0.0, P = 0.930) in dependence prevalence, controlling for other study characteristics, higher study male sample proportion was related to higher dependence prevalence. Combined interview and questionnaire assessments showed higher prevalence compared to interviews only. Publications from 1990-1999 generated higher prevalence compared to 2000-2009 and 2010-2023 publications. Dependents were associated with a wide array of demographic inequalities, and biophysical, cognitive, emotional, and psychosocial problems. SUMMARY One of three persons who initiate androgen use experiences dependence along with various serious disorders. Androgen use and dependence should be considered an important public health issue requiring targeted health interventions.
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Affiliation(s)
- Jenny Eriksrød Skauen
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
| | - Ståle Pallesen
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
| | - Astrid Bjørnebekk
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital
| | - Razieh Chegeni
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - André Syvertsen
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
| | - Andrea Petróczi
- School of Life Sciences, Pharmacy and Chemistry, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Dominic Sagoe
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
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Seib DR, Tobiansky DJ, Meitzen J, Floresco SB, Soma KK. Neurosteroids and the mesocorticolimbic system. Neurosci Biobehav Rev 2023; 153:105356. [PMID: 37567491 DOI: 10.1016/j.neubiorev.2023.105356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
The mesocorticolimbic system coordinates executive functions, such as working memory and behavioral flexibility. This circuit includes dopaminergic projections from the ventral tegmental area to the nucleus accumbens and medial prefrontal cortex. In this review, we summarize evidence that cells in multiple nodes of the mesocorticolimbic system produce neurosteroids (steroids synthesized in the nervous system) and express steroid receptors. Here, we focus on neuroandrogens (androgens synthesized in the nervous system), neuroestrogens (estrogens synthesized in the nervous system), and androgen and estrogen receptors. We also summarize how (neuro)androgens and (neuro)estrogens affect dopamine signaling in the mesocorticolimbic system and regulate executive functions. Taken together, the data suggest that steroids produced in the gonads and locally in the brain modulate higher-order cognition and executive functions.
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Affiliation(s)
- Désirée R Seib
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
| | - Daniel J Tobiansky
- Department of Biology and Neuroscience Program, St. Mary's College of Maryland, St. Mary's City, MD, USA
| | - John Meitzen
- Department of Biological Sciences and Center for Human Health and the Environment, NC State University, Raleigh, NC, USA
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Kiran K Soma
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Scarth M, Westlye LT, Havnes IA, Bjørnebekk A. Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters. BMC Psychiatry 2023; 23:342. [PMID: 37193971 DOI: 10.1186/s12888-023-04781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls. METHODS A sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use. RESULTS In a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified. CONCLUSIONS AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.
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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, Oslo, 0424, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT, Oslo University Hospital, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ingrid A Havnes
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Oslo, 0424, Norway
- Institute of Clinical Medicine, 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, Oslo, 0424, Norway
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Henriksen HCB, Havnes IA, Jørstad ML, Bjørnebekk A. Health service engagement, side effects and concerns among men with anabolic-androgenic steroid use: a cross-sectional Norwegian study. Subst Abuse Treat Prev Policy 2023; 18:19. [PMID: 37013635 PMCID: PMC10071723 DOI: 10.1186/s13011-023-00528-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use. METHODS The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi2 or Fisher exact tests for numerical and categorical variables, respectively. RESULTS All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%). CONCLUSIONS Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs.
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Affiliation(s)
- Hans Christian Bordado Henriksen
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ingrid Amalia Havnes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marie Lindvik Jørstad
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- National Advisory Unit on Substance Use Treatment, 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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Sessa F, Esposito M, Salerno M. Experimental studies on androgen administration in animal models: current and future perspectives. Curr Opin Endocrinol Diabetes Obes 2022; 29:566-585. [PMID: 35943186 DOI: 10.1097/med.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW This review aims to report the most recent (2020-2022) experimental scientific studies conducted on animal models, in order to highlight the relevant findings on the adverse effects related to androgen administration. RECENT FINDINGS Forty-one studies published between January 2020 and July 2022 were selected. The majority of studies investigated the effects of one androgen, whereas only four studies analyzed the effects of two drugs. Nandrolone decanoate was the most investigated drug (20 articles), boldenone was tested in 8 articles, testosterone and stanozolol were used in 7 articles each, 17b-trenbolone, metandienone, and oxandrolone were tested in 1 article each. The articles clarify the adverse effects of androgen administration on the heart, brain, kidney, liver, reproductive and musculoskeletal systems. SUMMARY The main findings of this review highlight that androgen administration increases inflammatory mediators, altering different biochemical parameters. The results concerning the reversibility of the adverse effects are controversial: on the one hand, several studies suggested that by stopping the androgen administration, the organs return to their initial state; on the other hand, the alteration of different biochemical parameters could generate irreversible organ damage. Moreover, this review highlights the importance of animal studies that should be better organized in order to clarify several important aspects related to androgen abuse to fill the gap in our knowledge in this research field.
