Adolescent anabolic steroid use, gender, physical activity, and other problem behaviors*

Appearance and performance factors associated with muscle building supplement use and favourable attitudes towards anabolic steroids in adolescent boys

Introduction

The demand for appearance and performance enhancing substances, including muscle building supplements and anabolic androgenic steroids, is increasing in Australia. However, little is known about the associations between appearance and performance-based factors and appearance and performance enhancing substances (APES), particularly among adolescent boys. This study sought to examine (a) the prevalence of muscle building supplement use in a sample of adolescent boys and (b) how both performance and appearance factors relate to muscle building supplement use and favourable attitudes towards anabolic androgenic steroids in this sample.

Method

N = 488 adolescent boys aged 13-16 (Mage = 14.59) from nine Australian schools completed measures of supplement use, favourable attitudes towards using steroids, muscle dissatisfaction, body fat dissatisfaction, mesomorphic ideal internalisation, weight training, and sports participation. Hierarchical logistic regressions were used to examine cross-sectional correlates of muscle building supplement use and favourable attitudes towards using anabolic androgenic steroids.

Results

In the past three months, 12.7% of the sample had used muscle building supplements. Both appearance and performance-related factors - mesomorphic ideal internalisation and weight training - were related to muscle building supplement use. Only one appearance-related factor - body dissatisfaction - was related to favourable attitudes towards anabolic androgenic steroids.

Discussion

The findings from this study are important as they may help to guide intervention strategies regarding appearance and performance enhancing substance use by Australian adolescent boys, with the ultimate goal of ensuring this population's safety.

Does Warm Glow Promote Physical Activity? Examining the Relative Effectiveness of Self-Benefiting versus Other-Benefiting Incentives in Motivating Fitness App Use by Corporate Sponsorship Programs

Despite an essential step in the self-regulation process, the feature of offering rewards - in particular, offering tangible rewards - is underdeveloped in most fitness mobile apps. The present study addressed this issue by harnessing the contributions of corporations in the form of providing incentives to fitness app users as part of their corporate social responsibility initiatives. This study investigated the dual mechanisms through which incentive type and functional congruence shape consumers' intention to use a fitness app and their attitudes toward the sponsor, respectively. Through a 2 (self-benefiting vs. other-benefiting incentives) by 2 (low vs. high congruence) experiment, this study found that when using other-benefiting incentives, incentives provided by high-congruence sponsors elicited more favorable attitude toward the incentive than those provided by low-congruence sponsors and, in turn, increased users' propensity to use the app. But this indirect effect was not in play when using self-benefiting incentives. From the sponsor's perspective, in the low-congruence condition, other-benefiting incentives were more effective in leading users to attribute altruistic motives to the sponsorship, resulting in more favorable attitudes toward the sponsor; however, the mediating mechanism failed to operate under the high-congruence condition. Taken together, this research shed light on the mediating mechanisms and boundary conditions of strategies of partnering sponsorship with fitness apps, making this type of partnership a win-win initiative for both the app users and the corporations involved.

Examining the impact of weight bias on the association between exercise identity and maladaptive exercise behaviors

OBJECTIVE

Though exercise behaviors are typically viewed as health-promoting, certain forms of exercise (i.e., excessive exercise, unhealthy muscle-building behaviors) are considered maladaptive and are associated with negative physical and psychological outcomes. Psychosocial factors may put people at greater risk for engaging in maladaptive exercise. Based on deviance regulation theory, weight bias was examined as a potential moderator of the association between exercise identity and both excessive exercise and muscle-building behaviors.

DESIGN

The current study is a secondary analysis of a larger data set investigating associations between athletic identity, exercise behaviors, and disordered eating behaviors. Hypotheses were examined using moderation testing in multiple linear regression.

MAIN OUTCOME MEASURES

Participants (N = 225, 50.2% female) completed the Eating Pathology Symptoms Inventory as a measure of maladaptive exercise.

RESULTS

Controlling for sex, age, athlete status, and body mass index, weight bias moderated the association between exercise identity and both excessive exercise and muscle-building behaviors. Among individuals with high exercise identity, higher weight bias was associated with increased maladaptive exercise behaviors.

CONCLUSION

Individuals with higher exercise identity and higher weight bias may be at greatest risk of engaging in maladaptive exercise. Preventive interventions for maladaptive exercise behaviors may consider targeting exercise identity and weight bias.

Anabolic androgenic steroid dependence is associated with executive dysfunction

BACKGROUND

Anabolic androgenic steroid (AAS) dependence is associated with a high prevalence of intra- and interpersonal problems, hence it is central to identify cognitive factors related to the development and maintenance of dependence.

METHODS

The study explores executive functions (EFs) in a sample of 174 male weightlifters, divided into three groups; 1) AAS dependents; n = 58, 2) AAS non-dependents; n = 38 and 3) AAS non-users; n = 78, using a targeted battery of neuropsychological (NP) tests, and self-report questionnaires assessing EFs in everyday life, ADHD symptoms and psychological distress.

RESULTS

Multivariate analysis of variance showed significant between-group differences on several EFs, including working memory [F (2, 169) = 13.79, p < .001, ηp² = 0.14], mental flexibility [F (2, 169) = 4.82, p = .009, ηp² = 0.05], problem-solving [F (2, 169) = 4.77 p = .010, ηp² = 0.05] and inhibition [F (2, 163) = 4.15, p = .017, ηp² = 0.05]. Additionally, significant between-group differences were seen for self-reported problems with EFs [F (2, 124) = 4.38 p = .015, ηp² = 0.07], ADHD symptoms [F (2, 124) = 7.02 p = .001, ηp² = 0.10], and psychological distress [F (2, 124) = 4.11 p = .019, ηp² = 0.06]. Post hoc tests showed that AAS dependents exhibited poorer EFs and reported more psychological distress compared to non-users.

