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Kutscher E, Arshed A, Greene RE, Kladney M. Exploring Anabolic Androgenic Steroid Use Among Cisgender Gay, Bisexual, and Queer Men. JAMA Netw Open 2024; 7:e2411088. [PMID: 38743422 PMCID: PMC11094559 DOI: 10.1001/jamanetworkopen.2024.11088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Importance Anabolic androgenic steroids (AAS) are disproportionately used by sexual minority men, with the physical and mental health implications of AAS use incompletely understood. Objective To understand the reasons for use and health care needs of gay, bisexual, and queer cisgender men using AAS. Design, Setting, and Participants This qualitative study was conducted from November 2021 to May 2023 using self-administered questionnaires and semistructured interviews that were transcribed and coded using reflexive thematic analysis. Participants were recruited through convenience and snowball sampling from lesbian, gay, bisexual, transgender, and queer clinical centers in New York, New York, as well as through online platforms. All patients self-identified as cisgender and gay, bisexual, or queer. Exposures History of nonprescribed AAS use for a minimum of 8 consecutive weeks was required. Main Outcomes and Measures The primary outcomes were reasons for and health implications of AAS use and interactions with health care practitioners, as determined through interviews. Interview transcripts were collected and analyzed. Results Thematic saturation was reached after interviews with 12 male participants (mean [SD] age, 44 [11] years), with the majority of participants identifying as gay (10 participants [83%]), White non-Hispanic (9 participants [75%]), being in their 30s and 40s (9 participants [75%]), holding a bachelor's degree or higher (11 participants [92%]), and having used steroids for a mean (SD) of 7.5 (7.1) years. One participant (8%) self-identified as Black, and 2 (17%) identified as Hispanic. Seven men (58%) met the criteria for muscle dysmorphia on screening. Nine overarching themes were found, including internal and external motivators for initial use, continued use because of effectiveness or fear of losses, intensive personal research, physical and emotional harms experienced from use, using community-based harm reduction techniques, frustration with interactions with the medical community focused on AAS cessation, and concerns around the illegality of AAS. Conclusions and Relevance In this qualitative study, AAS use among cisgender gay, bisexual, and queer men was found to be associated with multifactorial motivators, including a likely AAS use disorder and muscle dysmorphia. Despite all participants experiencing harms from use, men seeking medical help found insufficient support with practitioners insistent on AAS cessation and, thus, developed their own harm reduction techniques. Further research is needed to assess the utility of practitioner education efforts, the safety and efficacy of community-developed harm reduction methods, and the impact of AAS decriminalization on health care outcomes for this patient population.
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Affiliation(s)
- Eric Kutscher
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- NYU Grossman School of Medicine, New York, New York
| | - Arslaan Arshed
- NYU Grossman School of Medicine, New York, New York
- Bellevue Hospital Center, New York, New York
| | - Richard E. Greene
- NYU Grossman School of Medicine, New York, New York
- Bellevue Hospital Center, New York, New York
| | - Mat Kladney
- NYU Grossman School of Medicine, New York, New York
- Bellevue Hospital Center, New York, New York
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Horn J. The dichotomy between health and drug abuse in bodybuilding. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:212-225. [PMID: 38645972 PMCID: PMC11027851 DOI: 10.1177/14550725231206011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/21/2023] [Indexed: 04/23/2024] Open
Abstract
Aim: The aim of the present study was to investigate the expansion and prevalence of anabolic steroid use by examining the divergent effects between health and drug abuse and to create more awareness around the harmful consequences of these drugs when administered at abusive levels. Methods: A focused and concise literature search was conducted, and 101 high-quality articles were included in the review. Results: The findings underscore the adverse health risks of steroid abuse, emphasizing the stark contrast between health and drug abuse. Conclusions: While steroids and other performance-enhancing drugs can yield muscle growth, strength and even fat loss, abusing these substances can lead to adverse health outcomes. Furthermore, within the fitness subculture, particularly in the realm of bodybuilding, steroid abuse fosters an atmosphere of cheating and deception, frequently downplaying or ignoring the negative and sometimes deadly consequences it brings.
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Wenbo Z, Yan Z. The Uses of Anabolic Androgenic Steroids Among Athletes; Its Positive and Negative Aspects- A Literature Review. J Multidiscip Healthc 2023; 16:4293-4305. [PMID: 38170017 PMCID: PMC10759908 DOI: 10.2147/jmdh.s439384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
The use of anabolic androgenic steroids (AAS) for strength training and muscle building is a widespread practice among athletes and young individuals. Athletes and bodybuilders are using these substances for various purposes, such as enhancing muscle mass, strengthening their bodies, and enhancing their performances. AAS exert a wide range of physiological effects that result in the activation of central signaling, resulting in adverse effects. Moreover, excessive use of AAS which can be categorized as AAS abuse; is linked to biological and psychological pathologies, which can lead to mortality. Complications arising from steroid abuse involve both cellular and physiological complications. Cellular complications arise when activation of signaling proteins like mTOR, Akt, etc. leads to alteration in protein synthesis pathways, cell cycle, oxidative stress, and apoptosis, contributing to damage at the cellular level. Physiological complications are evident with cardiovascular pathologies, including an altered lipid profile, cardiac hypertrophy, hypogonadism after discontinuation of AAS, and modulation of GABA receptors in the brain, all contributed by the androgen receptor signaling. Clinical complications budding from these altered physiological processes lead to clinical effects like testicular dysfunction, acne, gynecomastia, and neuropsychiatric disorders. Despite potential therapeutic benefits, AAS use is prohibited by the World Anti-Doping Agency (WADA) due to concerns over adverse health effects. This review highlights the molecular mechanisms, physiological processes, and clinical complications arising from the excessive use of AAS among athletes.
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Affiliation(s)
- Zhang Wenbo
- Department of Physical Education, Changchun Institute of Education, Changchun, Jilin, 130033, People’s Republic of China
| | - Zhang Yan
- School of Physical Education, Inner Mongolia Minzu University, Tongliao, Neimeng, 028000, People’s Republic of China
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Grant B, Minhas S, Jayasena CN. A review of recent evidence on androgen abuse from interviews with users. Curr Opin Endocrinol Diabetes Obes 2023; 30:285-290. [PMID: 37646503 PMCID: PMC10621637 DOI: 10.1097/med.0000000000000834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Androgens (also known as anabolic-androgenic steroids; AAS) are increasingly being abused worldwide to enhance body physique or athletic performance. Qualitative studies including interviews provide a wider understanding of androgen abuse and focus specific support needs to this group. This narrative review summarizes recent studies (2021-2023) using interviews with individuals abusing androgens. RECENT FINDINGS Motivations for androgen abuse in men include desires to achieve certain physicality, enhance self-confidence and improve libido. The risks of androgen abuse are justified to achieve these outcomes and men may use other illicit substances as postcycle-therapy to lessen the risks. Some adverse effects may be more pronounced with certain substances. The therapeutic relationship with healthcare professionals is often described negatively by androgen abusers due to stigma and a perceived lack of knowledge. Both healthcare professionals and androgen abusers agree that development of guidelines are needed. Androgen abuse in women is rare however body dissatisfaction and desires for improve appearance and strength are motivators. SUMMARY Recent qualitative studies have helped further our understanding of men and women who abuse androgens, however the small number of recently published studies confirms there is still a paucity of evidence in the literature. Further research is needed to develop specific harm minimization strategies in those abusing androgens.
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Affiliation(s)
- Bonnie Grant
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, London, UK
| | - Channa N. Jayasena
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital
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Grant B, Kean J, Vali N, Campbell J, Maden L, Bijral P, Dhillo WS, McVeigh J, Quinton R, Jayasena CN. The use of post-cycle therapy is associated with reduced withdrawal symptoms from anabolic-androgenic steroid use: a survey of 470 men. Subst Abuse Treat Prev Policy 2023; 18:66. [PMID: 37951896 PMCID: PMC10640727 DOI: 10.1186/s13011-023-00573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Anabolic-androgenic steroids (AAS) mimic the effects of testosterone and may include testosterone itself; they are used for body enhancement within the general population. AAS use has been linked with increased mortality, cardiovascular disease, mental health disorders, and infertility. AAS-induced hypogonadism can persist for an uncertain time period despite cessation, during which men may report physical and neuropsychiatric symptoms. In an attempt to mitigate these symptoms and expedite testicular recovery, many men self-administer post-cycle-therapy (PCT), typically involving human chorionic gonadotrophin (hCG) and selective oestrogen receptor modulators (SERMs), which are known to potently stimulate testicular function. However, this practice has no objective evidence of effectiveness to lessen the severity or duration of hypogonadal symptoms. METHODS An anonymous survey of four-hundred-and-seventy men using AAS explored the symptoms they experienced when ceasing AAS use; the effect of PCT on relieving their symptoms, and their perceived role for health service support. RESULTS The majority of respondents were white, aged 18-30 years old, and working in skilled manual work. 51.7% (n = 243) reported no issues with AAS use, but 35.3% reported increased aggression. 65.1% (n = 306) of respondents had attempted AAS cessation and 95.1% of these experienced at least one symptom upon AAS cessation. Low mood, tiredness and reduced libido were reported in 72.9%, 58.5% and 57.0% of men stopping AAS use, respectively, with only 4.9% reporting no symptoms. PCT had been used by 56.5% of respondents with AAS cessation and mitigated cravings to restart AAS use, withdrawal symptoms and suicidal thoughts by 60%, 60% and 50%, respectively. The effect of stopping AAS on body composition and recovery of testosterone or fertility was a concern in 60.5% and 52.4%, respectively. Most respondents felt PCT should be prescribed under medical supervision in the community. CONCLUSIONS Our survey suggests that the majority of men stopping AAS use are using some form of PCT. Some self-reported symptoms of AAS-induced hypogonadism such as cravings to restart AAS use reduce by 60% and suicidal thoughts reduce by 50%. These individuals are concerned about the negative effect of AAS use and cessation. This study provides crucial information for planning future research to evaluate the effects of PCT on symptoms when men stop AAS use.
