1
|
Jambi S, Mirza A, Zughaibi T, Khalil H, Borai A. The assessment of liver function test and fertility hormones in Saudi athletes using anabolic androgenic steroids. Saudi Pharm J 2024; 32:101954. [PMID: 38292405 PMCID: PMC10825542 DOI: 10.1016/j.jsps.2024.101954] [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: 07/26/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Background A growing number of athletes are using synthetic anabolic-androgenic steroids (AAS), comprised of testosterone and other derivatives, to enhance athletic performance and muscle mass. Over the years, numerous reports elucidated the side effects of the illegal use of AAS, such as infertility, and liver disorders. The effect of AAS on the hepatic and reproductive systems in Saudi athletes has not yet been studied. Therefore, this study examined the liver function and sex hormone parameters of AAS users as compared to non-users. Methods Fasting blood samples were collected from 16 male Saudi athletes, 10 AAS-users (cases) and 6 non-users (controls) to measure liver function tests (ALT, AST, GGT, ALP, total protein, albumin, direct and total bilirubin) and muscle enzymes (CK, LDH), Fertility hormones (LH, FSH, total testosterone, estradiol, and prolactin) were included also. Furthermore, a self-reported questionnaire was obtained to identify the type of AAS used, the dosage, and the length of the course before sample collection. Results The results show a statistically significant increase in ALT (P < 0.001), AST (P < 0.001), CK (P < 0.05), and a significant decrease (P < 0.05) in albumin (P < 0.001) and total bilirubin levels (P < 0.01) in AAS-users. Total testosterone increased significantly among AAS (P < 0.05), along with a significant decrease in LH (P < 0.01), and FSH (P < 0.001) levels, while serum prolactin and estradiol levels were significantly increased (P < 0.05). Conclusion AAS can enhance physical performance and appearance, its potential adverse effects on the hepatic and reproductive systems necessitate careful consideration. Our research demonstrates an increase in the liver-specific enzyme ALT in AAS users relative to non-users and the possibility that short-term AAS usage increases the risk of liver injury.
Collapse
Affiliation(s)
- Shatha Jambi
- King Abdullah International Medical Center, King Saud bin Abdul Aziz University for health science, Pathology, King Abdul-Aziz Medical City, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Applied medical Sciences, Jeddah, Saudi Arabia
| | - Ahmed Mirza
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdul-Aziz University, Jeddah, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Torki Zughaibi
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdul-Aziz University, Jeddah, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Haitham Khalil
- King Abdullah International Medical Center, King Saud bin Abdul Aziz University for health science, Pathology, King Abdul-Aziz Medical City, Saudi Arabia
| | - Anwar Borai
- King Abdullah International Medical Center, King Saud bin Abdul Aziz University for health science, Pathology, King Abdul-Aziz Medical City, Saudi Arabia
| |
Collapse
|
2
|
Yen H, Lalor L. Non-syndromic and Syndromic Severe Acne in Adolescent Patients. Med Clin North Am 2024; 108:27-42. [PMID: 37951654 DOI: 10.1016/j.mcna.2023.05.014] [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] [Indexed: 11/14/2023]
Abstract
Acne is a common skin disorder in adolescents. However, severe acne that is persistent and refractory to conventional treatment or has other associated symptoms should raise suspicion for non-syndromic or syndromic acne.
Collapse
Affiliation(s)
- Hsi Yen
- Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, TBRC 2nd Floor Suite C2010, Milwaukee, WI 53226, USA
| | - Leah Lalor
- Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, TBRC 2nd Floor Suite C2010, Milwaukee, WI 53226, USA.
| |
Collapse
|
3
|
Mulawkar PM, Maheshwari PN, Gauhar V, Agrawal SG, Mohammed TO, Singh AG, Tak GR, Shah US, Shukla DP, Mamankar D. Use of Anabolic-Androgenic Steroids and Male Fertility: A Systematic Review and Meta-analysis. J Hum Reprod Sci 2023; 16:268-285. [PMID: 38322636 PMCID: PMC10841926 DOI: 10.4103/jhrs.jhrs_90_23] [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: 07/15/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 02/08/2024] Open
Abstract
Background Anabolic-androgenic steroids (AASs) are often used by men for bodybuilding and to improve sports performance. The use is not limited to professional competitive athletes, but many amateur men. Objective The objective of this study was to assess and systematically review the effects of AAS on male fertility parameters, spermiogram, testosterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH) and to review reversibility and other morbidity impacting fertility. Methods Eligibility criteria - We included studies mentioning data about adult males using supraphysiologic doses of AAS for sports performance or appearance enhancement, with comparison data from general population or matched controls if available reporting fertility parameters and sexual performance. Information sources - A systematic literature search was performed using PubMed, MEDLINE, EMBASE, Google Scholar and World of Science. Controlled clinical trials randomised or nonrandomised (if available), case series with or without matched controls, case reports, cross-sectional surveys, reports on follow-up of subjects caught in doping test and their fertility parameters when reported. Risk of bias/quality assessment - The quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. Results Included studies - Thirty-two studies were included. There were 12 cohort studies, 5 case-control studies, 9 cross-sectional surveys and 6 case reports. The study population comprised 9371 individuals, of which 2671 were AAS users. Synthesis of results - AAS users had reduced levels of FSH and LH than the naïve population. These levels remained low for 3-6 months after stopping AAS. One year after stopping AAS, the users and naïve population had insignificant differences in FSH and LH values. The total testosterone (TT) levels were comparable in users and naïve populations at baseline, 3 months and 6 months after stopping, but at 1 year, TT values were lower in AAS users. Sperm concentration in AAS users and naïve population was similar, but sperm motility was lower in AAS users. The testicular size was lower in AAS users. The erectile function improved with AAS use, but on withdrawal, there was decreased libido and erectile dysfunction. Most AAS users need additional medications to mitigate detrimental effects on fertility. Description of the effect - AAS use negatively impacted the gonadotrophin levels and had lower sperm motility and testicular size. Strength - Comprehensive review of 32 publications, study population of 9371 individuals, of which 2671 were AAS users, meta-analysis of reproductive hormones, semen parameters and testis size. Limitations The limitations are small sample size of most of the studies, polypharmacy, lack of information on dosing and high heterogeneity. Interpretation AAS use is detrimental for sperm motility and has a partially reversible negative impact on male fertility. Users must be cautioned about its negative impact on libido and erectile function.Registration: PROSPERO Registration No. CRD42023411294.