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Affiliation(s)
- Francesco Sessa
- Department of Medical, Surgical and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
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Harvey O, van Teijlingen E, Parrish M. Mixed-methods research on androgen abuse - a review. Curr Opin Endocrinol Diabetes Obes 2022; 29:586-593. [PMID: 35943190 DOI: 10.1097/med.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the mixed-methods studies from the last 2 years (2021-2022) into androgen use to highlight the most relevant developments within the field. RECENT FINDINGS The literature review found seven papers from 2021 to 2022. These seven cover a range of important considerations, including interventions to reduce androgen use, educational tools to increase professionals' knowledge, explorations on the comorbidity of use with other substances, motivations for use, potential risks factors for androgens' initiation, or risks of using androgens. Key findings include a greater understanding of motivations for use, particularly in females and older males; identification of potential risks for starting use/using androgens; benefits of including practical strength exercises in preventive intervention programmes and the efficacy of e-learning tools to increase professionals' knowledge of androgens use, as well as an increase in their confidence to support androgen users. SUMMARY The key implications for clinical practice are that we still need to support healthcare professionals to overcome the barriers for increasing their skills and knowledge around androgen use. A recognition that people who have become dependent on androgen use are potentially at risk of considerable harm, with further research needed into sub-groups of androgen users. VIDEO ABSTRACT , http://links.lww.com/COE/A35.
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Ganson KT, Jackson DB, Testa A, Nagata JM. Performance-Enhancing Substance Use and Intimate Partner Violence: A Prospective Cohort Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22944-NP22965. [PMID: 35119318 PMCID: PMC9679551 DOI: 10.1177/08862605211073097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research has shown that performance-enhancing substance (PES) use, including anabolic-androgenic steroids (AAS), is associated with interpersonal violence (e.g., fighting). This study aimed to determine whether legal PES use and AAS use are associated with intimate partner violence (IPV) involvement cross-sectionally and over seven-year follow-up in a nationally representative prospective cohort study. Data from the National Longitudinal Study of Adolescent to Adult Health (N = 12,288) were analyzed (2021). Logistic regression analyses were conducted to determine the associations between legal PES use and AAS use at Wave III (2001-2002; ages 18-26) and IPV victimization (five variables) and IPV perpetration (five variables) at Wave III and Wave IV (2008-2009; ages 24-32), adjusting for relevant demographic and confounding variables. Results from cross-sectional analyses showed that legal PES use and AAS use were associated with higher odds of both any IPV victimization and sexual IPV victimization, and both any IPV perpetration and physical IPV perpetration by pushing or shoving a partner. Results from prospective analyses showed that AAS use, but not legal PES use, was associated with higher odds of all five IPV victimization variables (any IPV victimization: adjusted odds ratio [AOR] 1.72, 95% confidence interval [CI]1.04-2.84; two forms of physical abuse: 1: AOR 2.01, 95% CI 1.15-3.50; 2: AOR 2.11, 95% CI 1.06-4.21; incurring an injury from IPV victimization: AOR 4.90, 95% CI 1.71-14.01; and sexual IPV victimization AOR 2.44, 95% CI 1.05-5.65), as well as three IPV perpetration variables (any IPV perpetration: AOR 2.11, 95% CI 105-4.23; one form of physical abuse perpetration: AOR 2.58, 95% CI 1.06-6.27; and sexual IPV perpetration: AOR 3.80, 95% CI 1.44-10.02). These results emphasize the adverse social and interpersonal risks associated with PES use. Continued research, health care, and public health prevention and intervention efforts to reduce the use of PES and occurrence of IPV are warranted.