CONCLUSION

AAS dependence is associated with executive dysfunction, which might be related to continued abuse despite adverse side-effects and social consequences. Increased awareness of executive dysfunction could have important implications for treatment and rehabilitation.

Adolescent Anabolic-Androgenic Steroid Use in Association with Other Drug Use, Injection Drug Use, and Team Sport Participation

Introduction

The majority of epidemiologic research on adolescent non-medical anabolic-androgenic steroid (AAS) use was conducted in the 1990s and early 2000s, indicating a need to update evidence for the modern era. We aim to understand the prevalence of AAS use among US adolescents and assess associations between AAS use, sports participation, other drug use, and injection drug use (IDU).

Methods

Using data from the 2017 National Youth Risk Behavior Survey, we estimated the prevalence of AAS use and tested for associations between AAS use, sports participation, and drug use, overall and by sex.

Results

The prevalence of AAS use was 2.98%. The prevalence among boys (3.46%) was higher than among girls (2.41%). AAS use was high among youth with lifetime heroin use (64.41%) and IDU (64.42%). There was no association between AAS and team sport participation (p=0.61).

Conclusions

Our results indicate that adolescent AAS use is an aspect of polysubstance use rather than a substance used solely for performance enhancement in sports. Research with adolescents should be mindful of the overlap of heroin and AAS use among youth with IDU.

Anabolic androgenic steroid dependence is associated with impaired emotion recognition

RATIONALE

Illicit use of anabolic androgenic steroids (AAS) has grown into a serious public health concern throughout the Western World. AAS use is associated with adverse medical, psychological, and social consequences. Around 30% of AAS users develop a dependence syndrome with sustained use despite adverse side effects. AAS dependence is associated with a high frequency of intra- and interpersonal problems, and it is central to identify factors related to the development and maintenance of dependence.

METHODS

The present study investigated the ability to recognize emotion from biological motion. The emotional biological motion task was administered to male AAS dependent users (AAS dependents; n = 45), AAS non-dependent users (AAS non-dependents; n = 38) and a comparison-group of non-using weightlifters (non-users; n = 69).

RESULTS

Multivariate analysis of variance showed a general impairment in emotion recognition in AAS dependents, compared to the non-using weightlifters, whereas no significant impairment was observed in AAS non-dependents. Furthermore, AAS dependents showed impaired recognition of fearful stimuli compared to both AAS non-dependents and non-using weightlifters. The between-group effect remained significant after controlling for Intelligence Quotient (IQ), past 6 months of non-AAS drug use, antisocial personality problems, anxiety, and depression.

CONCLUSION

AAS dependents show impaired emotion recognition from body movement, fear in particular, which could potentially contribute to higher frequency of interpersonal problems and antisocial behaviors in this population.

Structural brain characteristics of anabolic-androgenic steroid dependence in men

AIM

To identify differences in brain morphology between dependent and non-dependent male anabolic-androgenic steroid (AAS) users.

DESIGN

This study used cross-sectional data from a longitudinal study on male weightlifters.

PARTICIPANTS

Oslo University Hospital, Norway.

SETTING

Eighty-one AAS users were divided into two groups; AAS-dependent (n = 43) and AAS-non-dependent (n = 38).

MEASUREMENTS

Neuroanatomical volumes and cerebral cortical thickness were estimated based on magnetic resonance imaging (MRI) using FreeSurfer. Background and health information were obtained using a semi-structured interview. AAS-dependence was evaluated in a standardized clinical interview using a version of the Structured Clinical Interview for DSM-IV, adapted to apply to AAS-dependence.

FINDINGS

Compared with non-dependent users, dependent users had significantly thinner cortex in three clusters of the right hemisphere and in five clusters of the left hemisphere, including frontal, temporal, parietal and occipital regions. Profound differences were seen in frontal regions (left pars orbitalis, cluster-wise P < 0.001, right superior frontal, cluster-wise P < 0.001), as has been observed in other dependencies. Group differences were also seen when excluding participants with previous or current non-AAS drug abuse (left pre-central, cluster-wise P < 0.001, left pars orbitalis, cluster-wise P = 0.010).

CONCLUSION

Male dependent anabolic-androgenic steroid users appear to have thinner cortex in widespread regions, specifically in pre-frontal areas involved in inhibitory control and emotional regulation, compared with non-dependent anabolic-androgenic steroid users.

DOPING SURVEY IN THE YOUTH SCHOOL GAMES IN BRAZIL

ABSTRACT Introduction: Doping control is an important means for preventing the use of illegal substances and methods in sports. Objective: This study investigated the self-reported use of illegal substances among young Brazilian students in the Youth School Games, the main sporting event among school-aged athletes in Brazil with almost 2 million students during all the phases. Methods: Cross-sectional study with athletes of the Youth School Games 2006 aged 14-17 years. The subjects were randomly selected and completed an anonymous questionnaire about substances use. Chi-square test was used for comparison of proportions between different variables on self-reported use of substances. Univariate and multivariate analyzes and logistic regression were performed. Results: Among the 402 athletes (aged 14-17) who volunteered to participate, the results showed high prevalence of alcohol (35.8%), nutritional supplements (39.1%), and tobacco (5.4%). Regarding illegal drugs and doping, 1.7% reported the use of stimulants, 2.2% illicit drugs, 0.5% anabolic steroids, and 1.7% hormones and other similar substances. Moreover, a different use of stimulants was found (especially Judo and Table tennis), medications (especially Judo and Chess) and dietary supplements (especially Swimming and Judo, with over 50% reported use). Conclusion: The present study suggests that the use of substances among young athletes is similar to the results found among adult Olympic athletes as per International Olympic Committee and World Anti-Doping Agency, especially regarding the use of dietary supplements, anabolic steroids, and stimulants according to data collected by other studies. We consider that the findings of the present work indicate the need for specific efforts to monitor, prevent, and control use of substances among school athletes in big events and competitions, such as this research on doping in the Youth School Games.

