The assessment of liver function test and fertility hormones in Saudi athletes using anabolic androgenic steroids

Background

A growing number of athletes are using synthetic anabolic-androgenic steroids (AAS), comprised of testosterone and other derivatives, to enhance athletic performance and muscle mass. Over the years, numerous reports elucidated the side effects of the illegal use of AAS, such as infertility, and liver disorders. The effect of AAS on the hepatic and reproductive systems in Saudi athletes has not yet been studied. Therefore, this study examined the liver function and sex hormone parameters of AAS users as compared to non-users.

Methods

Fasting blood samples were collected from 16 male Saudi athletes, 10 AAS-users (cases) and 6 non-users (controls) to measure liver function tests (ALT, AST, GGT, ALP, total protein, albumin, direct and total bilirubin) and muscle enzymes (CK, LDH), Fertility hormones (LH, FSH, total testosterone, estradiol, and prolactin) were included also. Furthermore, a self-reported questionnaire was obtained to identify the type of AAS used, the dosage, and the length of the course before sample collection.

Results

The results show a statistically significant increase in ALT (P < 0.001), AST (P < 0.001), CK (P < 0.05), and a significant decrease (P < 0.05) in albumin (P < 0.001) and total bilirubin levels (P < 0.01) in AAS-users. Total testosterone increased significantly among AAS (P < 0.05), along with a significant decrease in LH (P < 0.01), and FSH (P < 0.001) levels, while serum prolactin and estradiol levels were significantly increased (P < 0.05).

Conclusion

AAS can enhance physical performance and appearance, its potential adverse effects on the hepatic and reproductive systems necessitate careful consideration. Our research demonstrates an increase in the liver-specific enzyme ALT in AAS users relative to non-users and the possibility that short-term AAS usage increases the risk of liver injury.

Knowledge and attitudes toward the use of anabolic-androgenic steroids among physical education university students: a cross-sectional study from Palestine

The use of androgenic-anabolic steroids (AASs) has increased in recent years, especially among athletes, due to their effect on body shape and performance. These agents could have serious side effects on this highly susceptible population, which tends to use these substances frequently to promote muscle growth and physical performance. Therefore, this study aimed to evaluate the knowledge and attitudes toward the use of anabolic androgenic steroids among physical education university students in Palestine. A cross-sectional study of physical education students from November 2020 to January 2021 was conducted using an electronic questionnaire. The main outcome was to measure the level of knowledge and use of the AAS. A total of 380 students were included. The mean age of the students was 21 years (SD = 4.2), and the study participants were distributed almost equally according to sex. Approximately a quarter of the students were smokers. Eighty percent (80%) of the study participants were from the West Bank, while the remaining 20% were from Jerusalem and 48 territories. Furthermore, most of the students lived with their families; half lived in cities, approximately 152 (40%) lived in villages, and only 29 (8%) lived in camps. The average level of knowledge of the AAS was 2.95 out of 8 (37/100), with a median of three. Furthermore, only 36 (10%) of the participants had satisfactory knowledge, scoring 80% or more. Regarding the use of AAS, 11 (2.9%) participants, all males, confirmed that they were currently using AAS. Additionally, approximately 28 (7%) had previously used them, while 30 (8%) planned to try them in the future. Overall, 221 (58%) patients were confirmed to use vitamins and minerals. Our study showed that most of the participants had a substantial lack of information on the potential side effects of AAS, while the level of use was comparable with that of other populations.

Knowledge and Awareness About Anabolic-Androgenic Steroid Use as a Body Shape Enhancer and Its Side Effects Among Adult Gym Participants in Jeddah, Saudi Arabia

BACKGROUND

Anabolic steroids, often referred to as anabolic-androgenic steroids, are steroidal androgens that include testosterone and other naturally occurring androgens, as well as synthetic androgens that are chemically linked to testosterone and have similar actions.

MATERIAL AND METHODS

A cross-sectional study was conducted to evaluate the knowledge and awareness about anabolic-androgenic steroid (AAS) use and its side effects among adult gym participants in Jeddah. A total of 269 adults fulfilling the inclusion criteria were included. The questionnaire covered the demographics, attitudes, and behaviors associated with AAS use and consisted of single-response questions and four multiple-response questions. All statistical methods used were two-tailed with an alpha level of 0.05, considering significance if the p-value was less than or equal to 0.05. The overall awareness score was categorized as "poor" if the students' score was less than 60% of the overall score and "good" if the students' score was 60% or more. Descriptive analysis was done by prescribing frequency distributions and percentages for study variables, including the adult's personal data, reasons for going to the gym, and duration.

RESULTS

This study shows a prevalence of 6.3% of adults' use of AAS, which was higher than in some regions in Saudi Arabia. The largest age group that uses AAS, according to this study, is 26-45 years old. A total of 185 (68.8%) were males, and a total of 185 (68.8%) were university graduates. The most reported reasons for going to the gym included fitness (63.2%), muscle building (52.8%), entertainment (39.4%), and weight loss (37.9%). 94.4% of people think that anabolic steroids are harmful to the body, and 80.3% know that misuse of anabolic steroids may lead to problems with the kidneys and liver. 75.1% of male adults and 76.8% of university graduates had good knowledge and awareness. The internet is the most common source of information.