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Affiliation(s)
- Kyle T. Ganson
- Factor-Inwentash Faculty of Social
Work, University of Toronto, Toronto, ON, Canada
| | - Dylan B. Jackson
- Department of Population, Family,
and Reproductive Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | - Alexander Testa
- Department of Criminology &
Criminal Justice, University of Texas at San
Antonio, San Antonio, TX, USA
| | - Jason M. Nagata
- Department of Pediatrics, University of
California, San Francisco, San Francisco, CA, USA
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Noebel NA, Oberle CD, Marcell HS. Orthorexia nervosa and executive dysfunction: symptomatology is related to difficulties with behavioral regulation. Eat Weight Disord 2022; 27:2019-2026. [PMID: 34997552 DOI: 10.1007/s40519-021-01343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This research explored whether orthorexia nervosa is associated with deficits in executive function. METHODS A non-clinical sample of participants (n = 405; 80% women, 53% white, mean age = 24, mean body mass index = 25) completed the Orthorexia Nervosa Inventory (ONI) and the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A). RESULTS ONI scores were weakly to moderately correlated with all BRIEF-A scales (p < 0.001 for eight scales, p < 0.05 for one scale), exhibiting the greatest correlations with the scales assessing behavioral regulation: Emotional Control (r = 0.34), Inhibition (r = 0.30), Set Shifting (r = 0.25), and Self-Monitoring (r = 0.28). Hierarchical regression analyses revealed that eight of these nine relationships remained significant (p < 0.001 for five scales including all behavioral regulation scales, p < 0.01 for two scales, p < 0.05 for one scale) after controlling for demographic variables (e.g., gender, body mass index, age, education level) and diagnoses of an eating disorder, obsessive-compulsive disorder, attention deficit/hyperactivity disorder, autism, and learning disability. CONCLUSION These findings suggest that, despite unique manifestations, orthorexia and anorexia may possess an overlapping neuropsychological profile marked by deficits in executive function, which may negatively impact daily life. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Natalie A Noebel
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Crystal D Oberle
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA.
| | - Haley S Marcell
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
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13
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Ganson KT, Jackson DB, Testa A, Murnane PM, Nagata JM. Associations Between Anabolic-Androgenic Steroid Use and Sexual Health Behaviors Among Adolescent Boys: Results From the 2019 Youth Risk Behavior Survey. Am J Mens Health 2022; 16:15579883221110350. [PMID: 35996359 PMCID: PMC9421234 DOI: 10.1177/15579883221110350] [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] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to determine the association between lifetime anabolic-androgenic steroid (AAS) use and seven indicators of sexual health behaviors among a nationally representative sample of adolescent boys in the United States. Multiple modified Poisson regression analyses were conducted to determine the associations between any lifetime AAS use and seven indicators of sexual health behaviors among 2,095 sexually active adolescent boys from the 2019 National Youth Risk Behavior Survey. Sexually active boys who reported lifetime AAS use were at greater risk of having sexual intercourse before the age of 13 years (adjusted risk ratio [aRR] = 2.73, 95% confidence interval [CI] = [1.44, 5.17]), reporting ≥4 sexual partners in their lifetime (aRR = 1.96, 95% CI = [1.34, 2.89]) and in the past 3 months (aRR = 6.77, 95% CI = [3.19, 14.37]), having been tested for HIV in their lifetime (aRR = 2.49, 95% CI = [1.13, 4.73]), and having been tested for any sexually transmitted infection in the past 12 months (aRR = 3.14, 95% CI = [1.63, 6.03]). These findings align with prior research among adult men and have implications for public health and health care prevention efforts to reduce the use of AAS, as well as support the engagement in safe sexual health behaviors among adolescent boys.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexander Testa
- Department of Criminology and Criminal Justice, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Pamela M Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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14
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Ganson KT, Jackson DB, Testa A, Murnane PM, Nagata JM. Performance-Enhancing Substance Use and Sexual Risk Behaviors among U.S. Men: Results from a Prospective Cohort Study. JOURNAL OF SEX RESEARCH 2022; 59:758-764. [PMID: 34860634 PMCID: PMC9163206 DOI: 10.1080/00224499.2021.2012114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Performance-enhancing substance (PES) use is common among young men and prior research has documented cross-sectional associations between anabolic-androgenic steroid (AAS) use and sexual risk behaviors. However, this relationship remains understudied among a longitudinal cohort of young adult men, and research on prospective associations between legal PES (e.g., creatine) use and sexual risk behaviors is lacking. The current study addressed these oversights using data from the National Longitudinal Study of Adolescent to Adult Health (N = 5,451). AAS use and legal PES use were assessed at Wave III (ages 18-26) and 10 indicators of sexual risk behavior were assessed at seven-year follow up (Wave IV; ages 24-32). Linear and logistic regression analyses were conducted adjusting for demographic and behavioral confounders. Participants who reported AAS use and legal PES use had significantly higher number of one-time sexual partners and higher odds of multiple sex partners around the same time in the past 12 months. Participants who reported AAS use had higher odds of any STI in the past 12 months. These results extend prior research on the risk behaviors and adverse effects of PES use. Health care professionals should assess for PES use among young adult men and provide guidance on healthful sexual behaviors.