Collapse
Affiliation(s)
- Prashant Motiram Mulawkar
- Urology, Tirthankar Superspeciality Hospital, Mumbai, India
- Department of Urology, GMC and SSH, Mumbai, India
- Urology, University of Edinburgh, Edinburgh, UK
| | | | - Vineet Gauhar
- Urology, Ng Teng Fong General Hospital, NUHS, Singapore
| | | | | | | | - Gopal Ramdas Tak
- Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | | | | | | |
Collapse
|
4
|
Esposito M, Salerno M, Calvano G, Agliozzo R, Ficarra V, Sessa F, Favilla V, Cimino S, Pomara C. Impact of anabolic androgenic steroids on male sexual and reproductive function: a systematic review. Panminerva Med 2023; 65:43-50. [PMID: 35146992 DOI: 10.23736/s0031-0808.22.04677-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Anabolic-androgenic steroids (AASs) are a complex cluster of synthetic derivatives of testosterone. AAS abuse is considered a major public health issue since it has increased among young/adolescent males. The use of steroids has a prevalence rate of 14% in young athletes and 30-75% in professional athletes or bodybuilders. AASs simulate the testosterone mechanism, binding the intracellular androgen receptor, and dysregulating the normal hypothalamic-pituitary-gonadal axis in the same way as exogenous testosterone. Abuse can produce several side effects on organs, such as the genital system. The physio-pathological mechanisms that cause AAS abuse-related, genital system disorders in humans are still not completely known. EVIDENCE ACQUISITION This study focuses on the effect of AASs on the male reproductive organs in humans and animals. EVIDENCE SYNTHESIS A systematic review was performed using SCOPUS, PubMed, Google Scholar, and Web of Sciences database up to 31 December 2021 using the keywords: "anabolic-androgenic steroids," "erectile dysfunction," "spermatogenesis" and "infertility;" (anabolic agents) "erectile dysfunction," "spermatogenesis" and "infertility." The review of the literature identified 66 articles published until 2021. Sixty-two articles were included. The use of AASs induces testicular atrophy and azoospermia known as "anabolic steroid-induced hypogonadism." Anabolic steroid induced infertility is characterized by oligo or azoospermia and abnormalities in sperm motility and morphology. Although sperm quality recovers in most cases within 4 months of stopping anabolic steroid abuse, the negative consequences on spermatogenesis can take up to 3 years to disappear. Human studies reported a positive correlation between AAS abuse in athletes and an increase in morphologically abnormal spermatozoa. Animal studies showed the destruction of Leydig cells and testicular atrophy in animals treated with cycles of AASs. CONCLUSIONS The present review of the literature highlights how little is known about the action of AASs on the male genital system. However, although their use is prohibited in many countries, the black market for these substances is still very frequent. The scientific landscape still has a lot to invest in the research of AAS on the male genital system to make young people even more aware of the negative aspects of these substances, contributing to the reduction of these products in an inappropriate way.
Collapse
Affiliation(s)
- Massimiliano Esposito
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Monica Salerno
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Gianluca Calvano
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Roberta Agliozzo
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Vincenzo Ficarra
- Section of Urology, Department of Human and Pediatric Pathology Gaetano Barresi, University of Messina, Messina, Italy
| | - Francesco Sessa
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Vincenzo Favilla
- Section of Urology, Department of Human and Pediatric Pathology Gaetano Barresi, University of Messina, Messina, Italy
| | - Sebastiano Cimino
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Cristoforo Pomara
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy -
| |
Collapse
|
5
|
Drug-Induced Liver Injury From Enobosarm (Ostarine), a Selective Androgen Receptor Modulator. ACG Case Rep J 2021; 8:e00518. [PMID: 34368386 PMCID: PMC8337042 DOI: 10.14309/crj.0000000000000518] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
Anabolic steroids are well-known to cause liver injury, which may manifest with jaundice and elevated liver enzymes. Selective androgen receptor modulators (SARMs) have been developed to enhance muscle bulk without the side effects associated with exogenous androgen steroids. We report a case of significant cholestatic liver injury associated with a SARM, ostarine (enobosarm), similar to that associated with anabolic steroids. Liver injury from SARMs has not been reported frequently, and we speculate that this may be seen more often as the consumption of SARMs increases in the athletic market.