CONCLUSION

Our study provides clear evidence that there is a high awareness of AAS and its side effects and a high prevalence of its use among male gym participants in Jeddah. The use of AAS is a national problem that the authorities need to act on. There is a strong need for health policy reforms to reduce the rise of AAS use among young adults.

The awareness and experience of healthcare providers with the use of anabolic androgenic steroids by gym users

OBJECTIVES

This study aims to evaluate healthcare providers' awareness and experience with anabolic androgenic steroid (AAS) use among gym users in Jordan and their role in mitigating AAS misuse.

METHODS

A cross-sectional study was conducted between November 2022 and Feb 2023. During the study period, 158 physicians involved in prescribing AAS or treating adverse effects associated with these agents were invited to participate. A questionnaire was created and uploaded on Google Forms and distributed through social media platforms to reach physicians from different medical subspecialties.

RESULTS

Of the 158 physicians surveyed, 30.4% were general practitioners, and 63.3% reported having formal education about the risks of bodybuilding with AAS. Among the participants, 48.7% had encountered gym users who were using AAS, with the main reason for referral being the management of side effects associated with AAS use. The median knowledge score regarding AAS and their complications was 10.0 out of 14 (IQR = 7.0), indicating adequate knowledge about most AAS side effects. Around 46% of the physicians (n = 73, 46.2%) believed that gym users might struggle to disclose AAS because they lack trust in them. Finally, the most common advice to gym users was informing them about the health-associated consequences of AAS use, with 92.2% of physicians providing this advice.

CONCLUSION

Although healthcare professionals in Jordan had adequate knowledge about AAS, they needed more to make them confident in dealing with AAS use. This highlights the necessity for specialized teaching and training programs to enhance their knowledge and skills in providing accurate information to AAS users.

Early Pharmacologic Approaches to Avert Anabolic Steroid-induced Male Infertility: A Narrative Review

PURPOSE

To review the impact of testosterone and other androgenic-anabolic steroids (AASs) on male fertility, exploring potential drugs that can be used to preserve or restore male fertility upon AAS use or prior contact.

METHODS

A review was performed to provide a unifying clinical link between drugs used to preserve or restore male fertility (ie, clomiphene citrate, human chorionic gonadotropin, selective estrogen receptor modulators, recombinant luteinizing and follicle-stimulating hormones, and human menopausal gonadotrophin) in the context of AAS-induced infertility and related aspects.

FINDINGS

Human chorionic gonadotropin (125-500 IU every other day), clomiphene citrate (12.5-50 mg/d), recombinant luteinizing hormone (125-500 IU every other day), recombinant follicle-stimulating hormone (75-150 IU 1-3×/wk), and human menopausal gonadotrophin (75-150 IU 1-3×/wk) are promising early pharmacologic approaches to avert AAS-induced male infertility. Additionally, a full partner assessment is crucial to the success of a couple planning to have children. The partner's age and gynecopathies must be considered. Egg or sperm cryopreservation can also be alternatives for future fertility. Reinforcing AAS cessation is imperative to achieving better success in misusers.

IMPLICATIONS

The exponential increase in AAS misuse raises concerns about the impact on male fertility. This review suggests that gonadotropin analogs and selective androgen receptor modulators (clomiphene citrate) are viable approaches to early preserve or restore fertility in men on AAS use or with previous contact. However, proper standardization of doses and combinations is required and hence physicians should also be aware of patients' and partners' fertility.

Performance-Enhancing Substance Use and Sexual Risk Behaviors among U.S. Men: Results from a Prospective Cohort Study

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.

Anabolic-Androgenic Steroid Abuse among Gym Users, Eastern Province, Saudi Arabia

Background and Objectives: The main aim of the present study was to assess the use of androgenic–anabolic steroids (AAS) and to investigate its potentially unfavorable effects among gym members attending gym fitness facilities in Eastern Province, Saudi Arabia. Materials and Methods: A cross-sectional questionnaire-based study was carried out during the summer of 2017. Male gym users in the Eastern Province region of Saudi Arabia were the respondents. Information on socio-demographics, use of AAS, knowledge, and awareness about its side effects were collected using a self-administered questionnaire. Results: The prevalence of AAS consumption among trainees in Eastern Province was 21.3%. The percentage was highest among those 26–30 years of age (31.9%), followed by the 21–25 (27.4%) (p = 0.003) age group. Participants in the study were not aware of the potential adverse effects of AAS use. Adverse effects experienced by 77% of AAS users include psychiatric problems (47%), acne (32.7%), hair loss (14.2%), and sexual dysfunction (10.7%). Moreover, it appears that trainers and friends are major sources (75.20%) for obtaining AAS. Conclusion: AAS abuse is a real problem among gym members, along with a lack of knowledge regarding its adverse effects. Health education and awareness programs are needed not only for trainees, but also for trainers and gym owners as they are reportedly some of the primary sources of AAS.

Knowledge and beliefs about the use/abuse of oral contraceptive pills among males: A mixed-method explanatory sequential study in community pharmacy settings

BACKGROUND

Oral contraceptive pills (OCPs) are considered one of the most important birth control methods globally. However, these pills were designed for female administration rather than males. This study was designed to investigate patterns of OCPs use and abuse among Jordanian males, according to the community pharmacists' observations.