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Affiliation(s)
- Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
| | - Pamela M. Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
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15
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Kildal E, Hassel B, Bjørnebekk A. ADHD symptoms and use of anabolic androgenic steroids among male weightlifters. Sci Rep 2022; 12:9479. [PMID: 35676515 PMCID: PMC9178025 DOI: 10.1038/s41598-022-12977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
Use of anabolic androgenic steroids (AAS) is associated with adverse health effects. The factors that predispose to AAS use among athletes are poorly understood, but attention deficit/hyperactivity disorder (ADHD), which is known to occur among athletes more often than in the general population, is associated with risk behaviors, including substance abuse. We aimed to see if AAS use in male weightlifters was associated with ADHD symptoms, and test the link between ADHD symptoms and cognitive performance. Hundred and forty male weightlifters, 72 AAS users and 68 weightlifting controls (WLC), completed the Achenbach system of empirically based assessment (ASEBA) for ADHD symptoms and underwent cognitive examination. Self-reported ADHD symptom scores were significantly higher among AAS users compared to WLC, and scores in the range indicating clinically important ADHD was significantly more common in the AAS-using group. Age of onset of AAS use correlated inversely with ADHD scale score (r = - 0.35; p = 0.003). ADHD score correlated inversely with cognitive scores for working memory (r = - 0.25, p < 0.001), processing speed (r = - 0.24, p < 0.001), verbal learning and memory (r = - 0.19, p = 0.03), and problem solving (r = - 0.20, p = 0.02). AAS use among weightlifters is associated with ADHD symptoms and corresponding lower cognitive performance. Recognising a relationship between ADHD symptoms and AAS use may guide drug prevention strategies in sports.
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Affiliation(s)
- Emilie Kildal
- Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjørnar Hassel
- Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astrid Bjørnebekk
- The Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
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16
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Tomm RJ, Seib DR, Kachkovski GV, Schweitzer HR, Tobiansky DJ, Floresco SB, Soma KK. Androgen synthesis inhibition increases behavioural flexibility and mPFC tyrosine hydroxylase in gonadectomized male rats. J Neuroendocrinol 2022; 34:e13128. [PMID: 35583989 DOI: 10.1111/jne.13128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022]
Abstract
Behavioural flexibility is essential to adapt to a changing environment and depends on the medial prefrontal cortex (mPFC). Testosterone administration decreases behavioural flexibility. It is well known that testosterone is produced in the gonads, but testosterone is also produced in the brain, including the mPFC and other nodes of the mesocorticolimbic system. It is unclear how testosterone produced in the brain versus the gonads influences behavioural flexibility. Here, in adult male rats, we assessed the effects of the androgen synthesis inhibitor abiraterone acetate (ABI) and long-term gonadectomy (GDX) on behavioural flexibility in two paradigms. In Experiment 1, ABI but not GDX reduced the number of errors to criterion and perseverative errors in a strategy set-shifting task. In Experiment 2, with a separate cohort of rats, ABI but not GDX reduced perseverative errors in a reversal learning task. In Experiment 1, we also examined tyrosine hydroxylase immunoreactivity (TH-ir), and ABI but not GDX increased TH-ir in the mPFC. Our findings suggest that neurally-produced androgens modulate behavioural flexibility via modification of dopamine signalling in the mesocorticolimbic system. These results indicate that neurosteroids regulate executive functions and that ABI treatment for prostate cancer might affect cognition.