Collapse
|
6
|
Mohammed ET, Radi AM, Aleya L, Abdel-Daim MM. Cynara scolymus leaves extract alleviates nandrolone decanoate-induced alterations in testicular function and sperm quality in albino rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:5009-5017. [PMID: 31845274 DOI: 10.1007/s11356-019-07302-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
Nandrolone decanoate (ND) is a commonly used anabolic-androgenic steroid. These drugs are illegally self-administered by athletes to enhance their sports performance. However, their abuse could influence the testicular function and fertility. The main objective of this study was to evaluate the possible protective effects of Cynara scolymus leaf extract (CLE) on ND-induced testicular dysfunction in rats. Five groups of adult male rats (10 rats each) were used. Group I rats received only saline and served as controls. Group II rats were injected with a vehicle once weekly, while group III rats received intramuscular injections of ND (20 mg/kg/week for 60 days). Group IV rats orally received 1 g/kg/day of CLE and group V rats received ND and CLE at the aforementioned doses. The results revealed that ND has a negative impact on the testicular function as evidenced by the significant increases (p ≤ 0.05) in testicular malondialdehyde concentration and serum non-prostatic acid phosphatase activity, as well as the significant decreases in serum testosterone levels, testicular weight, glutathione concentration, catalase enzyme activity, and total antioxidant capacity. These results were accompanied by considerable alterations of sperm characters and histopathological studies of the testicular tissue. However, co-treatment with CLE extract significantly alleviated (p ≤ 0.05) almost all ND-induced pathological alterations. In conclusion, co-treatment of ND-intoxicated rats with CLE ameliorated the toxic effects of ND on the testicular structure and function, probably due to its antioxidant activity.
Collapse
Affiliation(s)
- Eman Taha Mohammed
- Biochemistry Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, 62515, Egypt.
| | - Abeer M Radi
- Pharmacology Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, 62515, Egypt
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex, France
| | - Mohamed M Abdel-Daim
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| |
Collapse
|
7
|
Maier MJ, Haeussinger FB, Hautzinger M, Fallgatter AJ, Ehlis AC. Excessive bodybuilding as pathology? A first neurophysiological classification. World J Biol Psychiatry 2019; 20:626-636. [PMID: 29057722 DOI: 10.1080/15622975.2017.1395070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: Excessive bodybuilding as a pathological syndrome has been classified based on two different theories: bodybuilding as dependency or as muscle dysmorphic disorder (MDD). This study is a first attempt to find psychophysiological data supporting one of these classifications.Methods: Twenty-four participants (bodybuilders vs healthy controls) were presented with pictures of bodies, exercise equipment or general reward stimuli in a control or experimental condition, and were measured with functional near-infrared spectroscopy (fNIRS). Higher activation in the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC) while watching bodies and training equipment in the experimental condition (muscular bodies and bodybuilding-typical equipment) would be an indicator for the addiction theory. Higher activation in motion-related areas would be an indicator for the MDD theory.Results: We found no task-related differences between the groups in the DLPFC and OFC, but a significantly higher activation in bodybuilders in the primary somatosensory cortex (PSC) and left-hemispheric supplementary motor area (SMA) while watching body pictures (across conditions) as compared to the control group.Conclusions: These neurophysiological results could be interpreted as a first evidence for the MDD theory of excessive bodybuilding.
Collapse
Affiliation(s)
- Moritz Julian Maier
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Graduate School of Neural and Behavioral Sciences, University Tuebingen, Tuebingen, Germany
| | | | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Andreas Jochen Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), Cluster of Excellence, University of Tuebingen, Tuebingen, Germany.,LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
8
|
Alharbi FF, Gamaleddin I, Alharbi SF, Almodayfer O, Allohidan F, Alghobain M, Arafah A, Al-Surimi K. Knowledge, attitudes and use of anabolic-androgenic steroids among male gym users: A community based survey in Riyadh, Saudi Arabia. Saudi Pharm J 2018; 27:254-263. [PMID: 30766438 PMCID: PMC6362160 DOI: 10.1016/j.jsps.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022] Open
Abstract
Recreational use of anabolic-androgenic steroids (AAS) is a growing worldwide public health concern. However, studies assessing the level of awareness and knowledge of its effects on health are fairly limited, especially in developing countries, including Saudi Arabia. This community-based cross-sectional study was conducted to assess knowledge, attitudes and practices among male gym members toward AAS in Riyadh (Saudi Arabia) from March to October 2016. Twenty gyms were randomly selected from four different geographical regions (clusters) within Riyadh. In total, 482 participants responded to the self-administered anonymous questionnaire, which covered socio-demographic data, data assessing knowledge, attitude and behavior related to AAS use. The mean (±standard deviation) age of study participants was 27.2 (±6.9) years. Among these, 29.3% of participants reported having used AAS, while the majority (53.5%) reported hearing of AAS use, mostly through friends. Most study participants reported awareness of the effects of AAS on muscle mass, body weight and muscles strength (53.2%, 51.1% and 45.5%, respectively). In contrast, a higher proportion of study participants were unaware of the side-effects of AAS use. A high proportion of study participants (43.2%) reported that they had been offered AAS and 68.7% believed that AAS are easily accessible. Most of the gym users (90.1%) reported never having used any narcotics or psychoactive drugs. Regression analysis revealed that use of anabolic-androgenic steroids is significantly associated with “weight lifting practice” OR [95%CI] = 1.9[1.02 − 3.61], P = 0.044; “using supplementary vitamins, OR [95%CI] = 7.8[4.05 − 15.03], P < 0.0001, knowing anyone using anabolic-androgenic steroids’ OR [95%CI] = 7.5[3.78 − 14.10], P < 0.0001, and someone advised Gym users to take anabolic-androgenic steroids” OR [95%CI] = 2.26[1.23 − 4.14], P < 0.008. Our findings suggest that the level of awareness regarding the possible side-effects of AAS is fairly limited. Thus, efforts directed toward educating the public and limiting access to AAS as well as health policy reforms are crucial to reduce future negative implications of AAS use.