METHOD

A mixed-method explanatory sequential study was conducted using an online self-administered survey, followed by semi-structured in-depth interviews for registered pharmacists, assistant pharmacists and pharmacy interns. The interviews were utilized using a conceptual framework. Inductive thematic analysis and descriptive/regression analyses were completed using Nvivo and SPSS, respectively.

RESULTS

A total of 158 questionnaire responses and 22 interviews were included in our analysis. Around half (48.4%) of the questionnaire responses confirmed that males could use OCPs for hair growth enhancement, muscle gain and acne treatment 12.7%, 31.7% and 4.4%, respectively. Through the interviews, the participating pharmacists highlighted that males use OCPs mostly for bodybuilding purposes, according to recommendations by their coaches at the gym. The most abused OCPs containing estrogen (Ethinyl estradiol) and progestins (Drospirenone or Levonorgestrel).

CONCLUSION

This study provided insight into unexpected uses of OCPs by males in Jordan. Community pharmacists have a crucial role in the management of OCPs use and abuse. However, restricted regulations and monitoring must be released and implemented on the community to limit such practices.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Random forest model to identify factors associated with anabolic-androgenic steroid use

Background

One of the types of doping that is commonly used by bodybuilders, is androgenic-anabolic steroids (AAS). The use of AAS besides violating sporting ethics would have serious consequences on physical and mental health statuses. This study aimed to determine the most important factors of using AAS among bodybuilders by prototype willingness model (PWM).

Methods

In this analytical cross-sectional study, 280 male bodybuilders were selected from the bodybuilding clubs in Hamadan city using multistage sampling in 2016. A self-administered questionnaire consisting of demographic information and constructs of the PWM was then used to collect data and random forest model was also applied to analyze the collected data.

Results

Behavioral willingness, attitude, and previous AAS use were found as the most important factors in determining the behavioral intention. Moreover, subjective norms, attitude, BMI, and prototypes were the factors with the greatest effect on predicting behavioral willingness of AAS use. As well, behavioral intention was observed to be more important than behavioral willingness for predicting of AAS use.

Discussion

The obtained results show that the reasoned action path has a greater impact to predict AAS use among bodybuilders compared to social reaction path.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00257-5.

Alcohol and substance use among first-year students at the University of Nairobi, Kenya: Prevalence and patterns

OBJECTIVE

Increase in alcohol and substance use among college students is a global public health concern. It is associated with the risk of alcohol and substance use disorders to the individual concerned and public health problems to their family and society. Among students there is also the risk of poor academic performance, taking longer to complete their studies or dropping out of university. This study determined the prevalence and patterns of alcohol and substance use of students at the entry to the university.

METHOD

A total of 406 (50.7% male) students were interviewed using the Assessment of Smoking and Substance Involvement Test (ASSIST) and the Alcohol Use Disorder Identification Tool (AUDIT). Bivariate logistic regression analyses were used to examine associations between substance use and students' socio-demographic characteristics. Multivariate logistic regression analysis was conducted to examine the predictors of the lifetime and current alcohol and substance use.

RESULTS

Lifetime and current alcohol and substance use prevalence were 103 (25%) and 83 (20%) respectively. Currently frequently used substances were alcohol 69 (22%), cannabis 33 (8%) and tobacco 28 (7%). Poly-substance use was reported by 48 (13%) respondents, the main combinations being cannabis, tobacco, and alcohol. Students living in private hostels were four times more likely to be current substance users compared with those living on campus (OR = 4.7, 95% CI: 2.0, 10.9).

CONCLUSION

A quarter of the study respondents consumed alcohol and/or substances at the entry to university pushing the case for early intervention strategies to delay initiation of alcohol and substance use and to reduce the associated harmful consequences.

Prevalence and Risk Factors Associated with Anabolic-androgenic Steroid Use: A Cross-sectional Study among Gym Users in Riyadh, Saudi Arabia

Objectives

Anabolic-androgenic steroids (AAS) have been used internationally for enhancing physical appearance and performance despite their significant side effects. We sought to identify the prevalence of AAS use and its different risk factors among gym users in Riyadh, Saudi Arabia.

Methods

A cross-sectional survey was distributed among gym users across 20 gyms in Riyadh. The cluster sampling technique was used to represent the four regions of Riyadh (North, South, East, and West). Univariate and multivariate analyses were performed to identify the factors associated with AAS.

Results

Out of 482 participants, 29.3% reported using AAS. The mean age of the study participants was 27.2±6.9 years, 61.0% were single, 67.1% were educated, 35.5% were government employees, and 31.1% were students. The use of AAS was more prevalent among gym members who practiced weightlifting (45.5%), were employed in the private sector (35.8%), and aged > 25 years old (53.3%). Multiple logistic regression showed that the most significant factors associated with the use of AAS among gym members were: weightlifting, using supplementary vitamins or minerals, following special diets, knowing individuals who used AAS, and being offered AAS.

Conclusions

Our study provides clear evidence that the lifetime prevalence of AAS use is high among male gym members in Riyadh with modifiable risk factors. The results could help public health policymakers to take the necessary measures to alleviate the potential negative implications of AAS use at the community level.