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Affiliation(s)
- Bonnie Grant
- Section of Investigative Medicine, Commonwealth Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Joseph Kean
- Bradford Metropolitan District Council, Britannia House, Hall Ings, Bradford, BD1 1HX, UK
| | | | - John Campbell
- Glasgow Alcohol & Drug Recovery Services, NHS Greater Glasgow & Clyde, Glasgow, Scotland, UK
| | | | | | - Waljit S Dhillo
- Section of Investigative Medicine, Commonwealth Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - James McVeigh
- Department of Sociology, Manchester Metropolitan University, 4 Rosamund Street West, Manchester, M15 6LL, UK
| | - Richard Quinton
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust & Translational & Clinical Research Institute, University of Newcastle-Upon-Tyne, Newcastle, UK
| | - Channa N Jayasena
- Section of Investigative Medicine, Commonwealth Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK.
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Izzat N, Abu-Farha R, Harahsheh MM, Thiab S. A qualitative assessment of anabolic-androgenic steroid use among gym users in Jordan: motives, perception, and safety. Int J Legal Med 2023; 137:1421-1430. [PMID: 37355480 DOI: 10.1007/s00414-023-03046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Over the years, the use of anabolic-androgenic steroids (AAS) has become widespread among athletes and bodybuilders. The prevalence of their use has been estimated at around 20 to 50% globally. Unfortunately, many athletes do not have the proper knowledge about the effects of these banned substances Thus, this study aims to qualitatively assess Jordanian gym users' AAS intentions, perceptions, and safety. METHODS Twenty male Jordanian anabolic steroid users were interviewed using in-depth interviews as part of a qualitative study evaluating the motivations, perceptions, and safety of AAS among gym users. RESULTS The findings of this study indicate that the desire to compete in bodybuilding contests was the primary motivation for participants to use AAS. The study participants mentioned using a combination of oral and injectable medications. Gym coaches and trainers were also identified as an essential source of information for AAS use. A very limited number of AAS users were getting their information from healthcare providers, and most of them have experienced some of these medications side effects but are still willing to continue the use of AAS to get what they need in terms of their physical appearance or for winning competitions. CONCLUSION There is an urgent need for structured awareness campaigns targeting gyms and fitness clubs' members to increase their knowledge about the side effects and health risks associated with the use of AAS. In addition, sports governing bodies should have stricter measures to tackle this problem and discourage athletes from using such products.
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Affiliation(s)
- Nawal Izzat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box 11937, Amman, Jordan
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box 11937, Amman, Jordan.
| | - Mea'ad M Harahsheh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samar Thiab
- Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Dotka M, Małek ŁA. Myocardial Infarction in Young Athletes. Diagnostics (Basel) 2023; 13:2473. [PMID: 37568836 PMCID: PMC10417275 DOI: 10.3390/diagnostics13152473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Myocardial infarction (MI) in young athletes is very rare but can have serious consequences, including sudden cardiac death (SCD), an increased proarrhythmic burden in future life, and/or heart failure. We present two cases of young athletes with MI. They did not have previous symptoms, traditional risk factors, or a family history of MI. One case involves a 37-year-old male amateur athlete who experienced two MI following intense physical exertion, likely due to the erosion of an insignificant atherosclerotic plaque caused by a sudden increase in blood pressure during exercise. The second case describes a 36-year-old male semi-professional runner who collapsed at the finish line of a half-marathon and was diagnosed with hypertrophic cardiomyopathy. The heart's oxygen demand-supply mismatch during intensive exercise led to MI. Following the case presentation, we discuss the most common causes of MI in young athletes and their mechanisms, including spontaneous coronary artery dissection, chest trauma, abnormalities of the coronary arteries, coronary artery spasm, plaque erosion, hypercoagulability, left ventricular hypertrophy, and anabolic steroids use.
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Affiliation(s)
- Mariusz Dotka
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Łukasz A. Małek
- Faculty of Rehabilitation, University of Physical Activity in Warsaw, 01-968 Warsaw, Poland
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Nuzzo JL. Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations. J Strength Cond Res 2023; 37:494-536. [PMID: 36696264 DOI: 10.1519/jsc.0000000000004329] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ABSTRACT Nuzzo, JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 37(2): 494-536, 2023-Biological sex and its relation with exercise participation and sports performance continue to be discussed. Here, the purpose was to inform such discussions by summarizing the literature on sex differences in numerous strength training-related variables and outcomes-muscle strength and endurance, muscle mass and size, muscle fiber type, muscle twitch forces, and voluntary activation; strength training participation rates, motivations, preferences, and practices; and injuries and changes in muscle size and strength with strength training. Male subjects become notably stronger than female subjects around age 15 years. In adults, sex differences in strength are more pronounced in upper-body than lower-body muscles and in concentric than eccentric contractions. Greater male than female strength is not because of higher voluntary activation but to greater muscle mass and type II fiber areas. Men participate in strength training more frequently than women. Men are motivated more by challenge, competition, social recognition, and a desire to increase muscle size and strength. Men also have greater preference for competitive, high-intensity, and upper-body exercise. Women are motivated more by improved attractiveness, muscle "toning," and body mass management. Women have greater preference for supervised and lower-body exercise. Intrasexual competition, mate selection, and the drive for muscularity are likely fundamental causes of exercise behaviors in men and women. Men and women increase muscle size and strength after weeks of strength training, but women experience greater relative strength improvements depending on age and muscle group. Men exhibit higher strength training injury rates. No sex difference exists in strength loss and muscle soreness after muscle-damaging exercise.
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Affiliation(s)
- James L Nuzzo
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Efimenko IV, Valancy D, Dubin JM, Ramasamy R. Adverse effects and potential benefits among selective androgen receptor modulators users: a cross-sectional survey. Int J Impot Res 2022; 34:757-761. [PMID: 34471228 DOI: 10.1038/s41443-021-00465-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022]
Abstract
Selective androgen receptor modulators (SARMs) are a class of androgen receptor ligands that bind androgen receptors and display tissue selective activation of androgenic signaling. SARMs have selective anabolic effects on muscle and bone, and were originally synthesized for treatment of muscle wasting conditions, osteoporosis, breast cancer. To date, no SARM has been clinically approved and little is known about the beneficial effects and other adverse effects on users. We examined the adverse effects and potential benefits of SARMs amongst users. We performed an internet survey assessing the demographics of users via a 32-question survey. Using reddit as a platform, we distributed the survey through various subreddits that included potential SARMs users. Out of the 520 responses, 343 participants admitted having used SARMs. Most were males (98.5%), between the ages of 18-29 (72.3%). More than 90% of users acquired SARMs via the internet and did not consult with a physician. More than half of SARMs users experienced side effects including mood swings, decreased testicular size, and acne. More than 90% of men reported increased muscle mass and were satisfied with their SARMs usage. Despite having seemingly positive effects, more than 50% of SARMs users report significant adverse effects. Chi square was the main method of statistical analysis. Future studies should focus on comprehensive reproductive evaluation of men using SARMs.
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Affiliation(s)
- Iakov V Efimenko
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - David Valancy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin M Dubin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Dead Bodybuilders Speaking from the Heart: An Analysis of Autopsy Reports of Bodybuilders That Died Prematurely. J Funct Morphol Kinesiol 2022; 7:jfmk7040105. [PMID: 36547651 PMCID: PMC9781327 DOI: 10.3390/jfmk7040105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
This study analyzed publicly available autopsy reports of male bodybuilders under the age of 50 who reportedly died from cardiovascular-related events. A general Google search with the terms "dead bodybuilders" was performed on 10 February 2022. Six reports were available for review and analysis. Bodybuilders had the following means: age (±SD) = 36 ± 7.1 years; height 1.82 ± 0.02 m; weight = 103.8 ± 5.3 kg; weight of heart = 575 ± 134.4 g; and left ventricular myocardium thickness (n = 3) = 16.3 ± 3.5 mm. The bodybuilders analyzed had a mean heart weight that is 73.7% heavier than the reference man (575 g vs. 332 g). Similarly, 100% of the autopsies reported left ventricular myocardium thickness of 16.3 ± 3.5 mm; this is 125% thicker than normative data for men. While abuse of AASs for prolonged periods of time may contribute to some of the cardiac abnormalities present in these bodybuilders, it should be noted that cardiac hypertrophy, including left ventricular hypertrophy, has also been reported in drug-free strength athletes. Each autopsy report included cardiovascular abnormalities within the cause of death. Association does not mean causation, but nonetheless bodybuilders should be aware of potential contributing cardiovascular risks with AAS abuse.
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Hearne E, Atkinson A, Boardley I, McVeigh J, Van Hout MC. ‘Sustaining masculinity’: a scoping review of anabolic androgenic steroid use by older males. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2132135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Evelyn Hearne
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Amanda Atkinson
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ian Boardley
- Department of Sociology, Manchester Metropolitan University, Manchester, UK
| | - Jim McVeigh
- School of Sport Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Marie Claire Van Hout
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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12
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Thirumalai A, Anawalt BD. Androgenic Steroids Use and Abuse. Urol Clin North Am 2022; 49:645-663. [DOI: 10.1016/j.ucl.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Bourgonjon B, Vermeylen K, Tytgat N, Forget P. Anaesthesia for elite athletes. Eur J Anaesthesiol 2022; 39:825-834. [PMID: 35943185 DOI: 10.1097/eja.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sports participation has been growing rapidly since the 1960s. Anaesthesiologists are increasingly confronted with athletes in a peri-operative setting. The right choice of type of anaesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation. PURPOSE This review aims to give an overview of athletes' specific anaesthetic management in peri-operative and postoperative settings and to guide the nonspecialised anaesthetist. METHODS We comprehensively reviewed the literature, gathered all the information available on, and synthesised it in a narrative way, regarding preoperative evaluation, intraoperative implications and postoperative pain management of the elite athlete undergoing a surgical procedure. RESULTS An anaesthesiologist should recognise the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarisation as normal features in the athlete's heart. Isotonic physiology typically produces four-chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Pre-operative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anaesthesiologist is mainly avoiding drugs on the prohibited list of the World Anti-Doping Agency (WADA). Postoperative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, injectable NSAIDs and local anaesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialised multidisciplinary pain clinics. CONCLUSION This literature review aims to serve as a guide for the anaesthesiologist taking care of the elite athlete.