Collapse
Affiliation(s)
- Fares F Alharbi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, College of Medicine, Riyadh, Saudi Arabia.,Department of Medicine, Mental Health Division, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Islam Gamaleddin
- Department of Medical Sciences, Institute of Environmental Studies and Research, Ain Shams University, Cairo, Egypt.,General Directorate of Poison Control Centers, MOH, Riyadh, Saudi Arabia
| | - Samar F Alharbi
- Pharmacy Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Omar Almodayfer
- Department of Medicine, Mental Health Division, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Allohidan
- Department of Medicine, Mental Health Division, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alghobain
- Department of Medicine, Mental Health Division, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Asaad Arafah
- Department of Medicine, Mental Health Division, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khaled Al-Surimi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, College of Public Health and Health Informatics, Riyadh, Saudi Arabia.,Primary Care and Public Health Department, School of Public health, Imperial College London, London, UK
| |
Collapse
|
9
|
Flo FJ, Kanu O, Teleb M, Chen Y, Siddiqui T. Anabolic androgenic steroid-induced acute myocardial infarction with multiorgan failure. Proc (Bayl Univ Med Cent) 2018; 31:334-336. [PMID: 29904303 DOI: 10.1080/08998280.2018.1460130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/28/2018] [Accepted: 03/08/2018] [Indexed: 10/16/2022] Open
Abstract
The abuse of anabolic androgenic steroids (AAS) has remained on the rise despite their well-known deleterious effects. We describe a case of AAS-induced multisystem failure following an extensive history of abuse in a 41-year-old bodybuilder. Furthermore, we review pertinent literature and discuss the different pathophysiologic mechanisms through which AAS affect the heart and other organs. This case points to the possibility of multiorgan involvement and severe cardiac effects of AAS abuse in young individuals who may not have any past medical history.
Collapse
Affiliation(s)
- Frederick J Flo
- Department of Emergency Medicine, Texas Tech University Health Science Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Obiajulu Kanu
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Science Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Mohamed Teleb
- Division of General Medicine, Department of Internal Medicine, Texas Tech University Health Science Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Yuefeng Chen
- Division of General Medicine, Department of Internal Medicine, Texas Tech University Health Science Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Tariq Siddiqui
- Division of General Medicine, Department of Internal Medicine, Texas Tech University Health Science Center Paul L. Foster School of Medicine, El Paso, Texas
| |
Collapse
|
10
|
Goldman A, Basaria S. Adverse health effects of androgen use. Mol Cell Endocrinol 2018; 464:46-55. [PMID: 28606866 DOI: 10.1016/j.mce.2017.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 01/21/2023]
Abstract
Anabolic androgenic steroids (AAS) are performance enhancing drugs commonly used by athletes and bodybuilders to improve appearance and athletic capability. Unfortunately, these testosterone derivatives can be associated with serious and potentially irreversible side effects, and can impact multiple organ systems. It is important that physicians be familiar with these adverse consequences so that they can appropriately counsel patients whom they suspect of AAS-abuse. In this chapter, we will review the negative effects of these compounds on various organ systems in men using AAS.
Collapse
Affiliation(s)
- Anna Goldman
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
11
|
Abstract
The use and effects of selected performance-enhancing drugs and nutritional supplements are reviewed. Recent sports medicine studies are mostly double blind and placebo controlled but contain relatively small sample sizes. Their data appear reliable and are reported in reputable journals. Definitions and methods used in sports medicine are provided to enhance the understanding of this literature. The use of performance-enhancing substances is probably under-reported. Anabolic-androgenic steroids are reportedly used in 0% to 1% of women, 0.5% to 3% of high school girls, 1% to 5% of men, 1% to 12% of high school boys, and up to 67% of some groups of elite athletes. The use of combinations of performance-enhancing substances is common. Carbohydrate loading, adequate protein intake, creatine, blood doping, and erythropoietin (epoetin alfa) appear to enhance performance. Anabolic-androgenic steroids enhance performance, but health risks limit their use. Growth hormones and β2 -selective adrenergic agonists may enhance performance, but additional studies are needed. Androstenedione, caffeine, amphetamines, and nonprescription sympathomimetics do not appear to enhance performance. Performance-enhancing drugs have shown some benefit in diseased patients with malnutrition and/or decreases in physical ability. Pharmacists and other health care providers have opportunities to improve the understanding, use, and monitoring of performance-enhancing substances.
