Prevalence of the use of anabolic-androgenic steroids in Brazil: a systematic review

Assessment of Anabolic Androgenic Steroids Use Among Professional CrossFit® Athletes: Motives, Perception, and Safety

BACKGROUND

Anabolic androgenic steroids (AAS) are traditionally used for the treatment/control of various diseases; however, they are being used for non-therapeutic and indiscriminate purposes to enhance sports performance and physical appearance. This study aimed to assess the prevalence and associated factors of AAS use among professional CrossFit® competitors.

METHODS

We conducted an observational cross-sectional survey in which an anonymous questionnaire was applied to professional CrossFit® athletes.

RESULTS

The prevalence of AAS usage was 33.3%. Most users were male (74.2%), aged between 30 and 39 years (51.6%), with completed higher education (83.9%), and had been training for more than 5 years (77.4%); the primary motivation for AAS use was performance enhancement (77.4%). Individuals who were older (p < 0.05) and more experienced in competitions (p < 0.01) are more likely to use AAS. Testosterone was the most employed AAS (71.0%); CrossFit® athletes typically used an average of 2 different AAS. The majority of users had notably sought advice from a physician (74.2%), and AAS were acquired from either drugstores (80.6%) or through illicit channels (29.0%). Moreover, 61.3% of AAS users reported experiencing adverse effects.

CONCLUSIONS

Our results demonstrated a higher prevalence of AAS users among professional competitors in CrossFit® compared to the general population; older age and greater experience in official competitions were decisive factors for a greater inclination toward AAS use. A significant percentage of athletes seek drugs through illegal channels. Despite the majority of users experiencing adverse effects, athletes report satisfaction with use, believing that the benefits still outweigh the drawbacks.

Abusive use of anabolic androgenic steroids, male sexual dysfunction and infertility: an updated review

The evolving prevalence of anabolic androgenic steroids (AAS) abuse among nonathletes is alarming because of the known harm to an individual's health. Among the adverse effects of AAS abuse, male infertility and sexual dysfunction have been often reported in the literature, but little is known regarding its actual prevalence, possible underpinning mechanisms, and potential treatments either during or post-AAS usage. Thus, the current narrative review summarizes the state-of-art regarding the effects of AAS on male fertility and sexual function. Evidence was gathered from the latest reviews and recent original studies, specifically from prospective cohorts and clinical trials, ultimately resulting in five main topics of discussion. First, AAS usage is briefly characterized by its historical background, main physiological mechanisms, and the most frequently used AAS substances. Second, data on the prevalence of AAS-induced male infertility and sexual dysfunction are described. Third, some new insights on possible underpinning mechanisms of AAS-induced male infertility and sexual dysfunction are thoroughly discussed, with particular attention to histological data derived from animal models and the latest insights from prospective cohorts in humans. Fourth, the potential treatments during and after the AAS usage are presented, highlighting the odds of resolving male infertility and sexual dysfunction. Fifth, future directions on this topic are discussed, focusing on the methodological robustness of scientific studies.

Unveiling the Nuances of Adult Female Acne: A Comprehensive Exploration of Epidemiology, Treatment Modalities, Dermocosmetics, and the Menopausal Influence

Previously considered a skin disease exclusively affecting adolescents, characterized by inflammatory and non-inflammatory skin lesions, acne vulgaris is now increasingly observed in adult life, including post-menopause. Today, adult female acne (AFA) is a common chronic inflammatory disease of the pilosebaceous unit, with polymorphic lesions presenting as open or closed comedones, papules, pustules, and even nodules or cysts, often with the presence of sequelae. AFA may persist from adolescence or manifest de novo in adulthood. Its etiology is multifactorial, involving genetic, hormonal, dietary, and environmental factors, yet still incompletely understood. Increased sebum production, keratinocyte hyper-proliferation, inflammation, and reduced diversity of Cutibacterium acnes strains are the underlying disease mechanisms. During menopausal transition, a relative increase in androgen levels occurs, just as estrogens begin to decline, which can manifest itself as acne. Whereas most AFA exhibit few acne lesions with normo-androgenic serum levels, baseline investigations including androgen testing panel enable associated comorbidities to be eliminated, such as polycystic ovarian syndrome, congenital adrenal hyperplasia, or tumors. Another interesting feature is AFA's impact on quality of life, which is greater than in adolescents, being similar to other chronic diseases like asthma. The therapeutic approach to AFA depends on its severity and associated features. This review investigates the intricate facets of AFA, with a specific focus on incidence rates, treatment modalities, and the curious impact of menopause. Utilizing insights from contemporary literature and scientific discussions, this article seeks to advance our understanding of AFA, offering new perspectives to shape clinical practices and improve patient outcomes.