Aggression Is Associated With Increased Anabolic-Androgenic Steroid Use Contemplation Among Adolescents

We investigated the relationship between aggression and anabolic-androgenic steroid (AAS) use intent among adolescents. A nationally representative sample of Norwegian 18-year-olds (N = 1,334, females = 58.7%) took part in a survey in 2013 (response rate = 64.9%). Participants completed the physical and verbal subscales of the Short-Form Buss-Perry Aggression Questionnaire, the Intent to use AAS Scale, the Alcohol Use Disorders Identification Test-Consumption, and the Hospital Anxiety and Depression Scale. They also provided demographic information and answered questions about AAS use, gambling participation, as well as cigarette and snus use. Descriptive statistics and multinomial logistic regression were used to analyze the data. Lifetime and past year prevalence of AAS use was 0.1%. Between 0.4% and 1.7% of participants disclosed intent to use while between 1.1% and 2.5% expressed neutral intent to initiate AAS use. Compared to persons low on aggression, individuals high on aggression were more likely to report intent and curiosity towards initiating AAS use. Our findings indicate that aggression is a risk factor for AAS use contemplation among adolescents.

Mad men, women and steroid cocktails: a review of the impact of sex and other factors on anabolic androgenic steroids effects on affective behaviors

RATIONALE

For several decades, elite athletes and a growing number of recreational consumers have used anabolic androgenic steroids (AAS) as performance enhancing drugs. Despite mounting evidence that illicit use of these synthetic steroids has detrimental effects on affective states, information available on sex-specific actions of these drugs is lacking.

OBJECTIVES

The focus of this review is to assess information to date on the importance of sex and its interaction with other environmental factors on affective behaviors, with an emphasis on data derived from non-human studies.

METHODS

The PubMed database was searched for relevant studies in both sexes.

RESULTS

Studies examining AAS use in females are limited, reflecting the lower prevalence of use in this sex. Data, however, indicate significant sex-specific differences in AAS effects on anxiety-like and aggressive behaviors, interactions with other drugs of abuse, and the interplay of AAS with other environmental factors such as diet and exercise.

CONCLUSIONS

Current methods for assessing AAS use have limitations that suggest biases of both under- and over-reporting, which may be amplified for females who are poorly represented in self-report studies of human subjects and are rarely used in animal studies. Data from animal literature suggest that there are significant sex-specific differences in the impact of AAS on aggression, anxiety, and concomitant use of other abused substances. These results have relevance for human females who take these drugs as performance-enhancing substances and for transgender XX individuals who may illicitly self-administer AAS as they transition to a male gender identity.

Sexual risk behaviors and steroid use among sexual minority adolescent boys

BACKGROUND

Previous research has extensively examined the relationship between the use of alcohol and illicit substances with sexual risk behaviors among sexual minority (i.e., gay and bisexual) male youth; however, no known studies have assessed the association of steroid use to risk behaviors among this population.

METHODS

Participants were 556 sexually active sexual minority adolescent boys (M age=16.2, SD=1.3), taken from a pooled dataset of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. The association between lifetime use of steroids and sexual risk behaviors were examined.

RESULTS

Controlling for number of sexual partners, depression, victimization, and race, boys who reported increased steroid use were at increased odds of engaging in condomless sex, OR=1.55, p=.003, and use of alcohol/drugs during sex, OR=1.48, p=.002.

CONCLUSIONS

Steroid use among sexual minority adolescent boys is prevalent and associated with HIV/STI sexual transmission risk behaviors.

Aggression and body image concerns among anabolic androgenic steroid users, contemplators, and controls in Norway

AAS users and contemplators were investigated for differences in aggression and body image concern. Prevalence rates were sought as a secondary aim. 396 male adolescents at Norwegian high schools completed a questionnaire battery during school hours. Prevalence of AAS use showed 4.0%; AAS contemplation showed 5.1%. No significant differences between the AAS users and contemplators were found on levels of aggression and body image concern. AAS users and contemplators reported significantly higher levels of aggression and body image concern compared nonusing controls. AAS contemplators enhance understanding of AAS use by representing psychosocial factors contributing to increased aggression, and AAS use or risk thereof indicative of an aggressive personality profile. Body image concerns for AAS users and contemplators may indicate that AAS use does not diminish body image concern, and that body image concern is a risk factor for AAS use. This is supportive of previous research.

Prevalence and correlates of anabolic-androgenic steroid use in a nationally representative sample of 17-year-old Norwegian adolescents

BACKGROUND

Anabolic-androgenic steroid (AAS) use has been identified as a serious public health problem.

OBJECTIVES

This study investigates the prevalence and correlates of AAS use among Norwegian adolescents.