Collapse
Affiliation(s)
- Eric G. Boyce
- Clinical Pharmacy, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104,
| |
Collapse
|
12
|
Abstract
Acne represents the most common inflammatory dermatosis seen worldwide and is the leading reason for seeing a dermatologist. This article provides some tips for managing acne in a safe and effective manner to minimize the physical and psychological scars that can result from acne. Tips include how to optimize available treatment regimens according to the evidence base and target therapy to pathophysiologic factors, while also tailoring treatments to patient expectation and needs. Attention is given to minimizing the emergence of antimicrobial resistance in acne patients and beyond.
Collapse
Affiliation(s)
- Alison M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate, North Yorkshire HG2 7SX, UK.
| |
Collapse
|
13
|
Dunn M, Henshaw R, McKay FH. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2015; 35:377-82. [PMID: 26644363 DOI: 10.1111/dar.12363] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIM To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. DESIGN AND METHODS Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. RESULTS Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. DISCUSSION AND CONCLUSION Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2016;35:377-382].
Collapse
Affiliation(s)
- Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | | | - Fiona H McKay
- School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
| |
Collapse
|
14
|
Ip EJ, Yadao MA, Shah BM, Lau B. Infectious disease, injection practices, and risky sexual behavior among anabolic steroid users. AIDS Care 2015; 28:294-9. [PMID: 26422090 DOI: 10.1080/09540121.2015.1090539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984-17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases.
Collapse
Affiliation(s)
- Eric J Ip
- a Department of Clinical Sciences , Touro University California College of Pharmacy , Vallejo , CA , USA
| | - Michael A Yadao
- a Department of Clinical Sciences , Touro University California College of Pharmacy , Vallejo , CA , USA
| | - Bijal M Shah
- b Department of Social , Behavioral, and Administrative Sciences, Touro University California College of Pharmacy , Vallejo , CA , USA
| | - Bonnie Lau
- c Department of Emergency Medicine , Kaiser Permanente Santa Clara Medical Center , Santa Clara , CA , USA.,d Division of Emergency Medicine , Stanford University School of Medicine , Palo Alto , CA , USA
| |
Collapse
|
15
|
Han H, Farouque O, Hare DL. Steroid‐induced cardiomyopathy. Med J Aust 2015; 203:226-7.e1. [DOI: 10.5694/mja14.01491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/30/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - David L Hare
- Austin Health, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| |
Collapse
|
16
|
Gheshlaghi F, Piri-Ardakani MR, Masoumi GR, Behjati M, Paydar P. Cardiovascular manifestations of anabolic steroids in association with demographic variables in body building athletes. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2015; 20:165-8. [PMID: 25983770 PMCID: PMC4400712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 10/04/2014] [Accepted: 01/07/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The most common drug abuse among athletes is anabolic steroids which lead to the development of cardiovascular diseases and sudden death. Thus, the aim of this study was to evaluate cardiovascular outcomes of anabolic consumption in body building athletes. MATERIALS AND METHODS Totally, 267 male athletes at the range of 20-45 years old with the regular consumption of anabolic steroids for >2 months with at least once weekly. High-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and hematocrit (Hct) levels were measured after 10 h of fasting. Data analysis was performed using K2, t-test, ANOVA and correlation coefficient through SPSS 17. RESULTS There was a nonsignificant difference between groups regarding HDL, TG, and total cholesterol. There was a significant decrease in the total and categorized LDL and Hct levels in consumers of anabolic steroid versus nonusers (P = 0.01 and P = 0.041, respectively). Results showed a significant increase in systolic and diastolic blood pressure (SBP and DBP) in anabolic steroid users which associates with duration of abuse (P = 0.02 and P = 0.03, respectively). No significant electrocardiography changes were found within the follow-up period. CONCLUSION Increase in SBP or DBP is a common complication of these drugs which can lead serious vascular disorders. The lower LDL cholesterol level might be due to the higher amounts of lipid consumption in these athletes.