Factors predicting normalization of reproductive hormones after cessation of anabolic-androgenic steroids in men: a single center retrospective study

OBJECTIVE

Symptomatic hypogonadism discourages men from stopping anabolic-androgenic steroids (AAS). Some men illicitly take drugs temporarily stimulating endogenous testosterone following AAS cessation (post-cycle therapy; PCT) to lessen hypogonadal symptoms. We investigated whether prior PCT use was associated with the normalization of reproductive hormones following AAS cessation.

METHODS

Retrospective analysis of 641 men attending a clinic between 2015-2022 for a single, nonfasting, random blood test <36 months following AAS cessation, with or without PCT. Normalized reproductive hormones (ie, a combination of reference range serum luteinizing hormone, follicle-stimulating hormone, and total testosterone levels) were the surrogate marker of biochemical recovery.

RESULTS

Normalization of reproductive hormones was achieved in 48.2% of men. PCT use was associated with faster biochemical recovery (13.0 (IQR8.0-19.0) weeks, PCT; 26.0 (IQR10.5-52) weeks, no-PCT; P < .001). Odds of biochemical recovery during multivariable analysis were: (1) higher with PCT (OR3.80) vs no-PCT (P = .001), in men stopping AAS ≤3 months previously; (2) reduced when 2 (OR0.55), 3 (OR0.46), or 4 (OR0.25) AAS were administered vs 1 drug (P = .009); (3) lower with AAS >6 vs ≤3 months previously (OR0.34, P = .01); (4) higher with last reported AAS >3 months (OR 5.68) vs ≤3 months (P = .001). PCT use was not associated with biochemical recovery in men stopping AAS >3 months previously.

CONCLUSION

Without evidence-based withdrawal protocols, men commonly try avoiding post-AAS hypogonadism with PCT, which is illicit, ill-defined, and not recommended. Only half of men had complete biochemical testicular recovery after stopping AAS. The surprising association of self-reported PCT use with short-term biochemical recovery from AAS-induced hypogonadism warrants further investigation.

Structural Changes in the Skeletal Muscle of Pigs after Long-Term Administration of Testosterone, Nandrolone and a Combination of the Two

Anabolic steroid hormones (AASs) are used in most countries of the world to accelerate the growth of animals, increase the volume of their muscles and thereby increase meat production. However, there is a strict ban on the use of AASs in the fattening of all animals in all countries of the European Union, and there must therefore be effective methods of detection and control of these substances. Methods based on chromatography and mass spectrometry may no longer be completely effective when faced with new synthetic steroids of unknown chemical structures and low concentrations. Therefore, there is an effort to develop new methods of AAS detection, based primarily on the monitoring of biological changes at the level of gene expression or changes in metabolism or structure at the cellular level. More detailed knowledge of the mechanisms of action of AASs on tissues is essential for these methods, and histological changes are one of them. In this study, we report histological changes in muscle structure after AAS application, specifically in the size of muscle fibers, the amount of endomysium and the number of nuclei and satellite cells in muscle fibers. A pig model was also intentionally used for the study, as no such study has been carried out on this species, and at the same time, pork is one of the most consumed meats across Europe. The results of histology and fluorescent antibody labeling showed that AASs increased the diameter and surface area of muscle fibers and also significantly increased the number of satellite cells on the fiber surface. The evident correlations between the number of satellite cells, all nuclei and the diameters of muscle fibers between some experimental groups provide evidence that the selected histological parameters could be additional detection mechanisms for screening a large number of samples and indicate the possibility of the presence of AASs in pork meat in the future.

Psychopathology among anabolic-androgenic steroid using and non-using female athletes in Norway