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Affiliation(s)
- Bram Bourgonjon
- From the Department of Anaesthesiology, GZA Antwerpen (BB), Department of Anaesthesiology, AZ Turnhout, Turnhout (KV), Department of Anaesthesiology, ASZ Aalst, Aalst, Belgium (NT) and Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen; Department of Anaesthesia, NHS Grampian, Aberdeen, UK (PF)
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Al Hashimi M. The deleterious effects of anabolic androgenic steroid abuse on sexual and reproductive health and comparison of recovery between treated and untreated patients: Single-center prospective randomized study. Andrologia 2022; 54:e14576. [PMID: 36065528 PMCID: PMC10078442 DOI: 10.1111/and.14576] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/12/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Anabolic androgenic steroids (AAS) abuse is a global health-related concern, as most of the related studies showed increasing trends and deleterious effects, mostly on sexual and fertility health. Unfortunately, there are no consensuses about the management pathways due to the lack of specific guidelines. We aimed to confirm the deleterious effects of AAS abuse, monitor the spontaneous recovery, and demonstrate the effects of treatment regimens on recovery. We enrolled 520 patients with a confirmed history of AAS intake within 1 year of presentation and evaluated their symptoms, hormones levels, and semen every 3 months until 12 months. All patients were monitored for spontaneous recovery in the first 3 months; if they showed no recovery, they were randomized to undergo either continued observation or commence medications. The most common presentation (84%) was a combination of sexual symptoms while some patients (18%) were infertile. Most patients (90%) reported low levels of luteinizing hormone, follicle-stimulating hormone, and total testosterone. After the 3-month observation, most patients (89%) started treatment, but some (11%) continued observation only. Treated patients showed faster improvement regarding the International Index of Erectile Function (IIEF) values, hormone levels, testicular size and semen parameters compared to non-treated patients (p < 0.005). Among the 94 patients who presented with infertility (18%), 61 had oligospermia and 33 had azoospermia. All received treatment, but only 14 (15%) achieved successful pregnancy at 12 months while all azoospermic's patients continued to have infertility at the end of the follow-up period. These findings demonstrated the significant negative impact of AAS abuse on sexual health and fertility, and the need for medical treatment to have faster recovery from their adverse effect.
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Affiliation(s)
- Manaf Al Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE.,Clinical Urology, Khalifa University, College of medicine and health sciences, Abu Dhabi, UAE
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James E, Wynn L. Testosterone vs. steroids: Comparing the disciplined bodywork projects of performance and image enhancing drug users in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103776. [DOI: 10.1016/j.drugpo.2022.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
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Khadem Amiri T, Salehidoost R. Anabolic-androgenic steroid use among Iranian male gym-goers. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2110952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Tohid Khadem Amiri
- Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rezvan Salehidoost
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Del Popolo Cristaldi F, Granziol U, Bariletti I, Mento G. Doing Experimental Psychological Research from Remote: How Alerting Differently Impacts Online vs. Lab Setting. Brain Sci 2022; 12:brainsci12081061. [PMID: 36009124 PMCID: PMC9405885 DOI: 10.3390/brainsci12081061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022] Open
Abstract
Due to pandemic-imposed restrictions on lab-based research, we have recently witnessed a flourishing of online studies in experimental psychology, based on the collection of fine behavioral measures such as reaction times (RTs) and accuracy. However, it remains unclear whether participants’ alerting levels may have a different impact on behavioral performance in the online vs. lab setting. In this work we administered online and in-lab the dynamic temporal prediction (DTP) task, which requires an implicit modulation of participants’ alerting by alternating experimental conditions implying either slower or faster response rates. We then compared data distribution, RTs, accuracy, and time-on-task effects across the adult lifespan between the settings. We replicated online and across the whole age range considered (19–69 y) all the task-specific effects already found in-lab (both in terms of RTs and accuracy) beyond the overall RTs delay typical of the online setting. Moreover, we found an interaction between the setting and task-specific features so that participants showed slower RTs only in experimental conditions implying a less urgent response rate, while no RTs delay and a slight accuracy increase emerged in faster conditions. Thus, the online setting has been shown to be methodologically sound in eliciting comparable effects to those found in-lab. Moreover, behavioral performance seems to be more sensitive to task-induced alerting shifts in the online as compared to the lab setting, leading to either a heightened or reduced efficiency depending on a faster or slower response rate of experimental conditions, respectively.
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Affiliation(s)
| | - Umberto Granziol
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - Irene Bariletti
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - Giovanni Mento
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
- Padova Neuroscience Center, University of Padova, Via Orus 2/B, 35129 Padova, Italy
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18
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Amaral JMX, Kimergård A, Deluca P. Prevalence of anabolic steroid users seeking support from physicians: a systematic review and meta-analysis. BMJ Open 2022; 12:e056445. [PMID: 35788077 PMCID: PMC9255415 DOI: 10.1136/bmjopen-2021-056445] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the overall prevalence of androgenic-anabolic steroids (AAS) users seeking support from physicians. Secondary objectives are to compare this prevalence in different locations and among subpopulations of AAS users, and to discuss some of the factors that could have influenced the engagement of AAS users with physicians. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, PsycINFO, Web of Science and SciELO were searched in January 2022. ELIGIBILITY CRITERIA Quantitative and qualitative studies reporting the number of AAS users who sought support from physicians, with no restrictions of language or time of publication. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the quality of studies, including publication bias. A random-effects meta-analysis was performed to estimate the overall prevalence of AAS users seeking support from physicians, followed by pooled prevalence rates by studies' location and the subpopulation of AAS users. RESULTS We identified 36 studies published between 1988 and 2021, involving 10 101 AAS users. The estimated overall prevalence of AAS users seeking support from physicians is 37.12% (95% CI 29.71% to 44.52%). Higher prevalence rates were observed in studies from Australia (67.27%; 95% CI 42.29% to 87.25%) and among clients of the needle and syringe exchange programme (54.13%; 95% CI 36.41% to 71.84%). The lowest prevalence was observed among adolescent AAS users (17.27%; 95% CI 4.80% to 29.74%). CONCLUSION Our findings suggest that about one-third of AAS users seek support from physicians, with remarkable differences between locations and subpopulations of AAS users. Further studies should investigate the factors influencing the engagement of AAS users with physicians. PROSPERO REGISTRATION NUMBER CRD42020177919.
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Affiliation(s)
| | - Andreas Kimergård
- Addictions, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Paolo Deluca
- Addictions, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
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19
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Butzke I, Iff S, Zitzmann M, Quednow BB, Claussen MC. [Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users]. PRAXIS 2022; 111:339-344. [PMID: 35473320 DOI: 10.1024/1661-8157/a003867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users Abstract. The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users' trust in physicians and drives them into the arms of so-called "gurus." The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.
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Affiliation(s)
- Ingo Butzke
- Klinik für Psychose und Abhängigkeit, PZM Psychiatriezentrum Münsingen AG, Münsingen, Schweiz
| | - Samuel Iff
- Klinik für Psychose und Abhängigkeit, PZM Psychiatriezentrum Münsingen AG, Münsingen, Schweiz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
| | - Michael Zitzmann
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung für Klinische und Operative Andrologie, Universitätsklinikum Münster, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Boris B Quednow
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
| | - Malte Christian Claussen
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
- Privatklinik Wyss AG, Münchenbuchsee, Schweiz
- Erwachsenenpsychiatrie, Psychiatrische Dienste Graubünden, Chur, Schweiz
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20
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Butzke I, Iff S, Zitzmann M, Quednow BB, Claussen MC. Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users. PRAXIS 2022; 111:e339-e344. [PMID: 35473322 DOI: 10.1024/1661-8157/a003868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users' trust in physicians and drives them into the arms of so-called "gurus." The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.
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Affiliation(s)
- Ingo Butzke
- Clinic for Psychosis and Dependence, PZM Psychiatry Center Münsingen AG, Münsingen, Switzerland
| | - Samuel Iff
- Clinic for Psychosis and Dependence, PZM Psychiatry Center Münsingen AG, Münsingen, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Zitzmann
- Center for Reproductive Medicine and Andrology, Department of Clinical and Operative Andrology, University Hospital Münster, Westfälische Wilhelms-Universität Münster, Germany
| | - Boris B Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Malte Christian Claussen
- Clinic for Psychosis and Dependence, PZM Psychiatry Center Münsingen AG, Münsingen, Switzerland
- Private Clinic Wyss AG, Münchenbuchsee, Switzerland
- Adult Psychiatry, Psychiatric Services Grisons, Chur, Switzerland
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21
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Iff S, Gähwiler R, Butzke I, Quednow BB, Claussen MC. Recognizing IPED Use in Clinical Practice. PRAXIS 2022; 111:e333-e337. [PMID: 35473328 DOI: 10.1024/1661-8157/a003874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The non-medical use of image- and performance-enhancing drugs (IPEDs) is widespread in the fitness and bodybuilding scene. The reasons for IPED use are often hedonistic in nature and they are used in so-called "cycles" over several weeks. The most common side effects are: testicular atrophy, acne, hypersexuality, hypertension, gynecomastia, lipid metabolism disorders, mood swings, hair loss, and policythemia. Common consequences following IPED use are: decreased libido, oligo- or azoospermia, and erectile dysfunction. To reduce undesirable side effects and consequences, IPED users often take medications for self-treatment; occasionally IPED users also mention such medications and ask for them in the general medical practice.