Collapse
Affiliation(s)
- Farzad Gheshlaghi
- Department of Clinical Toxicology and Forensic Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Gholam Reza Masoumi
- Department of Clinical Toxicology and Forensic Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohaddaseh Behjati
- Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parva Paydar
- Pharmaceutical Students Research Committee, School of Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
17
|
Jenssen IH, Johannessen KB. Aggression and body image concerns among anabolic androgenic steroid users, contemplators, and controls in Norway. Body Image 2015; 12:6-13. [PMID: 25261635 DOI: 10.1016/j.bodyim.2014.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/14/2014] [Accepted: 08/18/2014] [Indexed: 12/11/2022]
Abstract
AAS users and contemplators were investigated for differences in aggression and body image concern. Prevalence rates were sought as a secondary aim. 396 male adolescents at Norwegian high schools completed a questionnaire battery during school hours. Prevalence of AAS use showed 4.0%; AAS contemplation showed 5.1%. No significant differences between the AAS users and contemplators were found on levels of aggression and body image concern. AAS users and contemplators reported significantly higher levels of aggression and body image concern compared nonusing controls. AAS contemplators enhance understanding of AAS use by representing psychosocial factors contributing to increased aggression, and AAS use or risk thereof indicative of an aggressive personality profile. Body image concerns for AAS users and contemplators may indicate that AAS use does not diminish body image concern, and that body image concern is a risk factor for AAS use. This is supportive of previous research.
Collapse
Affiliation(s)
- Ida Heimly Jenssen
- Østfold Hospital, Addiction Services, Department of Diagnosis and Treatment, Moss, Norway.
| | - Kim Berg Johannessen
- Center on Autobiographical Memory Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| |
Collapse
|
18
|
Piacentino D, Kotzalidis GD, Del Casale A, Aromatario MR, Pomara C, Girardi P, Sani G. Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Curr Neuropharmacol 2015; 13:101-21. [PMID: 26074746 PMCID: PMC4462035 DOI: 10.2174/1570159x13666141210222725] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/31/2014] [Accepted: 10/25/2014] [Indexed: 12/19/2022] Open
Abstract
The use of anabolic-androgenic steroids (AASs) by professional and recreational athletes is increasing worldwide. The underlying motivations are mainly performance enhancement and body image improvement. AAS abuse and dependence, which are specifically classified and coded by the DSM-5, are not uncommon. AAS-using athletes are frequently present with psychiatric symptoms and disorders, mainly somatoform and eating, but also mood, and schizophrenia-related disorders. Some psychiatric disorders are typical of athletes, like muscle dysmorphia. This raises the issue of whether AAS use causes these disorders in athletes, by determining neuroadaptive changes in the reward neural circuit or by exacerbating stress vulnerability, or rather these are athletes with premorbid abnormal personalities or a history of psychiatric disorders who are attracted to AAS use, prompted by the desire to improve their appearance and control their weights. This may predispose to eating disorders, but AASs also show mood destabilizing effects, with longterm use inducing depression and short-term hypomania; withdrawal/discontinuation may be accompanied by depression. The effects of AASs on anxiety behavior are unclear and studies are inconsistent. AASs are also linked to psychotic behavior. The psychological characteristics that could prompt athletes to use AASs have not been elucidated.
Collapse
Affiliation(s)
- Daria Piacentino
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, San Francesco Institute, Vasto, Italy
| | - Maria Rosaria Aromatario
- Department of Anatomical, Histological, Forensic Medicine, And Orthopedic Sciences. Sapienza University-Rome, Italy
| | - Cristoforo Pomara
- Department of Forensic Pathology, University of Foggia; Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Paolo Girardi
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Centro Lucio Bini, Rome, Italy
| | - Gabriele Sani
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Centro Lucio Bini, Rome, Italy; ; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, Rome, Italy
| |
Collapse
|
19
|
Zomorodian K, Rahimi MJ, Taheri M, Ghanbari Asad A, Khani S, Ahrari I, Pakshir K, Khashei R. The cutaneous bacterial microflora of the bodybuilders using anabolic-androgenic steroids. Jundishapur J Microbiol 2014; 8:e12269. [PMID: 25789120 PMCID: PMC4350042 DOI: 10.5812/jjm.12269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 07/10/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Anabolic-androgenic steroids (AAS) abuse by the athletes has dramatically increased during the recent decades. These substances might increase the skin lipids and enhance the cutaneous microbial proliferation. Objectives: The current study aimed to investigate the potential side effects of AAS on the bacterial microflora colonization of the bodybuilders` skin. Patients and Methods: The skin samples of 94 male bodybuilders (71 AAS users, 23 non-AAS users) and 46 subjects of the control group, with similar gender and age, were cultured and incubated in both aerobic condition to isolate Staphylococcus aureus and anaerobic condition for Propionibacterium acnes. The isolated bacteria were identified by standard microbiological techniques. Results: The skin lesions were more frequent in the body builders than the controls. Moreover, statistically significant differences were also observed in skin lesions among the AAS users and the non-AAS user athletes. The prevalence of S. aureus and P. acnes in the athletes was higher than that of the control group. In addition, there was a significant difference in distribution of P. acnes between the bodybuilders who used AAS and those who did not. Conclusions: A higher number of bacterial flora was found in the bodybuilders particularly those using AAS in comparison to the controls, which might be due to the influence of these AAS on the skin microflora and transmission of the bacteria through the direct contact of the naked skin with the exercise instruments.