Anabolic-Androgenic Steroid Use in the Eastern Mediterranean Region: a Scoping Review of Extant Empirical Literature

The use of image- and performance-enhancing drugs particularly anabolic-androgenic steroids (AAS) is not a new phenomenon. AAS use is not limited to athletes, with mainstream populations using these drugs for aesthetic purposes. Prevalence has been predominantly in Western countries, with some recent studies indicating a rise in popularity in the Eastern Mediterranean region. A scoping review of extant empirical literature from the Eastern Mediterranean region described and mapped what is known about the extent of AAS in the region. Four themes emerged from the review: (1) profile of AAS users; (2) AAS within gymnasium practice; (3) AAS regimes of use; and (4) knowledge and understanding of the AAS concept and related adverse effects. The review highlights a relatively new phenomenon of AAS use in the Eastern Mediterranean. The review underscores the need to carry out further research, particularly qualitative and quantitative studies with both genders, and cognisant of the complexities of culture and religiosity.

Prevalence of Performance-Enhancing Substance Use and Associated Factors among Portuguese Gym/Fitness Users

Background: Nowadays, doping is not confined to elite sport, it is also spread throughout gymnasia and fitness centers, and it is seen as a public health concern. Studies focusing on performance-enhancing substances (PES) use among gym users are few and mostly concern the practice of bodybuilding and the use of anabolic-androgenic steroids (AAS), without providing information about social indicators to further explore why this specific population use these substances. Objectives: To investigate the extent of PES use and examine the way social indicators, exercise profile and gym modalities influence the use of these substances among a sample of gym users. Methods: Cross-sectional descriptive study, among a convenience sample of 453 Portuguese gym users, recruited directly by five institutional gyms´ email and Facebook. Data were collected via a structured web-based survey, between October and November 2017. Multiple binary logistic regression, the Chi-Square test or Monte Carlo Simulation or Fisher's Exact test were used. The odds ratios and their respective 95% confidence intervals were calculated. Results: 11,1% of gym users reported the use of prohibited PES, which varies significantly according to gender, education, exercise profile and type of practice. Gender was associated with the class of PES used. Polypharmacy was a common practice among users, increasing the risk of side-effects. Peer effect and media appear to be strikingly important in the misuse of PES. Conclusion: Results provide precise insight into the specific factors associated with PES use, which could support prevention strategies in gym/fitness context.

Anabolic steroids among resistance training practitioners

OBJECTIVE

To compare the use of anabolic steroids (AS), the motivation to use them, their side effects, the source of information and the form in which AS were obtained, the medical follow-up, and the periodic examinations in resistance training practitioners who are either current or former users of AS.

METHODS

A prevalence survey was performed in the gyms of the city of Curitiba, including 719 current and former AS users who self-administered a questionnaire. The chi-square and z of proportions (p <0.05) statistical tests were conducted.

RESULTS

Esthetics was the main motivation associated with AS intake, leading to satisfactory results. The information about the form in which to use AS was provided by doctors and AS were either purchased at the pharmacy with a prescription or illegally. Current users reported a higher number of cycles and doses, a longer duration of use, as well as larger economical investments into AS. This shows a higher consumption of such drugs, regardless of the medical follow-up and post-cycle therapy.

CONCLUSION

Given that a change in the usage pattern was observed when increasing the AS consumption, this should be considered in the elaboration of public policies to inhibit such a trend.

Anabolic Androgenic Steroid Abuse and their Health Impacts: A Cross-sectional Study among Body Builders in a City of Eastern India

Background:

Anabolic-androgenic steroids (AASs), when taken in supraphysiologic doses, increase muscle strength and athletic performance. Evidence suggests that long-term use of AAS in supraphysiologic doses have adverse effects on health. Therefore, the study was conducted to find crude estimate of the prevalence of AAS use among attendees of the gymnasium, the factors that could have influenced them for AAS abuse and to assess the short- and long-term side effects as perceived by them.

Methods:

A cross-sectional study was conducted in selected gymnasiums of a smart city of India using a predesigned and pretested questionnaire. Snowball sampling method was undertaken. The study was from July 2015 to June 2016. Informed written consent was taken. The analysis was done using SPSS v. 20.0.

Results:

Of 84 bodybuilders approached, 74 participants used AAS. All users were male with mean age of 26.5 + 0.55 years. The mean age of initiation of AAS abuse was 23 years, and 66.2% (49) were unmarried. Eighty-five percent (63) preferred injectable. Seventy percent (52) abusers were influenced by trainers for abuse. Most commonly abused was Nandrolone decanoate (55.4%). Seventy-three percent were not aware of any legal ban on steroids. Reported benefits include increased strength, muscle size, and power, while harms were increased acne, deepening of voice, swelling of feet, increased irritability, depressive thoughts, impaired judgment, panic disorder, and withdrawal effect.

Conclusions:

Frequency of ASS use was substantial among young bodybuilders. Awareness about side effects was not a deterrent factor. Abusers were highly influenced by coaches. Efforts should be made for preventing easy access to AAS.

Knowledge of and Attitudes Toward the Use of Anabolic-Androgenic Steroids among the Population of Jeddah, Saudi Arabia

Purpose:

The aim of this study was to investigate the correlation between the use of anabolic-androgenic steroids (AASs) among the population of Jeddah, Saudi Arabia, and their knowledge and attitudes.

Methods:

This was a community-based, cross-sectional observational study. This study was conducted using a questionnaire that was distributed among the population during the period from February 3, 2018, to February 25, 2018. This questionnaire comprised 31 questions, designed to evaluate the knowledge and attitudes toward using AASs.