METHODS

In 2012, a nationally representative sample of 2,055 17-year-old adolescents (963 males and 1,088 females) participated in a survey. The response rate was 70.4%. In addition to questions about AAS use, participants completed the Parental Monitoring Scale, the Family Relations/Cohesion Scale, the Alcohol Use Disorders Identification Test C, the Mini-International Personality Item Pool-Five-Factor Model, the Eysenck Narrow Impulsiveness Subscale, the Arnett Inventory of Sensation Seeking, the Short-Form Buss-Perry Aggression Questionnaire, the Hospital Anxiety and Depression Scale, and the UCLA Loneliness Scale. They also answered questions about demography, gambling, smoking, snus, and narcotic use. Descriptive statistics and logistic regression were used to analyze the data.

RESULTS

The lifetime prevalence of AAS use was 0.30% (0.52% in males and 0.09% in females), while current prevalence was 0.25%. Moreover, 19.39% of the sample reported having an acquaintance who used or had used AAS. Having an acquaintance who used or had used AAS was significantly related to snus use, depression, aggression, extraversion, and conscientiousness in both univariate and multivariate logistic regression analyses. Conclusions/Importance: Our findings suggest a high prevalence of AAS use among Norwegian adolescents and denote the significance of social, personality, and health factors in adolescents' exposure to AAS milieu.

Frequency of use, awareness, and attitudes toward side effects of anabolic-androgenic steroids consumption among male medical students in Iran

This study was conducted to determine the frequency of anabolic-androgenic steroids consumption in male students studying at the university and their awareness, attitude, and role of sports activities; the present descriptive study was conducted on 271 volunteers in 2008. The data collected by self-report questionnaires was analyzed by descriptive inferential statistics. The prevalence of consumption was 3.3%, and it was significantly higher in those with a history of bodybuilding or athletic performance. The overall awareness rate was low, and the attitude was too optimistic. It seems that unawareness, incorrect attitude, and history of athletic performance increases the risk of consumption.

A systematic review of self-medication practices among adolescents

The purpose was to systematically review the global trends and factors influencing self-medication (SM) among adolescents. Databases (Medline/Pubmed, Ingenta, Cochrane Library, EMBASE, CINAHL, Proquest, Scopus, and Google Scholar) were searched for peer-reviewed research published between January 2000 and December 2013 on SM among adolescents aged 13-18 years. Articles were scrutinized for country of origin, sample size, recall period, prevalence rates and associations, influencing factors, medicines used, self-medicated health complaints, sources of drug information, recommendation and procurement, knowledge about medicines, and adverse drug reactions. One hundred and sixty-three publications met the inclusion criteria. SM prevalence ranged from 2% to 92% in different countries. The most frequently self-medicated over-the-counter and prescription-only medicines were analgesics and antibiotics, respectively. Headache, allergies, and fever were the most common self-medicated health complaints reported. Misuse of both over-the-counter and prescription-only medicines reflected a risky trend. Female gender, older age, maternal education, and familial practices were associated with SM among adolescents. The primary sources of drug information, recommendation, and procurement included pharmacists, parents, and friends. High-risk practices such as diversion of prescription medicines and utilization of previous prescriptions were also reported. Most studies revealed gaps in drug knowledge, although adolescents self-rated it as satisfactory. However, few adverse drug reactions were reported, probably because of lack of awareness about the potential harmful effects of medicines. Recommendations for "responsible SM" have been made to minimize the adverse effects of SM. Understanding the links between various factors promoting SM can be helpful in deriving strategies aimed at reducing drug-related health risks among adolescents. Moreover, these will aid in creating awareness among adolescents about the potential risks of using drugs without proper information and consultation. Studies need to be designed to assess the changing trend and identify new correlates of self-medication practices among adolescents, which pose fresh challenges to monitor the menace.

Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys

OBJECTIVES

We compared the lifetime prevalence of anabolic-androgenic steroid (AAS) misuse among sexual minority versus heterosexual U.S. adolescent boys, and secondarily, sought to explore possible intermediate variables that may explain prevalence differences.

METHODS

Participants were 17,250 adolescent boys taken from a pooled data set of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. Data were analyzed for overall prevalence of AAS misuse and possible intermediary risk factors.

RESULTS

Sexual minority adolescent boys were at an increased odds of 5.8 (95% confidence interval 4.1-8.2) to report a lifetime prevalence of AAS (21% vs. 4%) compared with their heterosexual counterparts, P < .001. Exploratory analyses suggested that increased depressive symptoms/suicidality, victimization, and substance use contributed to this disparity.

CONCLUSIONS

This is the first known study to test and find substantial health disparities in the prevalence of AAS misuse as a function of sexual orientation. Prevention and intervention efforts are needed for sexual minority adolescent boys.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

Nonmedical AAS use is a serious widespread public health problem.

Eating disorders and anabolic androgenic steroids in males--similarities and differences in self-image and psychiatric symptoms

Background

Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use.

Aim

The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.

Methods

This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List.

Results

The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image.

Conclusions

The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.

Anabolic-androgenic steroids and condom use: potential mechanisms in adolescent males

Previous research has revealed a significant bivariate relationship between anabolic-androgenic steroid (AAS) use and reduced condom use among adolescent boys. However, to date, no known studies have explored the psychological mechanisms that may explain this relationship. Thus, the current study sought to examine two possible mediators in the association between AAS and condom use: depressive symptoms and substance use. Data were extracted from a nationally representative sample of U.S. adolescents. Participants were 3,780 U.S. high school boys who responded to self-report items assessing a number of health behaviors, including symptoms of depression, substance use, AAS use, and use of condoms during their most recent act of intercourse. Both depression and substance use were significant mediators in the relationship between AAS and condom use. However, when these effects were contrasted, the indirect effect of substance use was significantly stronger in magnitude than the effect of depression. Although AAS use was associated with sexual risk behaviors among adolescent boys, significant variance in this relationship was accounted for by elevated levels of depression and substance use, with substance use demonstrating a particularly salient pathway.