Anabolic-androgenic steroids (AAS) are primarily used to improve physical appearance and increase lean muscle mass. Due to their masculinizing properties, the majority of people using AAS are men; however, AAS use among females may increase with changing body ideals trending towards a more muscular appearance. AAS use among males have been associated with risk-taking behavior, and increased prevalence of personality disorders and psychopathology. As a result of low perceived prevalence and stigma among females who use AAS, the relationship between AAS use and psychopathology in this population is not well-known. AAS using women (n = 16) and weight-lifting controls (WLC) (n = 16) completed questionnaires regarding AAS use, health and training information. Psychopathology was evaluated using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Group differences on demographic variables and scores on MCMI-III scales were evaluated with Mann-Whitney U tests. The clinical cut-off was then applied to all MCMI-III scales and groups were compared using Fisher's exact test. AAS consumers demonstrated significantly greater psychopathology than WLC on several scales. Externalizing personality disorder scales were elevated among those who use AAS relative to controls, such as borderline (p < 0.001), antisocial (p = 0.007) and sadistic (p = 0.002), and in addition depressive (p = 0.012), negativistic (p = 0.001) and masochistic (p = 0.029) personality disorders scales. Furthermore, all clinical syndromes were elevated among AAS consumers. AAS consumers thus demonstrated multi-pathology, and 56% (n = 9) of the group met the clinical criteria for six or more disorders. Females who use AAS experience in general increased levels of psychopathology compared to WLC. Clinicians should be aware of these traits and the challenges they present in providing care to this population.

Screening method for the characterization of anabolic steroids seized in Brazil using paper spray mass spectrometry and chemometric tools

This paper reports the use of paper spray mass spectrometry (PS-MS) combined with chemometric models to analyze seized samples of anabolic steroids. Because many forensic laboratories typically demand high-throughput analysis for this type of sample, we developed a quicker and simpler alternative analytical method for routine analysis with minimal sample preparation. Oily samples (n = 39) resulting from seizures carried out by Brazilian Federal and State Police units were selected for this study. These samples were analyzed by PS-MS in the positive ion mode and full scan (50-1000 m/z), providing spectra containing patterns of the respective active ingredients present in each product. A principal component analysis (PCA) model was built, which discriminated samples mainly according to their active ingredients and allowed to detect and characterize some cases of product counterfeiting. The variable selection method ordered predictors selection was employed jointly with PCA to improve sample cluster separation and to provide model simplification. The final PCA model was built with three principal components and using only 28 spectral variables. This model accounted for 69.82% of the variance and discriminated samples according to their specific active ingredients.

A Comprehensive Assessment of Knowledge, Attitudes, and Practicalities Related to Doping Agents use among Jordanians

Background

People perform sports for better health and wellbeing. However, the use of doping agents is emerging among young adults. This study investigated aspects related to doping agents.

Methods

A reliable self-administered questionnaire (Cronbach's alpha =0.72, Pearson's r = 0.89) was used to assess knowledge, attitudes, and practicalities related to the use of doping agents. Results for pharmacists as health care providers (HCP, n=550) were compared with non-healthcare providers (Non-HCP, n=319).

Results

Among pharmacists, 82.9% knew the definition of doping agents vs. 72.4% of non-HCP (P<0.001). However, 36.7% of pharmacists vs. 39.6% of non-HCP incorrectly classified doping agents (P=0.02). The majority of responders (89.8%) supported having an anti-doping authority, yet, only 15% were aware of the anti-doping organizations. The majority of responders (83%) did not receive an official education related to doping agents. Enhancing physical performance was perceived as a leading driver (82.1%) to use doping agents. More than 90% of responders supported awareness in the community. The perceived best tool for awareness was social media and TV sites, as suggested by pharmacists (95.0%) and non-HCP (92.1%, P=0.312). A total of 6.1% had ever used doping agents (3.6% pharmacist vs. 9.8% non-HCP, P<0.001). Almost half of the users utilized a diet or medication to counteract the side effects of doping agents. Within pharmacists, males received more requests to provide doping agents (41.9%) compared with females (23.8%, P<0.001).

Conclusion

It is crucial to enhance professional and legal knowledge and public awareness about doping agents, not only for non-HCP but also for HCPs. Applying more restrictions on doping agents is strongly recommended.

Advances in the Determination of Anabolic-Androgenic Steroids: From Standard Practices to Tailor-Designed Multidisciplinary Approaches

Anabolic-androgenic steroids (AASs), a group of compounds frequently misused by athletes and, unfortunately, also by the general population, have lately attracted global attention; thus, significant demands for more precise, facile, and rapid AAS detection have arisen. The standard methods ordinarily used for AAS determination include liquid and gas chromatography coupled with mass spectrometry. However, good knowledge of steroid metabolism, pretreatment of samples (such as derivatization), and well-trained operators of the instruments are required, making this procedure expensive, complicated, and not routinely applicable. In the drive to meet current AAS detection demands, the scientific focus has shifted to developing novel, tailor-made approaches leading to time- and cost-effective, routine, and field-portable methods for AAS determination in various matrices, such as biological fluids, food supplements, meat, water, or other environmental components. Therefore, herein, we present a comprehensive review article covering recent advances in AAS determination, with a strong emphasis on the increasingly important role of chemically designed artificial sensors, biosensors, and antibody- and fluorescence-based methods.

Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network

BACKGROUND

The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs.

METHODS

A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years.

RESULTS

In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period.

CONCLUSION

There is a need for the development of effectiveness evaluations of current interventions and any future service provision for people using image and performance enhancing drugs. While there have been no studies of this nature to date, this review illustrates the rich data that has been gathered through diverse methodologies, that will assist in the development of future effectiveness evaluations.

The Prevalence of Anabolic-Androgenic Steroid Misuse in Iranian Athletes: A Systematic Review and Meta-Analysis

Background:

Due to widespread abuse of anabolic-androgenic steroids among professional athletes and amateur sportsmen and their health-related problems, determining the prevalence and the pattern of anabolicandrogenic steroid misuse at the national level seems to be vital for designing efficient preventive and educational measures.

Methods:

This systematic review and meta-analysis was conducted via comprehensive searches of the electronic databases including PubMed, MedLine, Scopus, Google Scholar and National Persian Databases including SID, Magiran, IranDoc (between 1980 and Dec 2019 in English and Persian languages) and also from citations in the selected papers. Overall, 39 articles met the criteria and were included in qualitative and quantitative synthesis.

Results:

The overall prevalence rate of anabolic-androgenic steroid misuse in the Iranian athletic population was 36.2% (95% confidence interval (CI), 29–43) with significant heterogeneity between studies (I²=99.0%, P<0.001). Prevalence rate of anabolic-androgenic steroid misuse among elite, male and younger athletes was higher (P<0.05). Moreover, prevalence rate of anabolic-androgenic steroid misuse among body-building athletes (36.3%) was higher compared to other athletes (30.9%), (P<0.001).

Conclusion:

Due to the higher prevalence of anabolic-androgenic steroids misuse in Iran compared to global statistics and the potential for serious adverse effects, preventive strategies and policies should be regarded as a real concern for public health.

A sentinel population: The public health benefits of monitoring enhanced body builders

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.

Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice

Anabolic substances have been increasingly used by bodybuilders and athletes with the goal of improving performance and aesthetics. However, this practice has caused some concern to physicians and researchers because of unknowledge of consequences that the indiscriminate and illicit use of these substances can cause. Thus, this study analyzed the effects of two commercially available anabolic steroids (AS), Winstrol Depot® (Stanozolol) and Deposteron® (Testosterone Cypionate), in the neuronal density of limbic, motor and sensory regions on the cerebral cortex and in CA1, CA2, CA3 regions of the hippocampus. A total of 60 Swiss mice were used (30 males and 30 females), separated into three groups: control and two experimental groups, which received the AAS. From each brain, homotypic and semi-serial samples were taken in frontal sections from areas established for the study. The results showed that females treated with testosterone cypionate presented a reduction in all regions tested and the ones treated with Stanozolol showed a decrease in some hippocampal areas. Regarding male animals, stanozolol led to a decrease in neuron number in one hippocampal region. These data allow us to conclude that supra-physiological doses of steroids used in this study, can cause considerable damage to nervous tissue with ultrastructural and consequently behavioral impairment. These changes could interfere with the loss of physical yield and performance of athletes and non-athletes and may cause irreparable damage to individuals making irresponsible use of anabolic steroids.

FACTORS ASSOCIATED WITH ANABOLIC STEROID USE BY EXERCISE ENTHUSIASTS

ABSTRACT Introduction Synthetic anabolic-androgenic steroids (AAS) were developed with the purpose of obtaining drugs capable of increasing protein synthesis associated with a lower degree of virilization. Its use is common among bodybuilders who aim to increase physical strength and muscle mass in the short term. However, AAS cause side effects, which restrict their therapeutic use. Objective To identify factors associated with AAS use by exercise enthusiasts at gyms in São Luís, MA. Methods A cross-sectional study was carried out at 17 gyms. The sample totaled 723 exercise enthusiasts, who answered a structured questionnaire with multiple choice questions related to their lifestyle and the consumption of nutritional supplements and AAS use. Logistic regression analysis was used to verify the association of socioeconomic, demographic and behavioral factors with AAS use. Results Of the 723 exercise enthusiasts, 10.65% reported having used AAS. Of these, 97.4% declared their awareness of some side effect caused by AAS use. Factors associated with AAS use were: being male, age between 20 and 29 years, consumption of food supplements and participation in exercise for over a year. Conclusion The prevalence of AAS use by exercise enthusiasts at gyms in São Luís is high, and the risk factors identified enable us to target specific populations with preventive actions. Level of Evidence IIC; Cross-sectional study.