Results:

A total of 300 participants were enrolled in the study. The mean age of the population was 30.66 ± 9.2 years. Fourteen participants admitted using AASs, with a percentage of 4.7%, among whom 85.7% were male (P = 0.0005). Seventy-eight percent of AAS users believed that AASs do not cause tolerance when taken for a longtime (P = 0.023). However, the majority of both AAS users and nonusers did not agree on taking AASs for a longtime. Our results showed a strong correlation between not taking AASs and not consuming energy drinks (P = 0.0023). Half of our respondents exhibited poor knowledge regarding the side effects of AASs. The level of knowledge did not correlate with the use of AAS, gender, exercising, or consuming energy drinks.

Conclusion:

The results showed poor knowledge regarding using AASs among the population of Jeddah. Thus, we recommend having a national awareness program in order to prevent the possible side effects of misusing AASs.

Prevalence, Attitude, Knowledge, and Practice of Anabolic Androgenic Steroid (AAS) Use Among Gym Participants

Background:

Anabolic steroids (AS) are synthetic testosterone derivatives that last longer than physiological androgens in the body. Anabolic-androgenic steroid (AAS) abuse is spreading among athletes. The aim of this study is to assess the knowledge, attitudes, and practices of gym participants in Saudi Arabia.

Methods:

A cross-sectional survey was carried out among gym users from February 2017 to May 2017. The questionnaire included information on demographics related to the use of AAS and lifestyle habits. Any willing male gym participant could be included.

Results:

A total of 4860 male gym participants with a mean age of 28.6 ± 6.2 years were included. A majority were single, with a bachelor’s degree or higher. Moreover, 9.8% of the participants used AAS, of which 76.7% reported improved fitness. Friends were the main source of AAS-related information, but only 38.0% of AAS users sought medical consults. The oral route was most common, and testosterone enanthate was the AAS most used.

Conclusion:

Also, 9.8% of gym participants used AAS and were more likely to be involved in risky habits, such as smoking and growth hormone abuse. They were less aware of potential complications of AAS, with gym trainers being the predominant source of AAS substances.

Prevalence and awareness of Anabolic Androgenic Steroids (AAS) among gymnasts in the western province of Riyadh, Saudi Arabia

Background

Anabolic Androgenic Steroids (AAS) are synthetic derivatives of the male sex hormone (testosterone) that are increasingly used by athletes as performance enhancing drugs to increase muscle mass and strength. Multiple health adverse effects may be caused by its non-medical use. Several international and regional studies showed the high prevalence of AAS usage and low level of awareness of it among different populations.

Objective

To estimate the prevalence of AAS and to determine the level of awareness toward it among gymnasts in the western province of Riyadh.

Methods

This cross-sectional survey was conducted using a self-administered questionnaire distributed on 400 male gymnasts from 10 different fitness centers which have been chosen randomly from 23 centers in the western province of Riyadh city (Kingdom of Saudi Arabia) during 2016. Data analysis was performed by SPSS version 21, using descriptive statistics and Chi-square test.

Results

Among the 400 gymnasts who participated in the survey, a total of n=363 questionnaires were received completed. Of the responders, (n=89) were AAS users with a percentage 24.50%. The testosterone was the most commonly used type followed by Methandrostenolone then Stanozolol. The major sources for obtaining AAS were online shopping (45%) and gym-coach (22.5%). Regarding awareness, 74% of AAS users had an inadequate perception about AAS concept versus 55% of non-users with no significant difference (p=0.076). In addition, 82% of AAS users and 83% of non-users had inadequate knowledge of AAS adverse effects with no significant difference between the two categories (p=0.087).

Conclusion

The usage of AAS is high amongst gymnasts in the western province of Riyadh city considering they are prohibited. The level of awareness toward AAS is low among most gymnasts. We recommend for educational programs to be established in order to increase public awareness, in addition to a tightening of control by the responsible authorities over the sources of AAS procurement.

The interaction effects of resistance training and sustanon abuse on liver antioxidant activities and serum enzymes in male rats

BACKGROUND

Anabolic-androgenic steroids (AAS) are synthetic drugs derived from testosterone, the uncontrolled usage of which may lead to serious side effects. Previous studies have shown that resistance training (RT) is the main exercise modality practiced by AAS abusers. Thus, this work was carried out to evaluate the hepatotoxic effects of sustanon (Su) as an example of AAS in trained male rats.

METHODS

Rats were divided into sedentary/non-Su, sedentary/Su, RT/non-Su, and RT/Su. Su-administration groups received Su 10 mg/kg intramuscularly once a week for 8 weeks. In the 8-week RT, the rats climbed a vertical ladder 3 days/week.

RESULTS

After Su administration, the mean values of serum parameters related to hepatic function were within normal ranges. Superoxide dismutase, glutathione peroxidase, and glutathione reductase activities were higher (P < 0.05) in the liver of Su-treated rats. Chronic exercise alone did not change any of the above parameters.

CONCLUSIONS

The present findings suggest that the 8-week injection of Su, either with or without concurrent RT upregulation of enzymatic antioxidant activities and RT, did not attenuate the increase of enzymatic activities due to the Su administration. Furthermore, Su abuse in this dose did not make any severe liver damage.

Influence of knowledge and beliefs on consumption of performance enhancing agents in north-western Saudi Arabia

BACKGROUND

Consumption of performance enhancing agents (PEAs) has a wide range of negative health consequences, but knowledge of these consequences among gym users of PEAs in Saudi Arabia is not well understood.