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Affiliation(s)
- Ryan J Tomm
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Désirée R Seib
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - George V Kachkovski
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Helen R Schweitzer
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Daniel J Tobiansky
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kiran K Soma
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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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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18
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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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20
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Bonnecaze AK, O'Connor T, Burns CA. Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review. J Gen Intern Med 2021; 36:2055-2064. [PMID: 33948794 PMCID: PMC8298654 DOI: 10.1007/s11606-021-06751-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/21/2021] [Indexed: 02/07/2023]
Abstract
Anabolic androgenic steroid (AAS) and performance-enhancing drug (PED) use is a prevalent medical issue, especially among men, with an estimated 2.9-4 million Americans using AAS in their lifetime. Prior studies of AAS use reveal an association with polycythemia, dyslipidemia, infertility, hypertension, left ventricular hypertrophy, and multiple behavioral disorders. AAS withdrawal syndrome, a state of depression, anhedonia, and sexual dysfunction after discontinuing AAS use, is a common barrier to successful cessation. Clinical resources for these patients and training of physicians on management of the patient using AAS are limited. Many men are hesitant to seek traditional medical care due to fear of judgment and lack of confidence in physician knowledge base regarding AAS. While proposed approaches to weaning patients off AAS are published, guidance on harm reduction for actively using patients remains sparse. Medical education regarding the management of AAS use disorder is paramount to improving care of this currently underserved patient population. Management of these patients must be non-judgmental and focus on patient education, harm reduction, and support for cessation. The approach to harm reduction should be guided by the specific AAS/PEDs used.
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Affiliation(s)
- Alex K Bonnecaze
- Dept of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Thomas O'Connor
- Dept of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Cynthia A Burns
- Dept of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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21
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Bjørnebekk A, Kaufmann T, Hauger LE, Klonteig S, Hullstein IR, Westlye LT. Long-term Anabolic-Androgenic Steroid Use Is Associated With Deviant Brain Aging. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:579-589. [PMID: 33811018 DOI: 10.1016/j.bpsc.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND High-dose long-term use of anabolic-androgenic steroids (AASs) may cause a range of adverse effects, including brain and cognitive abnormalities. We performed age prediction based on brain scans to test whether prolonged AAS use is associated with accentuated brain aging. METHODS T1-weighted magnetic resonance imaging (3D MPRAGE [magnetization-prepared rapid acquisition gradient-echo]) scans were obtained from male weightlifters with a history of prolonged AAS use (n = 130) or no AAS use (n = 99). We trained machine learning models on combinations of regional brain volumes, cortical thickness, and surface area in an independent training set of 1838 healthy male subjects (18-92 years of age) and predicted brain age for each participant in our study. Including cross-sectional and longitudinal (mean interval = 3.5 years, n = 76) magnetic resonance imaging data, we used linear mixed-effects models to compare the gap between chronological age and predicted brain age (the brain age gap [BAG]) for the two groups and tested for group differences in the rate of change in BAG. We tested for associations between apparent brain aging and AAS use duration, pattern of administration, and dependence. RESULTS AAS users had higher BAG compared with weightlifting control subjects, which was associated with dependency and longer history of use. Group differences in BAG could not be explained by other substance use, general cognitive abilities, or depression. While longitudinal analysis revealed no evidence of increased brain aging in the overall AAS group, accelerated brain aging was seen with longer AAS exposure. CONCLUSIONS The findings suggest that long-term high-dose AAS use may have adverse effects on brain aging, potentially linked to dependency and exaggerated use of AASs.
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Affiliation(s)
- Astrid Bjørnebekk
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Tobias Kaufmann
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Lisa E Hauger
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, 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
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway; K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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22
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Hauger LE, Havnes IA, Jørstad ML, Bjørnebekk A. Anabolic androgenic steroids, antisocial personality traits, aggression and violence. Drug Alcohol Depend 2021; 221:108604. [PMID: 33621808 DOI: 10.1016/j.drugalcdep.2021.108604] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anabolic androgenic steroid (AAS) use is associated with a wide range of adverse physical, psychological and social effects. While some experience few side effects, others might experience severe consequences. Aggression and violence are among the often-cited side effects associated with high-dose AAS use; however, most of the knowledge is generated from subgroups, such as prison populations. A likely hypothesis is that AAS use is associated with aggression and violence, but that these associations are complex and may be mediated by several factors, such as substance use, AAS dependence and personality traits. METHODS In the present study, we tested this hypothesis by examining the relations between long-term AAS use and AAS dependence, aggression, interpersonal violence and potential mediating factors in a sample of male AAS exposed and non-exposed weightlifting controls (WLC), using self-report questionnaires. Based upon AAS dependence criteria, a sample of male AAS users and WLC (N = 139) were stratified into three groups: WLC (n = 66), AAS dependents (n = 41) and AAS non-dependents (n = 32). RESULTS The results demonstrate that AAS dependents reported significantly higher levels of aggression compared to WLC and AAS non-dependents. While interpersonal violence was reported in all three groups, the highest percentage was found in the AAS dependent group. CONCLUSION In summary, our study confirms a link between AAS use, aggression and violence in a weightlifting population. However, the association is foremost seen in AAS dependent users and it seems that antisocial personality traits are an important mediator.