Collapse
Affiliation(s)
- Kamiar Zomorodian
- Basic Sciences in Infectious Diseases Research Center, Shiraz University Of Medical Sciences, Shiraz, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Kamiar Zomorodian, Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7112305291, E-mail:
| | - Mohammad Javad Rahimi
- Basic Sciences in Infectious Diseases Research Center, Shiraz University Of Medical Sciences, Shiraz, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Taheri
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Ali Ghanbari Asad
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Soghra Khani
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Iman Ahrari
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Keyvan Pakshir
- Basic Sciences in Infectious Diseases Research Center, Shiraz University Of Medical Sciences, Shiraz, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Reza Khashei
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| |
Collapse
|
20
|
Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:27. [PMID: 24984881 PMCID: PMC4091955 DOI: 10.1186/1747-597x-9-27] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/26/2014] [Indexed: 12/31/2022]
Abstract
Background To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use. Methods We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. Results A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation. Conclusions Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.
Collapse
Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway.
| | | | | |
Collapse
|
21
|
|
22
|
Angell P, Chester N, Green D, Somauroo J, Whyte G, George K. Anabolic Steroids and Cardiovascular Risk. Sports Med 2012; 42:119-34. [DOI: 10.2165/11598060-000000000-00000] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
23
|
Campion S, Catlin N, Heger N, McDonnell EV, Pacheco SE, Saffarini C, Sandrof MA, Boekelheide K. Male reprotoxicity and endocrine disruption. EXPERIENTIA SUPPLEMENTUM (2012) 2012; 101:315-60. [PMID: 22945574 DOI: 10.1007/978-3-7643-8340-4_11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mammalian reproductive tract development is a tightly regulated process that can be disrupted following exposure to drugs, toxicants, endocrine-disrupting chemicals (EDCs), or other compounds via alterations to gene and protein expression or epigenetic regulation. Indeed, the impacts of developmental exposure to certain toxicants may not be fully realized until puberty or adulthood when the reproductive tract becomes sexually mature and altered functionality is manifested. Exposures that occur later in life, once development is complete, can also disrupt the intricate hormonal and paracrine interactions responsible for adult functions, such as spermatogenesis. In this chapter, the biology and toxicology of the male reproductive tract is explored, proceeding through the various life stages including in utero development, puberty, adulthood, and senescence. Special attention is given to the discussion of EDCs, chemical mixtures, low-dose effects, transgenerational effects, and potential exposure-related causes of male reproductive tract cancers.
Collapse
Affiliation(s)
- Sarah Campion
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Shokri S, Aitken RJ, Abdolvahhabi M, Abolhasani F, Ghasemi FM, Kashani I, Ejtemaeimehr S, Ahmadian S, Minaei B, Naraghi MA, Barbarestani M. Exercise and Supraphysiological Dose of Nandrolone Deconoate Increase Apoptosis in Spermatogenic Cells. Basic Clin Pharmacol Toxicol 2009; 106:324-30. [DOI: 10.1111/j.1742-7843.2009.00495.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Larance B, Degenhardt L, Copeland J, Dillon P. Injecting risk behaviour and related harm among men who use performance- and image-enhancing drugs. Drug Alcohol Rev 2009; 27:679-86. [PMID: 18825549 DOI: 10.1080/09595230802392568] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND AIMS Performance- and image-enhancing drugs have the potential to be a significant public health issue. Detailed data on PIEDs injection are difficult to obtain because of the illicit and unsupervised way in which many PIEDs are used, and the hidden nature of the group. Our study examines the patterns of use, risk behaviours and related harm associated with PIEDs injection. We also report the ways in which PIEDs users currently seek injecting equipment and harm-reduction advice. DESIGN AND METHOD Data were obtained via a structured questionnaire administered in face-to-face interviews with 60 men who used PIEDs (primarily anabolic androgenic steroids) for non-medical purposes. RESULTS Although the rates of needle sharing were low (5%), the men more frequently reported re-use of needles/equipment, injecting from a shared container (bladders, vials, etc.), injecting other illicit drugs, injecting insulin and targeting small muscle groups. Self-reports of being hepatitis C antibody positive were associated with lifetime use of heroin and injection of other illicit drugs. All HIV positive participants were gay/bisexual men. Participants reported a range of other injection-related injuries and diseases such as fevers, scarring and abscesses. 'Risky' injectors (38% of participants) were more likely to initiate PIEDs use at a younger age, use PIEDs in a larger number of cycles per year and report involvement in a violent/aggressive incident than 'low risk' injectors and report involvement in a violent/aggressive incident than 'low risk' injectors. Participants mainly reported seeking information about PIEDs from internet sites (62%) and friends (55%). CONCLUSIONS An over-reliance on personal networks and internet forums limits this groups' access to objective harm reduction advice and primary care services. Targeted, PIEDs-specific interventions are needed.