OBJECTIVES

Identify the knowledge, awareness, beliefs and attitudes of gym users about negative health consequences of using PEAs, and the relationship between these factors and use of these agents.

DESIGN

Cross-sectional study.

SETTING

Five gyms in Madinah city, Saudi Arabia.

SUBJECTS AND METHODS

Convenience sampling was used to recruit gym users. An electronic self-administered questionnaire was used to collect data.

MAIN OUTCOME MEASURE(S)

Level of knowledge about the negative health consequences of PEAs among gym users.

RESULTS

About 70% of 316 participants had used one or more of PEAs over the last six months. Of those, about 68.4% used protein powder supplements and 48.1% used energy drinks. Participants who believed that protein powder supplements (c2=52.3, P < .01) and energy drinks (c2=35.2, P < .01) had health hazards used these agents less often than others during the six months preceding data collection. Participants who had less knowledge about the negative health consequences were more likely to use protein powder supplement (t=2.38, P=.018). On the other hand, those who were more knowledgeable about the negative health consequences of insulin, were more likely to use insulin (t=2.45, P=.015).

CONCLUSION

Misuse of PEAs is widespread among gym users in Saudi Arabia. Improving the level of knowledge and awareness of possible serious health consequences would hopefully lead to reduced PEA consumption.

LIMITATIONS

The temporal sequence of cause and effect could not be determined in a cross sectional study. Convenience sampling in a single city limited the generalizability of the findings to all regions of Saudi Arabia.

The prevalence of anabolic androgenic steroid use amongst athletes in Riyadh (Saudi Arabia)

Objective

The aim of this study was to determine the prevalence of anabolic androgenic steroid (AAS) use among athletes and examine the extent of their knowledge on the effects of AAS in Riyadh, Saudi Arabia.

Methods

This cross-sectional study was conducted at gyms in Riyadh, Saudi Arabia, during 2015. In total 600 athletes from three gyms participated in the study. The study included Saudi and non-Saudi athletes chosen by the simple random sampling method. A self-reported questionnaire was used for data collection. The questionnaire was designed to study the prevalence and assess the knowledge of athletes regarding AAS use. Frequency and percentage distributions were used to describe the data. Comparison between the subgroups was made with a chi-square test.

Results

The percentage of AAS users was 30.5%. The age of AAS users ranged from 15 to 49 years with the majority (52.5%) belonging to age group of 25–29 years. Approximately 20% of the users admitted using AAS due to body dysmorphia as their best motivational factor; in addition, they also believed that there are no side effects of the use. Among the nonusers, 40% had appropriate knowledge, while all the AAS-users had inadequate knowledge about the adverse effects of AAS. Moreover, 77% of the users would recommend AAS to their friends but none from the nonusers. A significant difference in age distribution (df = 5, p<0.001) and knowledge (df = 4, p< 0.001) between users and nonusers was observed.

Conclusion

Most athletes were ignorant of the harmful side effects of the drug but still continued to use and promote it to other athletes. These athletes should intensify their knowledge and awareness regarding the use of AAS and its effects on the body.

Sport-Induced Substance Use-An Empirical Study to the Extent within a German Sports Association

In cooperation with the Sports Association of the Palatinate (SBP), a survey was conducted on substance use by recreational and amateur athletes. Distribution of the online questionnaire took place by means of chain-referral sampling, and questions on substance use were presented using the randomized response technique (RRT) to protect the anonymity of respondents and prevent socially desirable answers. The estimated lowest limit for the population share for use of prohibited substances during the last season (4%) and for lifetime use (3.6%) did not differ significantly. Approximately 21% of respondents had used substances for training or competitions that were taken for a purpose other than performance enhancement (e.g., to improve their mood or to help with recuperation from a minor injury or illness) in the last year. 49% had done so at some point in their life.

Usage and perceptions of anabolic-androgenic steroids among male fitness centre attendees in Kuwait--a cross-sectional study

Background

Considering the recent popularity of bodybuilding and the apparent spread of anabolic androgenic steroid (AAS) use amongst bodybuilding enthusiasts in Kuwait, there is a relative lack of scientific investigation into the use, knowledge and attitudes towards AAS amongst the population at risk of abusing it. Therefore, this study aims to investigate the frequency, knowledge, attitudes and practice of AAS use amongst male fitness centre attendees in Kuwait.

Methods

A cross sectional survey utilizing a self-administered questionnaire was used. Information on demographics as well as knowledge and attitude about and towards the use of AAS was included in the questionnaire. Ten fitness centres in Kuwait were randomly selected and questionnaires were distributed to all individuals leaving each centre on randomly selected days and periods of time for each centre. Overall n = 400 questionnaires were distributed.

Results

A total of n = 194 questionnaires were returned completed (~49 %). Of the responders, 22.7 % used AAS. The 19–25 age group had the highest occurrence (46.8 %) of first-time AAS use. In contrast with non-users, most (70.5 %) of AAS users believed that having an optimally muscular body can only be achieved by using AAS, and a small minority (6.8 %) believed that AAS usage would have significant harms to health. Only 18.2 % of AAS users had appropriate knowledge regarding the side effects of AAS. Non-users were as much uninformed as AAS users regarding the side effects of AAS.