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Affiliation(s)
- Lisa E Hauger
- The Anabolic Androgenic Steroid Research Group, The Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Norway; National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Postbox 4959, Nydalen, Norway.
| | - Ingrid A Havnes
- The Anabolic Androgenic Steroid Research Group, The Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Norway
| | - Marie L Jørstad
- The Anabolic Androgenic Steroid Research Group, The Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Norway
| | - Astrid Bjørnebekk
- The Anabolic Androgenic Steroid Research Group, The Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Norway
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Roşca AE, Vlădăreanu AM, Mititelu A, Popescu BO, Badiu C, Căruntu C, Voiculescu SE, Onisâi M, Gologan Ş, Mirica R, Zăgrean L. Effects of Exogenous Androgens on Platelet Activity and Their Thrombogenic Potential in Supraphysiological Administration: A Literature Review. J Clin Med 2021; 10:jcm10010147. [PMID: 33406783 PMCID: PMC7795962 DOI: 10.3390/jcm10010147] [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: 11/19/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 02/04/2023] Open
Abstract
Anabolic androgenic steroids (AAS), simply called “androgens”, represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe endpoints. The induction of a prothrombotic state is probably the most life-threatening consequence, suggested by numerous case reports in AAS-abusing athletes, and by a considerable number of human and animal studies assessing the influence of exogenous androgens on hemostasis. Despite over fifty years of research, data regarding the thrombogenic potential of exogenous androgens are still scarce. The main reason is the limited possibility of conducting human prospective studies. However, human observational studies conducted in athletes or patients, in vitro human studies, and animal experiments have pointed out that androgens in supraphysiological doses induce enhanced platelet activity and thrombopoiesis, leading to increased platelet aggregation. If this tendency overlaps previously existing coagulation and/or fibrinolysis dysfunctions, it may lead to a thrombotic diathesis, which could explain the multitude of thromboembolic events reported in the AAS-abusing population. The influence of androgen excess on the platelet activity and fluid–coagulant balance remains a subject of debate, urging for supplementary studies in order to clarify the effects on hemostasis, and to provide new compelling evidence for their claimed thrombogenic potential.
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Affiliation(s)
- Adrian Eugen Roşca
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.E.V.); (L.Z.)
- Victor Babeş National Institute of Research-Development in the Pathology Domain, 050096 Bucharest, Romania;
- Department of Cardiology, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania
- Correspondence: (A.E.R.); (A.-M.V.)
| | - Ana-Maria Vlădăreanu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (A.M.); (M.O.)
- Correspondence: (A.E.R.); (A.-M.V.)
| | - Alina Mititelu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (A.M.); (M.O.)
| | - Bogdan Ovidiu Popescu
- Victor Babeş National Institute of Research-Development in the Pathology Domain, 050096 Bucharest, Romania;
- Department of Neurology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Corin Badiu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, C.I. Parhon National Institute of Endocrinology, 11863 Bucharest, Romania;
| | - Constantin Căruntu
- Division of Physiology, Department of Fundamental Disciplines, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Suzana Elena Voiculescu
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.E.V.); (L.Z.)
| | - Minodora Onisâi
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (A.M.); (M.O.)
| | - Şerban Gologan
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Elias Clinical Hospital, 011461 Bucharest, Romania;
| | - Radu Mirica
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, “Sf. Ioan” Clinical Hospital, 042122 Bucharest, Romania;
| | - Leon Zăgrean
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.E.V.); (L.Z.)