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Affiliation(s)
- Samuell Iff
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
- Clinic for Psychosis and Dependence, PZM Psychiatry Center Münsingen AG, Switzerland
| | - Roman Gähwiler
- Center for Sports Medicine, Cantonal Hospital Aarau, Switzerland
| | - Ingo Butzke
- Clinic for Psychosis and Dependence, PZM Psychiatry Center Münsingen AG, Switzerland
| | - Boris B Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Malte Christian Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
- Private Clinic Wyss, Münchenbuchsee, Switzerland
- Department of Adult Psychiatry, Psychiatric Services Grisons, Chur, Switzerland
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22
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Iff S, Gähwiler R, Butzke I, Quednow BB, Claussen MC. [Recognizing IPED Use in Clinical Practice]. PRAXIS 2022; 111:333-337. [PMID: 35473323 DOI: 10.1024/1661-8157/a003846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Recognizing IPED Use in Clinical Practice Abstract. The non-medical use of image- and performance-enhancing drugs (IPEDs) is widespread in the fitness and bodybuilding scene. The reasons for IPED use are often hedonistic in nature and they are used in so-called "cycles" over several weeks. The most common side effects are: testicular atrophy, acne, hypersexuality, hypertension, gynecomastia, lipid metabolism disorders, mood swings, hair loss, and policythemia. Common consequences following IPED use are: decreased libido, oligo- or azoospermia, and erectile dysfunction. To reduce undesirable side effects and consequences, IPED users often take medications for self-treatment; occasionally IPED users also mention such medications and ask for them in the general medical practice.
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Affiliation(s)
- Samuel Iff
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
- Klink für Psychose und Abhängigkeit, PZM Psychiatriezentrum Münsingen AG, Münsingen, Schweiz
| | | | - Ingo Butzke
- Klink für Psychose und Abhängigkeit, PZM Psychiatriezentrum Münsingen AG, Münsingen, Schweiz
| | - Boris B Quednow
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
| | - Malte Christian Claussen
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Universität Zürich, Zürich, Schweiz
- Privatklinik Wyss AG, Münchenbuchsee, Schweiz
- Erwachsenenpsychiatrie, Psychiatrische Dienste Graubünden, Chur, Schweiz
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23
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Marsicano G, Cerpelloni F, Melcher D, Ronconi L. Lower multisensory temporal acuity in individuals with high schizotypal traits: a web-based study. Sci Rep 2022; 12:2782. [PMID: 35177673 PMCID: PMC8854550 DOI: 10.1038/s41598-022-06503-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Natural events are often multisensory, requiring the brain to combine information from the same spatial location and timing, across different senses. The importance of temporal coincidence has led to the introduction of the temporal binding window (TBW) construct, defined as the time range within which multisensory inputs are highly likely to be perceptually bound into a single entity. Anomalies in TBWs have been linked to confused perceptual experiences and inaccurate filtering of sensory inputs coming from different environmental sources. Indeed, larger TBWs have been associated with disorders such as schizophrenia and autism and are also correlated to a higher level of subclinical traits of these conditions in the general population. Here, we tested the feasibility of using a web-based version of a classic audio-visual simultaneity judgment (SJ) task with simple flash-beep stimuli in order to measure multisensory temporal acuity and its relationship with schizotypal traits as measured in the general population. Results show that: (i) the response distribution obtained in the web-based SJ task was strongly similar to those reported by studies carried out in controlled laboratory settings, and (ii) lower multisensory temporal acuity was associated with higher schizotypal traits in the “cognitive-perceptual” domains. Our findings reveal the possibility of adequately using a web-based audio-visual SJ task outside a controlled laboratory setting, available to a more diverse and representative pool of participants. These results provide additional evidence for a close relationship between lower multisensory acuity and the expression of schizotypal traits in the general population.
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Affiliation(s)
- Gianluca Marsicano
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Cerpelloni
- Center for Mind/Brain Sciences and Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy.,Laboratory of Biological Psychology, Department of Brain and Cognition, Leuven Brain Institute, KU Leuve, Leuven, Belgium.,Institute of Research in Psychology (IPSY) & Institute of Neuroscience (IoNS)-University of Louvain (UCLouvain), Leuven, Belgium
| | - David Melcher
- Center for Mind/Brain Sciences and Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy. .,Psychology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Luca Ronconi
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
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24
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Severity of anabolic steroid dependence, executive function, and personality traits in substance use disorder patients in Norway. Drug Alcohol Depend 2022; 231:109275. [PMID: 35030506 DOI: 10.1016/j.drugalcdep.2022.109275] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. OBJECTIVE To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). METHODS Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. RESULTS Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. CONCLUSION Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.
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25
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Arslan M, Yabancı Ayhan N, Sarıyer ET, Çolak H, Çevik E. The Effect of Bigorexia Nervosa on Eating Attitudes and Physical Activity: A Study on University Students. Int J Clin Pract 2022; 2022:6325860. [PMID: 36081811 PMCID: PMC9433244 DOI: 10.1155/2022/6325860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/01/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This study aims to examine the relationship between physical activity, eating attitude, and bigorexia nervosa among university students. METHOD A questionnaire form consisting of sociodemographic characteristics, eating habits, the Eating Attitude Scale (EAT-40), the International Physical Activity Questionnaire (IPAQ), and the Muscle Appearance Satisfaction Scale (MASS) was conducted on undergraduate students at Üsküdar University. RESULTS There were 1006 students who participated in this study with a mean age of 22.58 ± 2.87 years. The median "muscle appearance satisfaction" score of the obese students was statistically higher than the normal weight and underweight students. The median score for "Obesity Anxiety" was statistically higher in underweight students than in obese ones. A one-unit increase in IPAQ scores was related to an elevation of 24.9% in the MASS and a decrease of 17.9% in the EAT-40 scores, while a one-unit increase in MASS scores was related to a reduction of 12.5% in the EAT-40 scores. CONCLUSION Eating attitude is associated with bigorexia nervosa, and as MASS scores increase, EAT-40 scores decrease and as IPAQ scores increase, and EAT-40 scores decrease. In other words, as physical activity increases, muscle strength satisfaction elevates, and in parallel with this increase, a positive eating attitude improves.
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Affiliation(s)
- Müge Arslan
- Üsküdar University, Faculty of Health Science, Department of Nutrition and Dietetics, Istanbul, Turkey
| | - Nurcan Yabancı Ayhan
- Ankara University, Faculty of Health Science, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Esra Tansu Sarıyer
- Üsküdar University, Faculty of Health Science, Department of Nutrition and Dietetics, Istanbul, Turkey
| | - Hatice Çolak
- Üsküdar University, Faculty of Health Science, Department of Nutrition and Dietetics, Istanbul, Turkey
| | - Ekin Çevik
- Üsküdar University, Faculty of Health Science, Department of Nutrition and Dietetics, Istanbul, Turkey
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26
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Brusseau TA, Burns RD. Associations of Physical Activity, School Safety, and Non-Prescription Steroid Use in Adolescents: A Structural Equation Modeling Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:87. [PMID: 35010346 PMCID: PMC8751058 DOI: 10.3390/ijerph19010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Non-prescription steroid use can negatively impact adolescent physical and mental health and wellbeing. Determining correlates of this risk behavior is needed to help mitigate its prevalence. Two potential correlates are physical activity and school safety. The purpose of this study was to examine the associations of physical activity, school safety, and non-prescription steroid use within a sample of adolescents from the 2015-2019 US National Youth Risk Behavior Survey (YRBS). A multi-stage cluster sampling procedure yielded a representative sample of US adolescents from the 2015-2019 YRBS (n = 44,066; 49.6% female). Two latent variables indicating physical activity and unsafe schools were the independent variables. The dependent variable was a self-report of non-prescription steroid use. A weighted structural equation model examined the associations between physical activity and unsafe schools with non-prescription steroid use, controlling for age, sex, BMI %tile, race/ethnicity, and sexual minority status. The latent physical activity variable did not associate with non-prescription steroid use (β = 0.007, 95%CI: -0.01-0.02, p = 0.436); however, the unsafe schools latent variable did associate with non-prescription steroid use (β = 0.64, 95%CI: 0.59-0.69, p < 0.001). An unsafe school environment may be a determinant of non-prescription steroid use in adolescents. Physical activity behaviors did not associate with steroid use.
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27
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Ekström L, Broström S, Dahl ML, Börjesson A. A Summary of Online Enquiries Submitted to Anti-doping Hotline 2005–2018. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:787954. [PMID: 36304044 PMCID: PMC9580816 DOI: 10.3389/frph.2021.787954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Anabolic Androgenic Steroid (AAS) abuse in the society is considered a health problem and has been associated with cardiovascular toxicity, endocrine disruption, as well as psychiatric symptoms such as aggression and cognitive dysfunction. Men and women abusing AAS, as well as persons in close relationship to AAS abusers, may encounter concerns. Subsequently, the Anti-Doping Hotline was formed 1993 to answers questions about doping in the society. Here we have reviewed 7,123 enquiries posted on the Anti-Doping Hotline website between 2005 and 2018 to see what type of questions were raised. Most questions (n = 2,924) involved AAS, 60% from abusers themselves, and 17% from a person close to an AAS abusers. Only 2.3% of the questions concerned AAS abusing women. Of the AAS specific questions most were from persons who sought personal advice regarding risks and side effects. Notably, the AAS abusers themselves were concerned about somatic side effects (e.g., gynecomastia) and problems related to the AAS injection. The persons in close relationship to an AAS abusers on the other hand, expressed concerns about psychiatric changes including mood swings and aggressivity. In addition to AAS, 26 and 13% of the questions involved dietary supplements and other doping substances, respectively. A gradual decrease of questions regarding ephedrine was noted, whereas the numbers of SARMs related questions increased during this time. Our results show that there is a continuous need to provide medical, nursing, and social support and counseling to AAS abusers and their next of kin.