Corticotropin-releasing factor modulation of forebrain GABAergic transmission has a pivotal role in the expression of anabolic steroid-induced anxiety in the female mouse

Increased anxiety is commonly observed in individuals who illicitly administer anabolic androgenic steroids (AAS). Behavioral effects of steroid abuse have become an increasing concern in adults and adolescents of both sexes. The dorsolateral bed nucleus of the stria terminalis (dlBnST) has a critical role in the expression of diffuse anxiety and is a key site of action for the anxiogenic neuromodulator, corticotropin releasing factor (CRF). Here we demonstrate that chronic, but not acute, exposure of female mice during adolescence to AAS augments anxiety-like behaviors; effects that were blocked by central infusion of the CRF receptor type 1 antagonist, antalarmin. AAS treatment selectively increased action potential (AP) firing in neurons of the central amygdala (CeA) that project to the dlBnST, increased the frequency of GABA(A) receptor-mediated spontaneous inhibitory postsynaptic currents (sIPSCs) in dlBnST target neurons, and decreased both c-FOS immunoreactivity (IR) and AP frequency in these postsynaptic cells. Acute application of antalarmin abrogated the enhancement of GABAergic inhibition induced by chronic AAS exposure whereas application of CRF to brain slices of naïve mice mimicked the actions of this treatment. These results, in concert with previous data demonstrating that chronic AAS treatment results in enhanced levels of CRF mRNA in the CeA and increased CRF-IR in the dlBnST neuropil, are consistent with a mechanism in which the enhanced anxiety elicited by chronic AAS exposure involves augmented inhibitory activity of CeA afferents to the dlBnST and CRF-dependent enhancement of GABAergic inhibition in this brain region.

Anabolic androgenic steroid abuse: multiple mechanisms of regulation of GABAergic synapses in neuroendocrine control regions of the rodent forebrain

Anabolic androgenic steroids (AAS) are synthetic derivatives of testosterone originally developed for clinical purposes but are now predominantly taken at suprapharmacological levels as drugs of abuse. To date, almost 100 different AAS compounds that vary in metabolic fate and physiological effects have been designed and synthesised. Although they are administered for their ability to enhance muscle mass and performance, untoward side effects of AAS use include changes in reproductive and sexual behaviours. Specifically, AAS, depending on the type of compound administered, can delay or advance pubertal onset, lead to irregular oestrous cyclicity, diminish male and female sexual behaviours, and accelerate reproductive senescence. Numerous brains regions and neurotransmitter signalling systems are involved in the generation of these behaviours, and are potential targets for both chronic and acute actions of the AAS. However, critical to all of these behaviours is neurotransmission mediated by GABA(A) receptors within a nexus of interconnected forebrain regions that includes the medial preoptic area, the anteroventral periventricular nucleus and the arcuate nucleus of the hypothalamus. We review how exposure to AAS alters GABAergic transmission and neural activity within these forebrain regions, taking advantage of in vitro systems and both wild-type and genetically altered mouse strains, aiming to better understand how these synthetic steroids affect the neural systems that underlie the regulation of reproduction and the expression of sexual behaviours.

The use of anabolic androgenic steroids and polypharmacy: a review of the literature

BACKGROUND

A review of the literature was conducted to examine the relationship between the use of anabolic androgenic steroid (AAS) use and the use of other drugs.

METHODS

Studies published between the years of 1995 and 2010 were included in the review.

RESULTS

The use of AAS is positively associated with use of alcohol, illicit drugs and legal performance enhancing substances. In contrast, the relationship between AAS and the use of tobacco and cannabis is mixed.

CONCLUSION

Results of the review indicate that the relationship between AAS use and other substance use depends on the type of substance studied. Implications for treatment and prevention are discussed. Suggestions for future research are provided.

Sport, and use of anabolic androgenic steroids among Icelandic high school students: a critical test of three perspectives

BACKGROUND

This study investigates the use of anabolic androgenic steroids (AAS) among a national representative sample of high school students in Iceland. We test several hypotheses drawn from three perspectives. The first perspective focuses on the use of AAS as an individual phenomenon motivated by the desire to succeed in sport. The second perspective views the use of AAS as shaped by norms and values embedded in social relationships of formally organized sport. The third perspective suggests that factors outside sport, which have been shown to correlate with the use of other substances, predict the use of AAS.

METHOD

We use logistic regression and predicted probabilities to analyze data from a national representative survey of 11,031 Icelandic high school students.

RESULTS

Our results indicated that the use of AAS is not significantly related to participation in formally organized sports. However, it positively relates to fitness and physical training in informal contexts. We found a relatively strong relationship between the use of AAS and the use of illicit substances and a moderate relationship between AAS use and alcohol and tobacco consumption. We also found a significant negative relationship between AAS use and school integration and school achievement, and a significant positive relationship between AAS use and school anomie. The relation between AAS use and family-related variables was weaker. Finally, we found that the relationship between sport participation, physical exercise, and AAS use varies across levels of anomie and integration.