Conclusion

The usage of AAS is high amongst male gym users in Kuwait and is likely to present an additional burden to the health service. An effective initiative to minimize the burden of AAS abuse should focus on changing the attitudes towards AAS rather than spreading awareness of their side effects.

Improvements in body composition, cardiometabolic risk factors and insulin sensitivity with trenbolone in normogonadic rats

Trenbolone (TREN) is used for anabolic growth-promotion in over 20 million cattle annually and continues to be misused for aesthetic purposes in humans. The current study investigated TREN's effects on body composition and cardiometabolic risk factors; and its tissue-selective effects on the cardiovascular system, liver and prostate. Male rats (n=12) were implanted with osmotic infusion pumps delivering either cyclodextrin vehicle (CTRL) or 2mg/kg/day TREN for 6 weeks. Dual-energy X-ray Absorptiometry assessment of body composition; organ wet weights and serum lipid profiles; and insulin sensitivity were assessed. Cardiac ultrasound examinations were performed before in vivo studies assessed myocardial susceptibility to ischemia-reperfusion (I/R) injury. Circulating sex hormones and liver enzyme activities; and prostate and liver histology were examined. In 6 weeks, fat mass increased by 34±7% in CTRLs (p<0.01). Fat mass decreased by 37±6% and lean mass increased by 11±4% with TREN (p<0.05). Serum triglycerides, HDL and LDL were reduced by 62%, 57% and 78% (p<0.05) respectively in TREN rats. Histological examination of the prostates from TREN-treated rats indicated benign hyperplasia associated with an increased prostate mass (149% compared to CTRLs, p<0.01). No evidence of adverse cardiac or hepatic effects was observed. In conclusion, improvements in body composition, lipid profile and insulin sensitivity (key risk factors for cardiometabolic disease) were achieved with six-week TREN treatment without evidence of adverse cardiovascular or hepatic effects that are commonly associated with traditional anabolic steroid misuse. Sex hormone suppression and benign prostate hyperplasia were confirmed as adverse effects of the treatment.

Steroids, psychosis and poly-substance abuse

OBJECTIVE

To review consequences of the changing demographic profile of anabolic-androgenic steroid (AAS) use.

METHOD

Case report and review of key papers.

RESULTS

We report here a case of a 19-year-old Irish male presenting with both medical and psychiatric side effects of methandrostenolone use. The man had a long-standing history of harmful cannabis use, but had not experienced previous psychotic symptoms. Following use of methandrostenolone, he developed rhabdomyolysis and a psychotic episode with homicidal ideation. Discussion Non-medical AAS use is a growing problem associated with medical, psychiatric and forensic risks. The population using these drugs has changed with the result of more frequent poly-substance misuse, potentially exacerbating these risks.

CONCLUSION

A higher index of suspicion is needed for AAS use. Medical personnel need to be aware of the potential side effects of their use, including the risk of violence. Research is needed to establish the magnitude of the problem in Ireland.

Doping in gymnasiums in Amman: the other side of prescription and nonprescription drug abuse

This study investigated the abuse of over-the-counter (OTC) products (e.g., proteins, dietary supplements) and prescription drugs (e.g., hormones) in gymnasiums in Amman by random distribution of a structured questionnaire to 375 gym clients (November 2012-February 2013). Data were analyzed using SPSS for Windows (version 17.0). A total of 31 (8.8%) clients admitted to using 21 products (mentioned 71 times) of anabolic steroids and other hormones (e.g., growth hormone and thyroxine) to increase muscular power at the gym or build muscle mass. Abuse of different prescription and OTC drugs among gymnasium clients is present in Jordan, but current methods for controlling the problem are ineffective. Better methods should be developed. The study's limitations are noted.

Anabolic-androgenic steroid use among Brazilian bodybuilders

This cross-sectional, quantitative, exploratory study investigated the prevalence and profile of anabolic-androgenic steroids (AAS) users amongst a convenience sample of 510 bodybuilders from 52 gyms, in João Pessoa, Brazil, with a structured questionnaire containing selected questions about socioeconomic and training variables on the use of AAS. Data were analyzed using frequency and chi-square tests. AAS prevalence use was 20.6%; mostly young men (98.1%), of a low education level (46.7%), who trained for more than 4 years (49.5%). The use of AAS was related to the use of dietary supplements. About 81% of consumed AAS consisted of Deca-Durabolin, Winstrol, and Sustanon. Study's limitations are noted.

Media exposure, mediated social comparison to idealized images of muscularity, and anabolic steroid use

This study examined the association between anabolic-androgenic steroid (AAS) use and dominant sociocultural factors, specifically media exposure to idealized images of male muscularity, and mediated social comparison trends among a sample of young Arab adults. The study found evidence that participants more exposed to content that promotes muscularity and those who idealize images of muscularity and perceive them as motivators for achieving muscularity are more likely to be AAS users. It also found that a significant percentage of participants used at least one kind of dietary supplement and that the level of AAS use among health club participants indicates it is a significant public health problem in Lebanon. The study suggests that dealing with this problem requires a unique approach, beyond the typical awareness of risks strategy, since some users were well aware of the risks yet continue to use AAS, and their motivations pertain more to body image and sexuality. A stronger approach that utilizes critical media literacy teaching that ingrains these issues into school and university curricula will have a more lasting impact.

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.