Prevalence and profile of users and non-users of anabolic steroids among resistance training practitioners

Background

To verify the prevalence and profile of users and non-users of anabolic steroid (AS) among resistance training practitioners.

Methods

An observational, cross-sectional survey was performed in 100 gyms in Curitiba city, involving 5773 individuals and self-administered questionnaires. The chi-square and z-tests of proportions were used for comparison between the groups (p < 0.05).

Results

83.2% did not use, 9.1% formerly used, 3.4% currently used, and 4.3% intended used AS. The prevalence of former or current AS users was 16.9 and 6.5% among men and women, respectively. The prevalence ratios were as follows: 1) 2.6 male users for each woman; 2) 3.3 individuals aged 30–44 years and 2.8 individuals aged 18–29 years for each individual aged over 45 years. Beginners were not interested in using AS, but individuals who had trained longer had higher prevalence of AS use.

Conclusions

The gym environment encouraged the use of AS owing to aesthetic appeal. Thus, suggesting the need for actions to prevent abusive use of AS considering the practitioners profile (practitioners were young, university and single).

Kidney disease associated with androgenic-anabolic steroids and vitamin supplements abuse: Be aware!

The excessive chase for beauty standards and the rise of muscle dysmorphia have ultimately led to an increase in androgenic-anabolic steroids (AAS) and intramuscular injections of vitamins A, D and E (ADE) abuse, which is associated with several adverse effects and has become a public health issue. This review of literature discusses kidney injury associated with the use of AAS and ADE, highlighting the mechanisms of acute and chronic renal lesion, such as direct renal toxicity, glomerular hyperfiltration and hypercalcemia. Future perspectives regarding evaluation and early diagnosis of kidney injury in these patients are also discussed.

Diagnosis and Management of Anabolic Androgenic Steroid Use

CONTEXT

The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak.

DESIGN

Key studies were extracted from PubMed (1990-2018) and Google Scholar with reference searches from relevant retrieved articles.

RESULTS

The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete's baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression.

CONCLUSIONS

Men who use AASs <1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use ≥1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

History and epidemiology of anabolic androgens in athletes and non-athletes

The use of androgens, frequently referred to as anabolic-androgenic steroids (AAS), has grown into a worldwide substance abuse problem over the last several decades. Testosterone was isolated in the 1930s, and numerous synthetic androgens were quickly developed thereafter. Athletes soon discovered the dramatic anabolic effects of these hormones, and AAS spread rapidly through elite athletics and bodybuilding from the 1950s through the 1970s. However it was not until the 1980s that widespread AAS use emerged from the elite athletic world and into the general population. Today, the great majority of AAS users are not competitive athletes, but instead are typically young to middle-aged men who use these drugs primarily for personal appearance. AAS abuse has now become particularly prevalent in regions such as Scandinavia, the United States, Brazil, and British Commonwealth countries, but remains rare in countries such as China, Korea, and Japan - a pattern that reflects cultural differences in attitudes towards male muscularity.

Being in control? A thematic content analysis of 14 in-depth interviews with 2,4-dinitrophenol users

BACKGROUND

2,4-Dinitrophenol (2,4-DNP) is a compound with multiple industrial purposes. Currently unlicensed for human consumption, it is used by the gym-going population for drastic, short-term body fat loss. Nonetheless, physiological mechanisms can lead to potentially fatal hyperthermia. Reported fatal incidents have caused concern and highlighted the need for intervention. Understanding decision-making leading to 2,4-DNP use alongside the perceived outgroup attitudes is vital to forming effective harm minimisation policies targeting current and potential users. First-hand accounts from this elusive population are scarce.

METHODS

Fourteen novel and experienced users (13 male, 1 female) were recruited via "snowballing" techniques. Semi-structured interviews were conducted, comprising 28 questions. Thematic content analysis was conducted using 37 codes.

RESULTS

Four characteristic themes emerged: 1. Users considered the Internet to be a crucial multifunctional resource directly impacting their 2,4-DNP use. 2. Users "respected" 2,4-DNP, proactively taking harm reduction measures. 3. Attitudinal polarisation towards 2,4-DNP within the gym-going community was consistent in all accounts. 4. Users perceived outgroup populations to have inherently negative attitudes towards their use. These themes fell under the all-encompassing theme of "being in control".