CONCLUSION

Our findings suggest that the use of AAS and especially illegal substances should be considered more as a social and a health problem rather than a sport specific issue. We found that high school students participating in fitness and informal training outside of formally organized sport clubs are the main risk group and should be the target of prevention efforts. However, this should not be done at the expense of general risk factors that affect AAS and other substances used by the general population. Finally, we suggest that prevention efforts should target both groups and individuals.

Chronic anabolic androgenic steroid exposure alters corticotropin releasing factor expression and anxiety-like behaviors in the female mouse

In the past several decades, the therapeutic use of anabolic androgenic steroids (AAS) has been overshadowed by illicit use of these drugs by elite athletes and a growing number of adolescents to enhance performance and body image. As with adults, AAS use by adolescents is associated with a range of behavioral effects, including increased anxiety and altered responses to stress. It has been suggested that adolescents, especially adolescent females, may be particularly susceptible to the effects of these steroids, but few experiments in animal models have been performed to test this assertion. Here we show that chronic exposure of adolescent female mice to a mixture of three commonly abused AAS (testosterone cypionate, nandrolone decanoate and methandrostenolone; 7.5 mg/kg/day for 5 days) significantly enhanced anxiety-like behavior as assessed by the acoustic startle response (ASR), but did not augment the fear-potentiated startle response (FPS) or alter sensorimotor gating as assessed by prepulse inhibition of the acoustic startle response (PPI). AAS treatment also significantly increased the levels of corticotropin releasing factor (CRF) mRNA and somal-associated CRF immunoreactivity in the central nucleus of the amygdala (CeA), as well as neuropil-associated immunoreactivity in the dorsal aspect of the anterolateral division of the bed nucleus of the stria terminalis (dBnST). AAS treatment did not alter CRF receptor 1 or 2 mRNA in either the CeA or the dBnST; CRF immunoreactivity in the ventral BnST, the paraventricular nucleus (PVN) or the median eminence (ME); or peripheral levels of corticosterone. These results suggest that chronic AAS treatment of adolescent female mice may enhance generalized anxiety, but not sensorimotor gating or learned fear, via a mechanism that involves increased CRF-mediated signaling from CeA neurons projecting to the dBnST.

The epidemiology of anabolic-androgenic steroid use among Australian secondary school students

There is evidence to suggest that the prevalence of anabolic-androgenic steroids (AAS) is higher among young people than the general population. The purpose of the current study was to examine the proportion of students who reported lifetime and past-year AAS use, explore other drug use among those who reported AAS use, and investigate demographic correlates of AAS use. Data was taken from a cross-sectional survey of a representative sample of Australian secondary students. A stratified two-stage probability sampling methodology was employed and schools were randomly sampled from each Australian State and Territory. A total of 376 schools participated in the survey. Lifetime AAS use was reported by 2.4% of 12-17-year-old students; use was more common among 12-15-year olds then 16-17-year olds. Regardless of age, being male, speaking a language other than English at home, not be at school on the previous school day, and rating own scholastic ability as below average were all associated with a greater likelihood of using AAS in their lifetime and in the past year. Those who reported AAS use also reported the use of a range of other substances, suggesting that AAS use may be part of a broader experimentation with substances. Interventions towards these groups regarding AAS may best be placed within a larger substance use intervention rather than being AAS-specific. In light of the low levels of AAS use among this group, more detailed research into AAS use among adolescent sporting groups may be warranted.

Substance use and misuse among professional ballet dancers

This study investigated substance use and misuse among 16 female and 9 male Croatian ballet professionals in 2008 using an original questionnaire. We analyzed social, personal, activity- and training-related, and educational factors, and criteria such as: binge alcohol drinking, cigarette smoking, appetite suppressant consumption, analgesic use, and actual and potential "doping" habits. Frequency tables and rank-order correlation were calculated. More than one third of the male dancers reported binge drinking, while 20% of the females smoked more than a box of cigarettes per day. Almost 25% of these dancers will use "doping" if it will ensure successful ballet performance, regardless of negative health consequences. In males, the risk of potential "doping" behavior increased with age. In females, education level was negatively related to cigarette smoking, but positively correlated to potential "doping" habits and behavior. In both genders, religiousness was the factor negatively related to the following: (1) potential "doping" behavior and (2) belief that "doping" exists in professional ballet. Results suggest that there is evident need for more specific medical and/or psychological services in professional ballet. The study's limitations are noted.

Substance use and misuse among Slovenian table tennis players

Substance use and misuse (SU&M) is regularly studied in sports, but we have found no such data for table tennis. We have studied SU&M in athletes competing at the Slovenian Nationals 2008-2009 (responding rate was 100%; 50 males and 29 females; aged 18 years or older). The anonymous questionnaire for studying SU&M and corresponding educational, socio-demographic, and sport factors was used. More than 90% of all the athletes included in our study do not rely on coaches' and/or physicians' opinion regarding nutritional supplements and doping. Chi-square test revealed higher prevalence of binge drinking, cigarette smoking, and potential doping behavior in males. In both genders, with the advancement of the sport status, the probability for potential doping behavior increases. In conclusion, we strongly suggest permanent SU&M educational programs for table tennis athletes as well as for their coaches and physicians.