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Affiliation(s)
- Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Broström
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Annica Börjesson
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28
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Linhares BL, Miranda EP, Cintra AR, Reges R, Torres LO. Use, Misuse and Abuse of Testosterone and Other Androgens. Sex Med Rev 2021; 10:583-595. [PMID: 37051948 DOI: 10.1016/j.sxmr.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION For several decades, testosterone and its synthetic derivatives have been used for anabolic and androgenic purposes. Initially restricted to professional bodybuilders, these substances gradually became more popular with recreational weightlifters. Considering its increasing prevalence, the consumption of anabolic androgenic steroids (AAS) has become a matter of great concern. Although most side effects are mild and reversible, some of them can cause permanent damage or can be potentially life threatening. OBJECTIVES To review and summarize medical literature regarding misuse and abuse of testosterone and other androgens, in order to provide evidence-based information on the main topics related to this subject, such as how to identify and how to deal with these patients, and to elucidate the multiple possible adverse effects secondary to this practice. METHODS Key studies were retrieved from PubMed (1989-2021) with reference searches from relevant articles. Search terms included "hypogonadism", "anabolic androgenic steroids", "androgens", "misuse AND testosterone", "abuse AND testosterone", and "side effects AND testosterone". RESULTS There is a significant lack of information in the peer-reviewed literature describing demographic data, implications for different organ systems and the management of current or former AAS users; however, androgen abuse has been already linked to a wide variety of cardiovascular diseases, metabolic, endocrine, neurological, psychiatric and liver disorders. Despite all this, most physicians still feel uncomfortable and hesitate to discuss the issue with patients. CONCLUSIONS The chronic use of high doses of AAS is associated with adverse effects in several organ systems; however, there are still many gaps in our knowledge about the long-term consequences of this practice and how to deal with these patients. Healthcare professionals have a crucial role in combating this public health problem, recognizing and preventing the spread of androgen abuse. Linhares BL, Miranda EP, Cintra AR, et al. Use, Misuse and Abuse of Testosterone and Other Androgens. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Bruno L Linhares
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Eduardo P Miranda
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Anna R Cintra
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Ricardo Reges
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
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Bhasin S, Hatfield DL, Hoffman JR, Kraemer WJ, Labotz M, Phillips SM, Ratamess NA. Anabolic-Androgenic Steroid Use in Sports, Health, and Society. Med Sci Sports Exerc 2021; 53:1778-1794. [PMID: 34261998 DOI: 10.1249/mss.0000000000002670] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This consensus statement is an update of the 1987 American College of Sports Medicine (ACSM) position stand on the use of anabolic-androgenic steroids (AAS). Substantial data have been collected since the previous position stand, and AAS use patterns have changed significantly. The ACSM acknowledges that lawful and ethical therapeutic use of AAS is now an accepted mainstream treatment for several clinical disorders; however, there is increased recognition that AAS are commonly used illicitly to enhance performance and appearance in several segments of the population, including competitive athletes. The illicit use of AAS by competitive athletes is contrary to the rules and ethics of many sport governing bodies. Thus, the ACSM deplores the illicit use of AAS for athletic and recreational purposes. This consensus statement provides a brief history of AAS use, an update on the science of how we now understand AAS to be working metabolically/biochemically, potential side effects, the prevalence of use among athletes, and the use of AAS in clinical scenarios.
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Affiliation(s)
- Shalender Bhasin
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Disa L Hatfield
- Department of Kinesiology, University of Rhode Island, Kingston, RI
| | - Jay R Hoffman
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH
| | | | | | - Nicholas A Ratamess
- Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ
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Abstract
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Andrology Department, Concord Hospital, Sydney, Australia
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Bonnecaze AK, O'Connor T, Burns CA. Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review. J Gen Intern Med 2021; 36:2055-2064. [PMID: 33948794 PMCID: PMC8298654 DOI: 10.1007/s11606-021-06751-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/21/2021] [Indexed: 02/07/2023]
Abstract
Anabolic androgenic steroid (AAS) and performance-enhancing drug (PED) use is a prevalent medical issue, especially among men, with an estimated 2.9-4 million Americans using AAS in their lifetime. Prior studies of AAS use reveal an association with polycythemia, dyslipidemia, infertility, hypertension, left ventricular hypertrophy, and multiple behavioral disorders. AAS withdrawal syndrome, a state of depression, anhedonia, and sexual dysfunction after discontinuing AAS use, is a common barrier to successful cessation. Clinical resources for these patients and training of physicians on management of the patient using AAS are limited. Many men are hesitant to seek traditional medical care due to fear of judgment and lack of confidence in physician knowledge base regarding AAS. While proposed approaches to weaning patients off AAS are published, guidance on harm reduction for actively using patients remains sparse. Medical education regarding the management of AAS use disorder is paramount to improving care of this currently underserved patient population. Management of these patients must be non-judgmental and focus on patient education, harm reduction, and support for cessation. The approach to harm reduction should be guided by the specific AAS/PEDs used.
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Affiliation(s)
- Alex K Bonnecaze
- Dept of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Thomas O'Connor
- Dept of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Cynthia A Burns
- Dept of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Whitaker DL, Geyer-Kim G, Kim ED. Anabolic steroid misuse and male infertility: management and strategies to improve patient awareness. Expert Rev Endocrinol Metab 2021; 16:109-122. [PMID: 33973822 DOI: 10.1080/17446651.2021.1921574] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Anabolic androgenic steroid use is an uncommon but important cause of male infertility. As paternal age and anabolic steroid use increases, providers are more likely than ever to encounter men with infertility and prior or concurrent anabolic steroid use. In this review, we outline the background, epidemiology and pathophysiology of anabolic steroid induced male infertility and provide recommendations regarding the diagnosis, management, and future prevention of this condition.Areas covered: Male reproductive physiology is a tightly regulated process that can be influenced by exogenous sources such as anabolic steroids and selective androgen receptor modulators (SARMs). Data suggest that a combination of selective estrogen receptor modulators (SERMs), human chorionic gonadotropin (hCG), aromatase inhibitors (AIs), and recombinant follicle-stimulating hormone (rFSH) may lead to spermatogenesis recovery.Expert opinion: Anabolic steroid and SARM users continue to exhibit lack of understanding regarding the potential side effects of their use on male fertility. Current literature suggests that spermatogenesis can be safely recovered using a combination of SERMs, hCG, AIs and rFSH although additional studies are necessary. While anabolic steroid prevention strategies have largely been focused on the individual level, further investigation is necessary and should be approached in a socioecological manner.
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Affiliation(s)
- Dustin L Whitaker
- Department of Urology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, United States
| | - Gabriella Geyer-Kim
- Department of Urology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, United States
| | - Edward D Kim
- Department of Urology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, United States
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Pope HG, Kanayama G, Hudson JI, Kaufman MJ. Review Article: Anabolic-Androgenic Steroids, Violence, and Crime: Two Cases and Literature Review. Am J Addict 2021; 30:423-432. [PMID: 33870584 DOI: 10.1111/ajad.13157] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/16/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anabolic-androgenic steroid (AAS) use has become a major worldwide substance use disorder, affecting tens of millions of individuals. Importantly, it is now increasingly recognized that some individuals develop uncharacteristically violent or criminal behaviors when using AAS. We sought to summarize available information on this topic. METHODS We reviewed the published literature on AAS-induced behavioral effects and augmented this information with extensive observations from our clinical and forensic experience. RESULTS It is now generally accepted that some AAS users develop uncharacteristically violent or criminal behaviors while taking these drugs. Although these behaviors may partially reflect premorbid psychopathology, sociocultural factors, or expectational effects, accumulating evidence suggests that they are also attributable to biological effects of AAS themselves. The mechanism of these effects remains speculative, but preliminary data suggest a possible role for brain regions involved in emotional reactivity, such as the amygdala and regions involved in cognitive control, including the frontal cortex. For unknown reasons, these effects appear idiosyncratic; most AAS users display few behavioral effects, but a minority develops severe effects. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Professionals encountering AAS users in clinical or forensic settings should be alert to the possibility of AAS-induced violence or criminality and should employ strategies to assess whether AAS is indeed a contributory factor in a given case. Further research is needed to elucidate the mechanism of AAS-induced violence and to explain why only a subset of AAS users appears vulnerable to these effects. (Am J Addict 2021;00:00-00).