CONCLUSION

For the first time, this study offers a rich detail of attitudes toward 2,4-DNP use by giving a collective voice to users. The element of control over every aspect of the users' life appears to be a significant contributor to the successful risk-management of 2,4-DNP use. In the absence of an established safe upper limit and effective regulatory control, education is critical to harm minimisation.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Low-intensity endurance exercise plus nandrolone decanoate modulates cardiac adiponectin and its receptors

Vast adverse effects of anabolic-androgenic steroids (AASs) on athletes' cardiovascular systems have been reported. However, there is still a lack of adequate information regarding the pathways and mechanisms involved. We tested the hypothesis that adiponectin and its receptors in the heart may be affected by long-term use of AASs alongside exercising. Male Wistar rats were randomized into the control (CTL), exercise (EX), nandrolone (Nan), arachis (Arach) group which treated with arachis as vehicle, trained vehicle (EX+Arach) and trained nandrolone (EX+Nan) groups that were treated for 8 weeks. One day after the end of the protocol, animals were sacrificed and their hearts were frozen. TNF-α and adiponectin proteins of hearts were evaluated quantitatively by ELISA kits, and Western blot analysis was used for measuring adiponectin receptor protein expression. TNF-α protein increased significantly in the EX+Nan group (P<.05 vs CTL group). The AdipoR1 protein was significantly higher in the presence of nandrolone alongside exercise (P<.05 vs Nan and EX+Arach groups, P<.01 vs CTL and Arach groups). In addition, AdipoR2 protein enhanced in the EX+Nan group when compared with the other groups (P<.05 vs EX and EX+Arach groups, P<.01 vs CTL, Arach and Nan groups). Chronic nandrolone plus mild endurance exercise may be associated with imbalance in pro-/anti-inflammatory cytokines and may induce a positive modulatory effect on cardiac adiporeceptors in rat. Further studies are required before these findings can be generalized to humans.

Success, Failure, and Unfinished Business of Education, Prevention, Policy, and Intervention Programs on Substance Misuse in Brazilian Sport

The current Brazilian situation is such that it is difficult to obtain a worldwide evaluation of failure in education, intervention, or prevention programs. How fragile Brazil's anti-doping system is, its appropriateness as well as its relevance, with needed policy infrastructures for achieving the selected goals, and how wide the gap is between education and prevention program effectiveness between high-performance athletes and recreational practitioners who just want to look good. An additional concern, and ever present flaw regarding Brazil's "common sportsman" in day-to-day society is their not receiving known and necessary "sports education," enabling the development of an "at-risk" population for self-harm. Reflections on public health policy are noted.

Recreational Anabolic-Androgenic Steroid Use Associated With Liver Injuries Among Brazilian Young Men

BACKGROUND

The recreational use of anabolic-androgenic steroids (AAS) has reached alarming levels among healthy people. However, several complications have been related to consumption of these drugs, including liver disorders.

OBJECTIVE

To evaluate the prevalence of liver injuries in young Brazilian recreational AAS users.

METHODS

Between February/2007 and May/2012 asymptomatic bodybuilders who were ≥18 years old and reported AAS use for ≥6 months were enrolled. All had clinical evaluations, abdominal ultrasound (AUS), and blood tests.

RESULTS

182 individuals were included in the study. The median age (interquartile range) was 26.0 years (22.0-30.0) and all were male. Elevated liver enzyme levels were observed in 38.5% (n = 70) of AAS users, and creatine phosphokinase was normal in 27.1% (n = 19) of them. Hepatic steatosis was observed by AUS in 12.1% of the sample. One individual had focal nodular hyperplasia and another had hepatocellular adenoma. One case each of hepatitis B and C virus infection was found. A diagnosis of toxic liver injury was suggested in 23 (12.6%) AAS users without a history of alcohol or other medications/drugs consumption, or evidence of other liver diseases.

CONCLUSIONS/IMPORTANCE

Young Brazilian recreational AAS users presented a wide spectrum of liver injuries that included hepatotoxicity, fatty liver, and liver neoplasm. They also presented risk factors for liver diseases such as alcohol consumption and hepatitis B and C virus infection. The results suggest that the risk of AAS use for the liver may be greater than the esthetic benefits, and demonstrate the importance of screening AAS users for liver injuries.