Position stand on androgen and human growth hormone use

Hoffman, JR, Kraemer, WJ, Bhasin, S, Storer, T, Ratamess, NA, Haff, GG, Willoughby, DS, and Rogol, AD. Position stand on Androgen and human growth hormone use. J Strength Cond Res 23(5): S1-S59, 2009-Perceived yet often misunderstood demands of a sport, overt benefits of anabolic drugs, and the inability to be offered any effective alternatives has fueled anabolic drug abuse despite any consequences. Motivational interactions with many situational demands including the desire for improved body image, sport performance, physical function, and body size influence and fuel such negative decisions. Positive countermeasures to deter the abuse of anabolic drugs are complex and yet unclear. Furthermore, anabolic drugs work and the optimized training and nutritional programs needed to cut into the magnitude of improvement mediated by drug abuse require more work, dedication, and preparation on the part of both athletes and coaches alike. Few shortcuts are available to the athlete who desires to train naturally. Historically, the NSCA has placed an emphasis on education to help athletes, coaches, and strength and conditioning professionals become more knowledgeable, highly skilled, and technically trained in their approach to exercise program design and implementation. Optimizing nutritional strategies are a vital interface to help cope with exercise and sport demands (). In addition, research-based supplements will also have to be acknowledged as a strategic set of tools (e.g., protein supplements before and after resistance exercise workout) that can be used in conjunction with optimized nutrition to allow more effective adaptation and recovery from exercise. Resistance exercise is the most effective anabolic form of exercise, and over the past 20 years, the research base for resistance exercise has just started to develop to a significant volume of work to help in the decision-making process in program design (). The interface with nutritional strategies has been less studied, yet may yield even greater benefits to the individual athlete in their attempt to train naturally. Nevertheless, these are the 2 domains that require the most attention when trying to optimize the physical adaptations to exercise training without drug use.Recent surveys indicate that the prevalence of androgen use among adolescents has decreased over the past 10-15 years (). The decrease in androgen use among these students may be attributed to several factors related to education and viable alternatives (i.e., sport supplements) to substitute for illegal drug use. Although success has been achieved in using peer pressure to educate high school athletes on behaviors designed to reduce the intent to use androgens (), it has not had the far-reaching effect desired. It would appear that using the people who have the greatest influence on adolescents (coaches and teachers) be the primary focus of the educational program. It becomes imperative that coaches provide realistic training goals for their athletes and understand the difference between normal physiological adaptation to training or that is pharmaceutically enhanced. Only through a stringent coaching certification program will academic institutions be ensured that coaches that they hire will have the minimal knowledge to provide support to their athletes in helping them make the correct choices regarding sport supplements and performance-enhancing drugs.The NSCA rejects the use of androgens and hGH or any performance-enhancing drugs on the basis of ethics, the ideals of fair play in competition, and concerns for the athlete's health. The NSCA has based this position stand on a critical analysis of the scientific literature evaluating the effects of androgens and human growth hormone on human physiology and performance. The use of anabolic drugs to enhance athletic performance has become a major concern for professional sport organizations, sport governing bodies, and the federal government. It is the belief of the NSCA that through education and research we can mitigate the abuse of androgens and hGH by athletes. Due to the diversity of testosterone-related drugs and molecules, the term androgens is believed to be a more appropriate term for anabolic steroids.

Determinants of anabolic-androgenic steroid risk perceptions in youth populations: a multivariate analysis

Grounded conceptually in social cognitive theory, this research examines how personal, behavioral, and environmental factors are associated with risk perceptions of anabolic-androgenic steroids. Ordinal logistic regression and logit log-linear models applied to data gathered from high-school seniors (N = 2,160) in the 2005 Monitoring the Future study showed significant explanatory effects for sex, race, exposure to drug spots, steroid availability, peer use of steroids, sensation-seeking, depression, and self-esteem. Females, African Americans, and those who had seen drug spots the most frequently estimated higher levels of risk associated with steroid use, while those who indicated ease in obtaining steroids and those with close friends who had used the drugs estimated lower risk. Also estimating lower levels of risk were sensation seekers, those who appeared depressed, and those with low levels of self-esteem. Analyses reveal how steroid risk determinants may differ from those related to methylenedioxymethamphetamine (i.e., MDMA, ecstasy) and marijuana use.

Association between narcotic use and anabolic-androgenic steroid use among American adolescents

Drawing on the data gathered in the 2006 Monitoring the Future study of American youth, the present research examines associations between use of narcotics and use of anabolic-androgenic steroids (AASs) among high-school seniors (n = 2,489). With independent measures and controls including sex, race, media exposure, socializing with friends, participation in recreational and school-sponsored sports, perceptions of drug use among professional athletes, and perceptions of steroid use among close friends, binary logistic regression analyses revealed significant associations between AAS use and the use of alcohol, crack cocaine, Vicodin, gamma-hydroxybutyrate (GHB), Ketamine, and Rohypnol. While use of both AASs and the narcotic drugs generally did not eclipse 5% of the sample, the numbers extend to many thousands in larger populations. Implications for health practitioners and recommendations for future research are offered. The study's limitations are noted.

The development of multiple drug use among anabolic-androgenic steroid users: six subjective case reports

Background

The inappropriate use of anabolic androgenic steroids (AAS) was originally a problem among athletes but AAS are now often used in nonsport situations and by patients attending regular addiction clinics. The aim of this study was to improve understanding of the development of multiple drug use in patients seeking treatment at an addiction clinic for AAS-related problems.

Methods

We interviewed six patients (four men and two women) with experience of AAS use who were attending an addiction clinic for what they believed were AAS-related problems. The patients were interviewed in-depth about their life stories, with special emphasis on social background, substance use, the development of total drug use and subjective experienced psychological and physical side effects.