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Affiliation(s)
- Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - James I Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Marc J Kaufman
- Harvard Medical School, Boston, Massachusetts.,McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
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Zoob Carter BN, Boardley ID, van de Ven K. The Impact of the COVID-19 Pandemic on Male Strength Athletes Who Use Non-prescribed Anabolic-Androgenic Steroids. Front Psychiatry 2021; 12:636706. [PMID: 33828494 PMCID: PMC8019803 DOI: 10.3389/fpsyt.2021.636706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background: One sub-population potentially affected by the COVID-19 pandemic are strength athletes who use anabolic-androgenic steroids (AAS). We examined links between disruption in AAS use and training due to the pandemic and mental health outcomes in this population, hypothesising: (a) the pandemic would be linked with reduced training and AAS use; and (b) athletes perceiving greater impact on their training and AAS use would report increases in detrimental mental health outcomes. Methods: Male strength athletes using AAS (N = 237) from 42 countries completed an online questionnaire in May 2020. A sub-sample (N = 90) from 20 countries participated again 4 months later. The questionnaire assessed pre-pandemic and current AAS use and training, alongside several mental health outcomes. Results: At Time 1, most participants perceived an impact of the pandemic on AAS use (91.1%) and/or training (57.8%). Dependent t-tests demonstrated significant reductions in training frequency (t = 7.78; p < 0.001) and AAS dose (t = 6.44; p < 0.001) compared to pre-pandemic. Linear regression showed the impact of the pandemic on training was a significant positive predictor of excessive body checking (B = 0.35) and mood swings (B = 0.26), and AAS dose was a significant positive predictor of anxiety (B = 0.67), insomnia (B = 0.52), mood swings (B = 0.37). At Time 2, fewer participants perceived an impact of the pandemic on AAS use (29.9%) and/or training (66.7%) than at Time 1. Training frequency (t = 3.02; p < 0.01) and AAS dose (t = 2.11; p < 0.05) were depressed in comparison to pre-pandemic. However, AAS dose had increased compared to Time 1 (t = 2.11; p < 0.05). Linear regression showed the impact of the pandemic on training/AAS use did not significantly predict any mental-health outcomes. However, AAS dose was a significant negative predictor of depressive thoughts (B = -0.83) and mood swings (B = -2.65). Conclusion: Our findings showed impact of the pandemic on the training and AAS use, reflected in reduced training frequency and AAS dose. However, whilst we detected some short-term consequential effects on mental health, these did not appear to be long-lasting.
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Affiliation(s)
- Barnaby N. Zoob Carter
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ian D. Boardley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Katinka van de Ven
- Centre for Rural Criminology, School of Humanities, Arts, and Social Sciences, University of New England, Armidale, NSW, Australia
- Drug Policy Modelling Program, Social Policy Research Centre, University of New South Wales, Sydney, NSW, Australia
- Human Enhancement Drugs Network, University of New England, Armidale, NSW, Australia
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Aziz SA. Attitude and health issue awareness of anabolic androgenic steroids use among male gym users in some gym centers in Sulaymaniyah city, Iraq. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1879294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sadat Abdulla Aziz
- Department of Basic Sciences, College of Veterinary Medicine, University of Sulaimani, Sulaymaniyah, Iraq
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Underwood M, van de Ven K, Dunn M. Testing the boundaries: Self-medicated testosterone replacement and why it is practised. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 95:103087. [PMID: 33342615 DOI: 10.1016/j.drugpo.2020.103087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/16/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as 'enhancement' or 'doping', and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance enhancing drugs (IPEDs), but never systematically explored. APPROACH This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as 'testosterone replacement therapy' (TRT). In particular, it focuses on the 26 (84%) of these individuals who self-medicated TRT. Data was analysed thematically (using NVivo) in order to answer the question: 'how and why is testosterone self-medicated?'. Using Bacchi's (2016) problematization approach to policy analysis, this paper also asks, 'what happens to the 'problem' of non-prescribed testosterone use if such use is therapeutic?'. FINDINGS Self-medicated TRT was found to be very similar to TRT as practised in medical contexts. Self-medication was often practised because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use. CONCLUSION By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualisations of all illicit testosterone use as 'abuse', and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment.
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Affiliation(s)
- Mair Underwood
- School of Social Science, The University of Queensland, Queensland 4072 Australia.
| | - Katinka van de Ven
- Centre for Rural Criminology, School of Humanities, Arts, and Social Sciences, University of New England, Armidale, NSW, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia; Human Enhancement Drugs Network (HEDN), NSW, Australia
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Australia
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Bonnecaze AK, O'Connor T, Aloi JA. Characteristics and Attitudes of Men Using Anabolic Androgenic Steroids (AAS): A Survey of 2385 Men. Am J Mens Health 2020; 14:1557988320966536. [PMID: 33307930 PMCID: PMC7739101 DOI: 10.1177/1557988320966536] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Additional characterization of patients using anabolic androgenic steroids (AAS) is needed to improve harm reduction and cessation resources for patients. Our group sought to expand upon the currently limited data regarding AAS use by performing a web-based survey assessing experiences of males using AAS. Participants included men over the age of 18 with history of AAS use within the past 5 years. Data were collected between August 2019 and April 2020. Primary outcome measures included age when starting AAS, dose of AAS, motivations for use, experiences with health-care professionals, and rate of successful cessation. The survey was accessed 3640 times, resulting in 2385 completed surveys meeting the inclusion criteria (68.93% participation rate). Average participant age was 31.69 ± 10.09 years. Over half of respondents were from the United States (n = 1271, 53.3%). Motives to use AAS included improving appearance (n = 1959, 82.2%), strength gain (n = 1192, 50%), and self-esteem/body image issues (n = 712, 29.87%). Participants rated physicians poorly, regarding knowledge of AAS (4.08 ± 2.23). Most participants did not reveal AAS use to their health-care providers (n = 1338, 56.1%); of those that did, 55.30% (n = 579) reported feeling discriminated against for their use. Of 46.16% (n = 1101) attempting AAS cessation, 60.22% (n = 663) were unsuccessful. Challenges in the management of AAS use include early onset of use, supraphysiologic doses used, and frequently present body image disorders stress. Distrust of health-care providers, poor cessation rates, and lack of physician training further exacerbate this. These findings should serve to reinforce previous calls to action for further research on the treatment of AAS use disorder.
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Affiliation(s)
- Alex K Bonnecaze
- School of Medicine, Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University, Winston-Salem, NC, USA
| | - Thomas O'Connor
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joseph A Aloi
- School of Medicine, Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University, Winston-Salem, NC, USA
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Bomfim JHGG. Pharmaceutical Care in Sports. PHARMACY 2020; 8:E218. [PMID: 33207610 PMCID: PMC7712766 DOI: 10.3390/pharmacy8040218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Pharmaceutical care in sports is a new field of work to clinical pharmacists, focused on promoting pharmacotherapeutic follow up and clinical services to athletes, physical activity practitioners and enthusiasts of any sports modality. A broad range of pharmaceuticals, dietary supplements and herbal drugs have been used historically as performance promoters, doping or ergogenic aids. In this context, the role of pharmacists in prevent adverse events, drug interactions or any drug related problems, as doping issues, was described. Its actions can be important to contribute with a multi professional clinical health team, leading athletes to use these resources in a rational way, promoting and optimizing the therapeutic when its necessary.
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Seara FAC, Pereira-Junior PP, Silva-Almeida C, Dos-Santos RC, Souza RN, Costa CRM, Domingos AE, Barbosa RAQ, Ferraz AP, Machado AAN, Ceccato VM, Takiya CM, Ponte CG, Reis LC, Olivares EL, Nascimento JHM. Anabolic steroid excess promotes hydroelectrolytic and autonomic imbalance in adult male rats: Is it enough to alter blood pressure? Steroids 2020; 163:108711. [PMID: 32739291 DOI: 10.1016/j.steroids.2020.108711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
AIM The present study investigated the effects of anabolic steroid (AS) excess on blood pressure regulation. METHODS Male Wistar rats were treated with nandrolone decanoate (AS) or vehicle (CTL) for 8 or 10 weeks. Saline (1.8%) and water intake were measured in metabolic cages. Urinary volume, osmolarity, Na+ and K+ concentrations, and plasma osmolarity were measured. The autonomic balance was estimated by heart rate variability at baseline or after icv injection of losartan. Cardiac function was assessed by echocardiography and ex vivo recordings. Myocardial collagen deposition was evaluated by Picrosirius-Red staining. Vascular reactivity and wall thickness were investigated in aortic sections. Blood pressure (BP) was assessed by tail-cuff plethysmography. Angiotensin II type I receptor (AT1R), renin, and mineralocorticoid receptor (MR) mRNA expression was measured in the kidneys and whole hypothalamus. RESULTS AS group exhibited decreased urinary volume and Na+ concentration, while urinary K+ concentration, plasma osmolarity, and renal AT1R and renin mRNA levels were increased compared to CTL (p < 0.05). Water intake was increased, and saline intake was decreased in the AS group (p < 0.01). AS group exhibited increased low-frequency/high-frequency-ratio, while it was decreased by icv injection of losartan (p < 0.05) compared to baseline. Neither cardiac function nor vascular reactivity/morphology was affected by AS excess (p > 0.05). Ultimately, BP levels were not altered by AS excess (p > 0.05). CONCLUSION AS excess promoted hydroelectrolytic and autonomic imbalance but did not alter vascular or cardiac function/morphology.
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Affiliation(s)
- Fernando A C Seara
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil.
| | - Pedro P Pereira-Junior
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Claudio Silva-Almeida
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Estácio de Sá University, Brazil
| | - Raoni C Dos-Santos
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil
| | - Raquel N Souza
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil
| | - César R M Costa
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Multicenter Postgraduate Program of Physiological Sciences, Brazilian Society of Physiology, Brazil
| | - Ainá E Domingos
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Raiana A Q Barbosa
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Ana P Ferraz
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - André A N Machado
- Laboratory of Biochemistry and Gene Expression, University of Ceará, Brazil
| | - Vânia M Ceccato
- Laboratory of Biochemistry and Gene Expression, University of Ceará, Brazil
| | - Christina M Takiya
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Cristiano G Ponte
- Federal Institute of Education, Science, and Technology of Rio de Janeiro, Brazil
| | - Luis C Reis
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Multicenter Postgraduate Program of Physiological Sciences, Brazilian Society of Physiology, Brazil
| | - Emerson L Olivares
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Multicenter Postgraduate Program of Physiological Sciences, Brazilian Society of Physiology, Brazil
| | - Jose H M Nascimento
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
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The Modulatory Role of Vitamin C in Boldenone Undecylenate Induced Testicular Oxidative Damage and Androgen Receptor Dysregulation in Adult Male Rats. Antioxidants (Basel) 2020; 9:antiox9111053. [PMID: 33126548 PMCID: PMC7694087 DOI: 10.3390/antiox9111053] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background: This study explored the effect of vitamin C (Vit-C) administration on the reproductive function of adult male Wistar rats injected with boldenone undecylenate (BOL). Methods: Rats were randomly assigned into control, vehicle control, Vit-C (120 mg/kg b.wt./day, orally), BOL (received 5 mg/kg b.wt./week, IM) and BOL+Vit-C-treated groups. After eight weeks, hormonal assay, semen evaluation, testicular enzymes, and antioxidants biomarkers were assessed. Besides, the histopathological and immunohistochemical investigations of the androgen receptor (AR) expression were performed. Results: The results revealed that serum testosterone, acid phosphatase, sorbitol dehydrogenase, sperm abnormalities, and testicular malondialdehyde were significantly incremented in the BOL-treated group. Testicular weight, sperm count, and sperm motility together with serum levels of luteinizing hormone, follicle-stimulating hormone, and estradiol, and testicular testosterone, catalase, superoxide dismutase, and reduced glutathione showed a significant decrease following BOL treatment. Besides, the AR immunoreactivity was significantly decreased in testicular tissues. Vit-C co-administration with BOL significantly relieved the BOL-induced sperm abnormalities, reduced sperm motility, testicular enzyme leakage, and oxidative damage. However, Vit-C could rescue neither BOL-induced hormonal disturbances nor AR down-regulation. Conclusions: The results provide further insight into the mechanisms of BOL-induced reproductive dysfunction and its partial recovery by Vit-C.