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Havnes IA, Bukten A, Rognli EB, Muller AE. Use of anabolic-androgenic steroids and other substances prior to and during imprisonment - Results from the Norwegian Offender Mental Health and Addiction (NorMA) study. Drug Alcohol Depend 2020; 217:108255. [PMID: 32949884 DOI: 10.1016/j.drugalcdep.2020.108255] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anabolic-androgenic steroid (AAS) use is associated with health problems and substance use. Substance use is common among inmates. This study aims to estimate lifetime and prison use of AAS and other substances, compare characteristics of groups of inmates, and describe factors associated with AAS use in a national prison population. METHODS Data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of people in prisons, included sociodemographic variables and lifetime and prison use of AAS and other substances. Altogether 1,499 inmates, including 96 (6.4%) women, were divided into three mutually exclusive groups according to lifetime AAS use, non-AAS substance use and no substance use. RESULTS Lifetime AAS use was reported by 427 (28.5%) inmates; 6 women and 421 men. Non-AAS substance use was reported by 593 (39.6%) and 479 (31.9%) had never used AAS or non-AAS substances. Compared to the non-AAS substance group, the AAS group reported younger debut ages for nearly all non-AAS substances, higher mean number of non-AAS substances used in their lifetime (8.9, 6.6, p < 0.001), during the six months prior to incarceration (5.2, 3.1, p < 0.001), and during (2.3, 1.3, p < 0.001) imprisonment. Although 120 (8.0%) inmates used AAS during the six months prior to incarceration, only ten continued during imprisonment. CONCLUSIONS Lifetime AAS use is common among inmates and may be an indicator of more severe substance use problems. Screening for previous and present AAS use at incarceration and increased staff awareness are needed to tailor treatment approaches appropriately.
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Affiliation(s)
- Ingrid Amalia Havnes
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Pb 4959, Nydalen, 0424, Oslo, Norway.
| | - Anne Bukten
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway; Section for Clinical Addiction Research (RusForsk), Oslo University Hospital, Pb 4956, Nydalen, 0424, Oslo, Norway
| | - Eline Borger Rognli
- Section for Clinical Addiction Research (RusForsk), Oslo University Hospital, Pb 4956, Nydalen, 0424, Oslo, Norway
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Vaskinn A, Hauger LE, Bjørnebekk A. Theory of mind in users of anabolic androgenic steroids. Psychopharmacology (Berl) 2020; 237:3191-3199. [PMID: 32623552 PMCID: PMC7524704 DOI: 10.1007/s00213-020-05603-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023]
Abstract
RATIONALE Anabolic androgenic steroids are used to improve physical performance or increase lean muscle mass. About one-third of users develop a dependency syndrome, which is characterized by elevated rates of psychopathology, cognitive impairments, and aggressive and antisocial behaviors. The mechanisms behind these intra- and interpersonal problems are not known. OBJECTIVE To examine theory of mind (ToM), i.e., the ability to infer the mental state of others, in users of anabolic androgenic steroids. Reduced ToM may be one factor underlying the interpersonal problems that have been reported with prolonged use of anabolic androgenic steroids. METHODS The Movie for the Assessment of Social Cognition (MASC) was used to assess ToM. Study participants were male/female weightlifters who used anabolic androgenic steroids (AAS, n = 34/9), who were dependent on anabolic androgenic steroids (AASdep, n = 44/7), and a non-using weightlifting comparison group (WLC, n = 69/16). RESULTS Analyses of variance showed that the AASdep group performed significantly worse than the WLC group, for all MASC measures (total ToM, cognitive ToM, affective ToM, overmentalizing/undermentalizing errors). Sex and sex x group interaction effects were non-significant. CONCLUSIONS Male and female weightlifters who were dependent on anabolic androgenic steroids had impaired ToM. Their reduced social cognition may be one contributing factor to the elevated rates of antisocial behavior reported in this population.
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Affiliation(s)
- Anja Vaskinn
- Norwegian Centre for Mental Disorders Research, Division Mental Health and Addiction, Oslo University Hospital, PO Box 4956, Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway.
| | - Lisa E. Hauger
- The Anabolic Androgenic Steroid Research Group, National Advisory Unit on Substance Use Disorder Treatment, Division Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
| | - Astrid Bjørnebekk
- The Anabolic Androgenic Steroid Research Group, National Advisory Unit on Substance Use Disorder Treatment, Division Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
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