Results

There was significant variation in the development of drug use in relation to social background, onset of drug use, relationship to AAS use and experience of AAS effects. All patients had initially experienced positive effects from AAS but, over time, the negative experiences had outweighed the positive effects. All patients were dedicated to excess training and took AAS in combination with gym training, indicating that the use of these drugs is closely related to this form of training. Use of multiple drugs was common either in parallel with AAS use or serially.

Conclusion

The study shows the importance of understanding how AAS use can develop either with or without the concomitant use of other drugs of abuse. The use of AAS can, however, progress to the use of other drugs. The study also indicates the importance of obtaining accurate, comprehensive information about the development of AAS use in designing treatment programmes and prevention strategies in this area.

Trends in non-medical use of anabolic steroids by U.S. college students: results from four national surveys

This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids (NMAS) among U.S. college students. Data were collected through self-administered mail surveys, from 15,282, 14,428, 13,953, and 10,904 randomly selected college students at the same 119 nationally representative colleges in 1993, 1997, 1999 and 2001, respectively. The prevalence of lifetime, past-year and past-month NMAS was 1% or less and generally did not change significantly between 1993 and 2001, with one exception: past-year NMAS increased significantly among men from 1993 (0.36%) to 2001 (0.90%). Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics. Lifetime and past-year NMAS were also positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders. Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV alcohol use disorder. Although the overall prevalence of NMAS remained low between 1993 and 2001, findings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior is associated with a wide range of risky health behaviors. The characteristics associated with NMAS have important implications for future practice and research.

Anabolic steroid abuse among teenage girls: an illusory problem?

BACKGROUND

Recent media reports have portrayed an alarming increase in apparent anabolic-androgenic steroid (AAS) use among American teenage girls; Congress even held hearings on the subject in June 2005. We questioned whether AAS use among teenage girls was as widespread as claimed.

METHODS

We reviewed four large national surveys and many smaller surveys examining the prevalence of AAS use among teenage girls. Virtually all of these surveys used anonymous questionnaires. We asked particularly whether the language of survey questions might generate false-positive responses among girls who misinterpreted the term "steroid." We also reviewed data from other countries, together with results from the only recent study (to our knowledge) in which investigators personally interviewed female AAS users.

RESULTS

The surveys produced remarkably disparate findings, with the lifetime prevalence of AAS use estimated as high as 7.3% among ninth-grade girls in one study, but only 0.1% among teenage girls in several others. Upon examining the surveys reporting an elevated prevalence, it appeared that most used questions that failed to distinguish between anabolic steroids, corticosteroids, and over-the-counter supplements that respondents might confuse with "steroids." Other features in the phrasing of certain questions also seemed likely to further bias results in favor of false-positive responses.

CONCLUSIONS

Many anonymous surveys, using imprecise questions, appear to have greatly overestimated the lifetime prevalence of AAS use among teenage girls; the true lifetime prevalence may well be as low as 0.1%. Future studies can test this impression by using a carefully phrased question regarding AAS use.

Self-administration of 3α-androstanediol increases locomotion and analgesia and decreases aggressive behavior of male hamsters

Androgens, such as testosterone (T), can have reinforcing effect, which may be due in part to actions of T's metabolite, 3alpha-androstanediol (3alpha-diol). To investigate rewarding effects of 3alpha-diol, gonadally intact adult male hamsters were given a two-bottle choice test to determine the amount of 3alpha-diol that would be self-administered over 4 days of exposure. After 2 days of habituation and 4 days of monitoring of consumption, hamsters were tested in an activity monitor and the open field (locomotion/exploration), paw lick (analgesia) and resident-intruder (aggression) tasks. Hamsters consumed significantly more 3alpha-diol than vehicle in the two-bottle choice test. Hamsters that were allowed to self-administer 3alpha-diol made significantly more beam breaks and total entries in the open field had increased latencies to pawlick, and engaged in significantly fewer attacks, than did hamsters with access to vehicle alone. Hamsters that self-administered 3alpha-diol had higher levels of 3alpha-diol in serum, hippocampus, prefrontal cortex, striatum and midbrain than did hamsters with access to vehicle alone. Together, these data suggest that 3alpha-diol may have rewarding effects.

Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem

Abuse of anabolic-androgenic steroids (AAS) by members of fitness centers and others in Germany has reached alarming dimensions. The health care system provides the illegal AAS to 48.1 % of abusers. Physicians are involved in illegal prescription of AAS and monitoring of 32.1 % of AAS abusers. Besides health-threatening cardiovascular, hepatotoxic and psychiatric long-term side effects of AAS, acne occurs in about 50 % of AAS abusers and is an important clinical indicator of AAS abuse, especially in young men 18-26 years of age. Both acne conglobata and acne fulminans can be induced by AAS abuse. The dermatologist should recognize bodybuilding acne, address the AAS abuse, and warn the patient about other potential hazards.

Sex- and age-specific effects of anabolic androgenic steroids on reproductive behaviors and on GABAergic transmission in neuroendocrine control regions

Illicit use of anabolic androgenic steroids (AAS) has become a prevalent health concern not only among male professional athletes, but, disturbingly, among a growing number of women and adolescent girls. Despite the increasing use of AAS among women and adolescents, few studies have focused on the effects of these steroids in females, and female adolescent subjects are particularly underrepresented. Among the hallmarks of AAS abuse are changes in reproductive behaviors. Here, we discuss work from our laboratories on the actions of AAS on the onset of puberty and sexual behaviors in female rodents, AAS interactions and sex- and age-specific effects of these steroids on neural transmission mediated by gamma-aminobutyric acid receptors within forebrain neuroendocrine control regions that may underlie AAS-induced changes in these behaviors.