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McVeigh J, Salinas M, Ralphs R. A sentinel population: The public health benefits of monitoring enhanced body builders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 95:102890. [PMID: 32912824 DOI: 10.1016/j.drugpo.2020.102890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 07/24/2020] [Indexed: 01/24/2023]
Abstract
There is heightened recognition of the public health implications of anabolic androgenic steroids (AAS) for the use of image and performance enhancement; with increasing evidence of their long-term negative health impacts, the hazards associated with their administration (often via injection), and the variability and unpredictability of their contents. In order to optimise the effects of these drugs, together with strict dietary and training regimes, AAS users typically supplement their use with an expansive and continually evolving range of ancillary drugs. The discovery and subsequent adoption of these drugs by the broader AAS user population is largely dependent upon a minority of social influencers within the bodybuilding community. Pioneering enhanced bodybuilders who self-experiment with a diverse range of image and performance enhancing drugs (IPEDs) and ancillary drugs have been the forerunners in the development of an underground user-led literature, online discussion forums, and were early adopters of internet-facilitated drug markets. Yet the impact of their self-experimentations extends well beyond the enhanced bodybuilding community, particularly in their use of ancillary drugs. Most significantly has been their role in the diffusion of various enhancement and psychoactive drugs to the wider population. Using the theoretical framework of the 'diffusion of innovation' we consider the role that pioneering enhanced bodybuilders have played in the diffusion of various enhancement and psychoactive drugs to the wider population through a focus on three substances: dinitrophenol (DNP), melanotan II and gamma-hydroxybtyrate (GHB). With an increasing range of drugs used by bodybuilders, coupled with an expansion in the use of online forums and online platforms to purchase pharmacological and new psychoactive drugs, we anticipate this trend of diffusion amongst the wider population will continue to flourish. Therefore, we highlight the need for policy makers to monitor emergent trends, not only in the general AAS population but particularly amongst enhanced bodybuilders.
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Affiliation(s)
- Jim McVeigh
- Substance Use and Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL, United Kingdom.
| | - Mike Salinas
- Substance Use and Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL, United Kingdom
| | - Rob Ralphs
- Substance Use and Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL, United Kingdom
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Carvalho FB, Bueno A, Lhamas CL, Gutierres JM, Carvalho MB, Brusco I, Oliveira SM, Bottari NB, Silva AD, Miron VV, Alves MS, Leitemperger JW, Loro VL, Schetinger MRC, Morsch VM, de Andrade CM. Impacts of dose and length of exposure to boldenone and stanazolol on enzymatic antioxidant systems, myeloperoxidase and NAGase activities, and glycogen and lactate levels in rat liver. Steroids 2020; 161:108670. [PMID: 32473164 DOI: 10.1016/j.steroids.2020.108670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 04/06/2020] [Accepted: 05/20/2020] [Indexed: 01/20/2023]
Abstract
We investigated the adverse effects of the anabolic androgenic steroids (AAS) boldenone (BOL) and stanazolol (ST) on the enzymatic antioxidant systems of the rat liver. Male Wistar rats were divided in three protocols (P): PI, 5 mg/kg BOL or ST once a week for 4 weeks; PII, 2.5 mg/kg BOL or ST once a week for 8 weeks; PIII, 1.25 mg/kg BOL or ST once a week for 12 weeks. AAS were administered intramuscularly (0.2 ml, olive oil vehicle) once a week in all protocols. Activities of the enzymes glutathione peroxidase (GPx), glutathione S-transferase (GST), and glutathione reductase (GR), superoxide dismutase (SOD), catalase (CAT), were investigated. We assessed the content of hydrogen peroxide (H2O2), glycogen and lactate; and enzyme markers of neutrophils (myeloperoxidase, MPO) and macrophages (NAGase). PI and PII altered the SOD and CAT activities and increased the H2O2 content. PI led to increases in the MPO and NAGase activities. In contrast, changes in GPx, GST and, GR were observed under PII and, to a greater extend, under PIII. Following PIII, GPx, GR, and GST exhibited reduced activities. All protocols altered the glycogen and lactate content. The use of high doses of AAS for a short duration first alters SOD/CAT activity. In contrast, at lower doses of AAS for long periods is associated with changes in the glutathione system. Protocols with high doses of AAS for a short duration exert the most deleterious effects on redox status, markers of cellular infiltration, and the metabolic functioning of hepatic tissues.
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Affiliation(s)
- Fabiano B Carvalho
- Graduate Program in Veterinary Medicine, Veterinary Hospital, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil; Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil.
| | - Andressa Bueno
- Graduate Program in Veterinary Medicine, Veterinary Hospital, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Cibele L Lhamas
- Graduate Program in Veterinary Medicine, Veterinary Hospital, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Jessié M Gutierres
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Mariana B Carvalho
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Indiara Brusco
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Sara M Oliveira
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Nathieli B Bottari
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Aniélen D Silva
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Vanessa V Miron
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Mariana S Alves
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Jossiele W Leitemperger
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Vânia L Loro
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Maria Rosa C Schetinger
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Vera M Morsch
- Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil
| | - Cinthia M de Andrade
- Graduate Program in Veterinary Medicine, Veterinary Hospital, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil; Graduate Program in Biological Sciences: Biochemical Toxicology, Center for Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria 97105-900, RS, Brazil.
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Seara FAC, Olivares EL, Nascimento JHM. Anabolic steroid excess and myocardial infarction: From ischemia to reperfusion injury. Steroids 2020; 161:108660. [PMID: 32492466 DOI: 10.1016/j.steroids.2020.108660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 01/06/2023]
Abstract
Anabolic steroids (AS) are synthetic testosterone-derivatives developed by the pharmaceutical industry to mimic testosterone biological effects. So far, AS have been implicated in the treatment of pathological conditions, such as hypogonadism, anemia, and cachexia. Since their discovery, though, AS have been illicitly used by elite and recreational athletes, bodybuilders and weightlifters in order to enhance athletic and aesthetic performance. This practice is characterized by cycles of administration and withdrawal, the combination of different AS compounds, and administration of doses 50 - 1000 times higher than those recommended for therapeutic purposes. AS excess has been correlated to cardiovascular detrimental effects, including cardiac hypertrophy, arrhythmias, and hypertension. Particularly, acute myocardial infarction (AMI) has been extensively reported by clinical and post-mortem studies. Atherosclerosis, hypercoagulability state, increased thrombogenesis and vasospasm have arisen as potential causes of myocardial ischemia in AS users. Additionally, several experimental reports have demonstrated that AS can increase the susceptibility to cardiac ischemia/reperfusion injury, whereas the cardioprotection elicited by physical exercise and ischemic postconditioning is blunted. Altogether, these factors can contribute to increased AMI morbidity and mortality during AS excess, particularly when AS are combined with other compounds, such as thyroid hormones, growth hormones, insulin, and diuretics.
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Affiliation(s)
- Fernando A C Seara
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Federal Rural University of Rio de Janeiro, Seropédica, RJ, Brazil; Multicenter Graduate Program in Physiological Sciences, Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Seropédica, Brazil; Laboratory of Cardiac Electrophysiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Emerson L Olivares
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Federal Rural University of Rio de Janeiro, Seropédica, RJ, Brazil; Multicenter Graduate Program in Physiological Sciences, Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - Jose H M Nascimento
- Laboratory of Cardiac Electrophysiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Melhem AJ, Araújo AC, Figueiredo FNS, Figueiredo DLA. Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924796. [PMID: 32848124 PMCID: PMC7476749 DOI: 10.12659/ajcr.924796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/06/2020] [Accepted: 07/13/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Misuse of androgenic anabolic steroids (AAS) is a current practice associated with vigorous bodybuilding for muscular hypertrophy, especially among gym practitioners and bodybuilders, influenced by the culture of body image. In addition to liver, psychiatric, genital, urinary, dermatological, and musculoskeletal complications, AAS misuse reportedly can lead to development of cardiovascular complications, such as hypertension, dyslipidemia, cardiac hypertrophy, and early coronary disease, and potentially acute myocardial infarction (AMI) and sudden death. CASE REPORT A 26-year-old male farmer who was also an amateur bodybuilder developed an extensive Killip Class I AMI in the anterior wall while using AAS. A few days before the acute event, his lipid and hormone levels were measured and found to be significantly elevated. The patient was asymptomatic after left anterior descending branch angioplasty, but he had significant electrocardiographic sequelae and ventricular dysfunction. CONCLUSIONS We describe the case of a young male bodybuilder using AAS who presented with AMI and was treated with primary angioplasty. Documentation of high levels of lipids and hormones 1 week before the acute event suggests some relationship between AAS and cardiovascular disease. The main effects of using these steroids on the cardiovascular system are reviewed. It is time for a new global warning about the risks of misusing AAS to obtain muscle hypertrophy. Based on current medical knowledge, these hormones should not be prescribed without a clear indication for their use.