Heavy episodic drinking and soccer practice among high school students in Brazil: the contextual aspects of this relationship

Background

Heavy episodic drinking (HED) (consumption of five or more drinks on the same occasion) among adolescents is related to several problems and partaking in sport or physical activities has been suggested as an option to prevent or reduce alcohol consumption among this population. The aim of this study was to investigate the relationship between soccer practice and heavy episodic drinking among high school students from Brazil.

Methods

Data were obtained from a cross-sectional study among a representative sample of public and private high school students from all Brazilian state capitals (N=19,132). Only students aged from 14 to 18 who reported having taken part in soccer practice, other team sports or non-practicing sports in the last month were included. Characteristics of sport practice (frequency and motivation) and HED in the last month (type of drink; where and with whom they drank; frequency of HED) were also considered. Regression models were controlled for sociodemographic variables.

Results

For all groups studied most of the students reported drinking beer, with friends and at nightclubs or bars. Soccer practice was associated to HED when compared to non-practicing sports and to other team sports. Compared to other team sports, playing soccer for pleasure or profession, but not for keep fit or health reasons, were more associated to HED. Frequency of soccer practice from 1 to 5 days per month and 20 or more days per month, but not from 6 to 19 days per month, were also more associated to HED.

Conclusions

The relationship between soccer and HED appears to be particularly stronger than in other team sports among adolescents in Brazil. Induced sociability of team sports practice cannot be assumed as the main reason for HED among soccer players. Possibly these results reflect the importance of a strong cultural association between soccer and beer in Brazil and these findings should be integrated to future prevention or intervention programs.

Prevalência do uso e conhecimento de esteroides anabolizantes androgênicos por estudantes e professores de educação física que atuam em academias de ginástica

INTRODUÇÃO: Os esteroides anabólicos androgênicos (EAA) são substâncias, quimicamente semelhantes à testosterona, utilizadas para o tratamento/controle de diversas doenças. Contudo, tais substâncias estão sendo empregadas de forma não terapêutica e indiscriminada com finalidades de melhora da performance esportiva e principalmente estética. OBJETIVO: analisar a prevalência do uso e o conhecimento de EAA por estudantes e professores de educação física que atuam em academias de ginástica de Belém, PA. Utilizou-se para a coleta de dados um questionário fechado e anônimo, aplicado a 117 pesquisados. A comparação da prevalência do uso e o grau de conhecimento dos pesquisados sobre EAA foi realizada através de estatística não paramétrica, prova de X² (Qui-quadrado), considerando o intervalo de confiança de 95% e p < 0,05. A média de idade dos participantes da pesquisa foi de 28,0 ± 6,3 anos e a prevalência do uso de EAA foi de 31,6% do total de sujeitos pesquisados. A prevalência maior foi entre os profissionais especialistas (39,3%), tendo como principal motivação para o uso de EAA a estética com 75,6%. Em relação ao conhecimento, verificou-se que as drogas classificadas como EAA foram: Durateston®, Deca-Durabolin®, oxandrolona/Winstrol®. Entretanto, estes profissionais confundiram-se ao apontar outras substâncias como sendo EAA, entre elas: hormônio do crescimento e óleos localizados. Entre os efeitos colaterais, os mais citados foram: acne, engrossamento da voz e agressividade; contudo, efeitos colaterais mais prejudiciais como câncer e aromatização foram menos assinalados. RESULTADOS: Demonstraram que a prevalência de uso de EAA foi significativa (p < 0,03) entre os estudantes e professores de educação física que atuam em academias de Belém, PA, revelando assim prováveis desconhecimentos destes sobre alguns dos efeitos colaterais, podendo implicar no uso indiscriminado destas drogas.

Vulnerability and the intention to anabolic steroids use among Iranian gym users: an application of the theory of planned behavior

This correlational study explored the psychological antecedents of 253 Iranian gym users' intentions to use the anabolic-androgenic steroids (AAS), based on the Theory of Planned Behavior (TPB). The three predictor variables of (1) attitude, (2) subjective norms, and (3) perceived behavioral control accounted for 63% of the variation in the outcome measure of the intention to use the AAS. There is some support to use the TPB to design and implement interventions to modify and/or improve individuals' beliefs that athletic goals are achievable without the use of the AAS.

Self-admitted behavior and perceived use of performance-enhancing vs psychoactive drugs among competitive athletes

The relationships between projected use, self-reported behavior and attitudes to performance-enhancing (PED) and recreational (RD) drugs were investigated among 82 competitive Hungarian athletes, with 14.6% admitting using PED and 31.7% using RD. Both the observed doping estimations (even those made by non-users) and self-admitted use were considerably higher than the average rate of positive doping tests (2% of all tests). The notable overestimation by PED users (34.6% vs 16.9%) was in keeping with the false consensus effect. A prediction model with attitude and projection to the likelihood of PED use suggested at least a 70% chance of self-involvement of athletes, with responses at or above the median scores (Performance Enhancement Attitude Scale ≥ 60 and estimation ≥ 50%) on the two independent measures. Users overestimated the prevalence of doping in their sport (P=0.007) but not RD use, with the converse holding for RD users' views of doping (P=0.029). PED users also showed a significantly more lenient attitude toward doping (P<0.001). This domain-specific characteristic adds new information to the ongoing research effort in understanding drug-doping co-morbidity. The reasons for elevated in-group projection are discussed, along with the potential application of this phenomenon in doping epidemiology studies.