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Affiliation(s)
- Abrão José Melhem
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil
| | - Amélia Cristina Araújo
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil
- Department of Cardiology, São Vicente Hospital, Guarapuava, PR, Brazil
| | - Felipe Nathan S. Figueiredo
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil
- Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - David Livingstone A. Figueiredo
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil
- Institute for Cancer Research, IPEC, Guarapuava, PR, Brazil
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Odoardi S, Mestria S, Biosa G, Valentini V, Federici S, Strano Rossi S. An overview on performance and image enhancing drugs (PIEDs) confiscated in Italy in the period 2017-2019. Clin Toxicol (Phila) 2020; 59:47-52. [PMID: 32475176 DOI: 10.1080/15563650.2020.1770277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONTEXT The illegal market of counterfeit and falsified medicines and supplements containing unlabeled pharmaceuticals is expanding worldwide. They are usually referred to by the term "performance and image enhancing drugs" (PIEDs) and are mainly steroids, stimulants, hormones, and drugs for erectile dysfunction. PIEDs are easily accessible through the online or black markets. We analyzed over 400 such medicines confiscated in Italy in the period 2017-2019, to determine their composition. METHODS Confiscated products were analyzed by gas chromatography/mass spectrometry and liquid chromatography/high-resolution mass spectrometry, in order to ascertain their composition and to evaluate the correspondence between what was declared on the label and the actual content, or to identify unknown products. RESULTS The most commonly found substance was anabolic steroids, found in 64% of products, with 11% containing hormone modulators, 6% stimulants, 6% sexual enhancers (mainly sildenafil) and other drugs, including thyroid hormones, melanin stimulators, and vitamins. These substances were often in mixtures. The products were often mislabeled, containing contaminants in addition to the drug declared, or consisted of a drug completely different from the one reported on the label. Fifteen percent of products had a qualitative composition completely different from that declared, while 10% of products showed cross-contamination with other drugs, mainly testosterone esters, probably due to the presence of residues of other drugs in the production line. In addition, 11% of products were not labeled, so their purported composition was unknown. DISCUSSION PIEDs pose a threat to public health. The main risks are related to the intrinsic toxicity of the substances found, especially when taken without a therapeutic indication. Another issue is related to the mislabeling of the fake medicines, and the poor-quality standard of counterfeit product preparation, with additional risks of the presence of other toxic ingredients or microbial contamination. CONCLUSIONS The use of counterfeit products is a public health concern, as it constitutes a high risk for consumer health. It is mainly caused by the uncontrolled use of steroids, stimulants, sexual enhancers, and other medicaments, without medical indication or supervision, with variable and unknown compositions and doses, as well as other contaminants as a result of the absence of good manufacturing practices.
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Affiliation(s)
- Sara Odoardi
- Department of Health Surveillance and Bioethics, Forensic Toxicology Laboratory, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, Rome, Italy
| | - Serena Mestria
- Department of Health Surveillance and Bioethics, Forensic Toxicology Laboratory, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, Rome, Italy
| | - Giulia Biosa
- Department of Health Surveillance and Bioethics, Forensic Toxicology Laboratory, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, Rome, Italy
| | - Valeria Valentini
- Department of Health Surveillance and Bioethics, Forensic Toxicology Laboratory, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, Rome, Italy
| | - Sofia Federici
- Department of Health Surveillance and Bioethics, Forensic Toxicology Laboratory, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, Rome, Italy
| | - Sabina Strano Rossi
- Department of Health Surveillance and Bioethics, Forensic Toxicology Laboratory, Università Cattolica del Sacro Cuore F. Policlinico Gemelli IRCCS, Rome, Italy
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Sauter M, Draschkow D, Mack W. Building, Hosting and Recruiting: A Brief Introduction to Running Behavioral Experiments Online. Brain Sci 2020; 10:E251. [PMID: 32344671 PMCID: PMC7226161 DOI: 10.3390/brainsci10040251] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
Researchers have ample reasons to take their experimental studies out of the lab and into the online wilderness. For some, it is out of necessity, due to an unforeseen laboratory closure or difficulties in recruiting on-site participants. Others want to benefit from the large and diverse online population. However, the transition from in-lab to online data acquisition is not trivial and might seem overwhelming at first. To facilitate this transition, we present an overview of actively maintained solutions for the critical components of successful online data acquisition: creating, hosting and recruiting. Our aim is to provide a brief introductory resource and discuss important considerations for researchers who are taking their first steps towards online experimentation.
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Affiliation(s)
- Marian Sauter
- Institute for Psychology, Bundeswehr University Munich, 85579 Neubiberg, Germany;
| | - Dejan Draschkow
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK;
| | - Wolfgang Mack
- Institute for Psychology, Bundeswehr University Munich, 85579 Neubiberg, Germany;
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Anabolic-Androgenic Steroid Use in the Eastern Mediterranean Region: a Scoping Review of Extant Empirical Literature. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00217-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractThe 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.
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Civilized Muscles: Building a Powerful Body as a Vehicle for Social Status and Identity Formation. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci8100287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper explored the relationship between having a muscular body and identity formation in young men. Theoretically, it was built on evolutionary psychology; empirically, it drew on the author’s research into young men’s use of anabolic-androgenic steroids in gym settings. The questions I addressed were the following: First, why does the building of a muscular body through weight and strength training appeal to young men who have not yet found their place in the societal hierarchy? Second, what identity-related consequences does it have for them, when the size and posture of their body changes? First, the paper outlined some important aspects of the civilizing process and evolutionary psychology in order to offer an explanation on how and why brute force has been marginalized in today’s society, while the strong body continues to appeal to us. Then followed an explanation of the concept of identity used in this context. Hereafter, it was examined how building a more muscular body influences the young men and their relationship with their surroundings. Next, an underlying alternative understanding of health that may influence young men’s decision to use anabolic steroids was discussed. The article concluded with some remarks on the body’s impact on identity in a time where a strong build no longer has any practical importance in our lives.
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Morelato M, Medeiros Bozic S, Rhumorbarbe D, Broséus J, Staehli L, Esseiva P, Roux C, Rossy Q. An insight into the sale of prescription drugs and medicine on the AlphaBay cryptomarket. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619872955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Internet access has provided new ways to trade goods. Unlike conventional legal sale sites, cryptomarkets facilitate exchanges in a context where the anonymity of participants is warranted. The aim of this article was to obtain a better understanding of the trafficking of prescription drugs and medicine on the AlphaBay cryptomarket. The results showed that alprazolam, oxycodone, and Adderall were the most offered prescription drugs while alprazolam, diazepam, and oxycodone were the most sold substances. The sale was dominated by North America, Australia, and Western European countries. The revenue of prescription drugs was estimated to be more than US$65 million since the creation of AlphaBay, a small market in comparison with the worldwide legal pharmaceutical market’s estimate of US$1.3 trillion in 2020. Digital traces offer a complementary way to understand the trafficking of prescription drugs and medicine and to identify the most prolific vendors and their implication in this trafficking.
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Affiliation(s)
- Marie Morelato
- University of Technology Sydney, Broadway, New South Wales, Australia
| | - Susana Medeiros Bozic
- University of Technology Sydney, Broadway, New South Wales, Australia
- Université de Lausanne, Switzerland
| | - Damien Rhumorbarbe
- University of Technology Sydney, Broadway, New South Wales, Australia
- Université de Lausanne, Switzerland
| | | | | | | | - Claude Roux
- University of Technology Sydney, Broadway, New South Wales, Australia
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Badenes-Ribera L, Rubio-Aparicio M, Sánchez-Meca J, Fabris MA, Longobardi C. The association between muscle dysmorphia and eating disorder symptomatology: A systematic review and meta-analysis. J Behav Addict 2019; 8:351-371. [PMID: 31505966 PMCID: PMC7044626 DOI: 10.1556/2006.8.2019.44] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Research shows inconsistent findings about the link between muscle dysmorphia (MD) and eating disorder (ED) symptomatology. The aim of this study is to synthesize the scientific evidence available on this topic, the researchers conducted a systematic review and meta-analysis. METHODS The literature search enabled us to identify 39 published articles, which provided 36 independent estimations of the correlation between the two variables. RESULTS Our analysis found a positive association between MD and ED symptoms (r+ = .36; 95% CI = 0.30, 0.41). Moderator analyses showed that the type of sample and the tools for assessing MD and ED were statistically associated with the MD-ED effect sizes. The methodological quality of the studies exhibited a positive, statistically significant association with the MD-ED effect sizes. CONCLUSIONS Higher levels of MD were related to greater ED symptomatology, but several study characteristics may moderate the association between the two variables. In this study, we discuss limitations and implications for clinical practice and future research.
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Affiliation(s)
- Laura Badenes-Ribera
- Departamento de Methodologia and Behavioral Science, University of Valencia, Valencia, Spain
| | | | - Julio Sánchez-Meca
- Departamento de Psicología Básica y Metodología, University of Murcia, Murcia, Spain
| | - Matteo Angelo Fabris
- Dipartimento di Psicologia, Università degli Studi di Torino, Turin, Italy,Corresponding author: Matteo Angelo Fabris; Dipartimento di Psicologia, Università degli Studi di Torino, Via Verdi 10, Turin 10124, Italy; Phone: +39 011 6703056; Fax: +39 011 8126231; E-mail:
| | - Claudio Longobardi
- Dipartimento di Psicologia, Università degli Studi di Torino, Turin, Italy
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