Collapse
Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | | | | | | |
Collapse
|
26
|
Predicting future anabolic-androgenic steroid use intentions with current substance use: findings from an internet-based survey. Clin J Sport Med 2009; 19:222-7. [PMID: 19423975 DOI: 10.1097/jsm.0b013e31819d65ad] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore how current substance use, including the use of sports supplements and illicit drugs, may impact upon a person's future intentions to use anabolic-androgenic steroids (AAS). DESIGN Web-based survey. PARTICIPANTS Two hundred fourteen exercising males (mean age, 30 years; range, 17-61 years) recruited from 5 gymnasia in Sydney, Australia, completed a web-based survey. The survey contained questions relating to sport supplement use, illicit substance use, reasons for currently not using AAS, and reasons for intending to use AAS in the future. INTERVENTIONS Participants completed a structured interview schedule that included questions regarding licit and illicit substance use, reasons for non-AAS use, and, where appropriate, reasons for intended future AAS use. MAIN OUTCOME MEASURES The planned main outcome measure was positive intention to use AAS. RESULTS Sixteen percent of the sample indicated that they would use AAS in the future. Reasons for future AAS use included increasing muscle size (80%), improving appearance (74%), and increasing strength (57%). Four-fifths (80%) of the sample reported use of sports supplements, with vitamins and protein supplements commonly reported (83% and 67%, respectively); more than one-third (36%) reported use of creatine in the past 6 months. Half (52%) of the sample reported use of illicit substances in the preceding 6 months, with amphetamines and cannabis commonly reported (66% and 62%, respectively). Significant predictors of intending to use AAS included past 6-month use of creatine and knowing AAS users. CONCLUSIONS The use of sport supplements and/or illicit substances may remove barriers for the future use of such drugs as AAS. Future research is necessary to explore in depth whether such substances may act as a "gateway" to future AAS use.
Collapse
|
27
|
Pagonis TA, Koukoulis GN, Hadjichristodoulou CS, Toli PN, Angelopoulos NV. Multivitamins and phospholipids complex protects the hepatic cells from androgenic-anabolic-steroids-induced toxicity. Clin Toxicol (Phila) 2009; 46:57-66. [PMID: 17852158 DOI: 10.1080/15563650701590910] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Androgenic-anabolic-steroids (AAS)-induced hepatotoxicity typically occurs with C-17 alkylated oral agents abused by exercising individuals at clinically recommended doses. Injectable compounds appear to have the same risk for hepatotoxicity, but are applied in doses three to six times higher than clinically recommended. AAS users occasionally try to avoid the well-known hepatotoxic effects associated with the abuse of a multitude of AAS agents, by using the pharmaceutical agent compound N a phospholipid/vitamin preparation. PRIMARY OBJECTIVE The investigation of the actual hepatoprotective effect of compound N against AAS-induced toxicity. METHODOLOGY This was an observational cohort study of 320 athletes; 160 were AAS users and the other 160 were not abusing any substances. Of the 160 users, 44 were using AAS and compound N (group A), and 116 were using solely AAS (group B). The 160 athletes abstaining from substances abuse acted as controls (group C). All athletes were tested for alterations in serum levels of hepatic enzymes. Enzyme levels before the study's onset and after the end of the 8-week AAS regimes were compared among the three groups, in order to delineate the hepatoprotective effect of compound N. RESULTS Prior to our research all groups showed normal values in all enzymes except creatine kinase (CK). After the 8-week period, CK levels were slightly lower in group A, but without variation in Groups B and C; -Glutamyl Transferase (GT) levels remained normal. Groups A and C had no elevations in any of the enzymes, except CK, while in group B all enzymes' values were elevated above the normal range. The only factor differentiating AAS users in group A from those in group B was the use of compound N, thus the results being suggestive of the compound's detoxification effect. The severity of AAS abuse was positively associated with the degree of changes ( values) in all measured enzymes except GT and CK. CONCLUSIONS Previous suggestions that serum hepatic enzyme elevations in exercising AAS abusers are connected to muscle fiber damage rather than the abuse itself, are contradicted by our results. Since all AAS abusing athletes were prone to exhibit elevations in enzymes' values, the mean values of group A were to be similar to those observed in group B, exceeding normal values. The group hepatic enzyme values of group B were significantly higher than the group C (control). Notably, group A did not have any statistically significant difference in the hepatic enzyme values compared to group C. The effect of exercise on these enzymes' elevations was ruled out by the comparability of training regimens and AAS toxicity was correlated to the severity of AAS abuse.
Collapse
Affiliation(s)
- Thomas A Pagonis
- Department of Endocrinology, Thessaly University Medical School, Larissa, Greece.
| | | | | | | | | |
Collapse
|
28
|
Melnik B, Jansen T, Grabbe S. Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J Dtsch Dermatol Ges 2007; 5:110-7. [PMID: 17274777 DOI: 10.1111/j.1610-0387.2007.06176.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abuse of anabolic-androgenic steroids (AAS) by members of fitness centers and others in Germany has reached alarming dimensions. The health care system provides the illegal AAS to 48.1 % of abusers. Physicians are involved in illegal prescription of AAS and monitoring of 32.1 % of AAS abusers. Besides health-threatening cardiovascular, hepatotoxic and psychiatric long-term side effects of AAS, acne occurs in about 50 % of AAS abusers and is an important clinical indicator of AAS abuse, especially in young men 18-26 years of age. Both acne conglobata and acne fulminans can be induced by AAS abuse. The dermatologist should recognize bodybuilding acne, address the AAS abuse, and warn the patient about other potential hazards.
Collapse
Affiliation(s)
- Bodo Melnik
- Department of Dermatology, Environmental Medicine and Health Science, Division of Human Sciences, University of OsnabrYck, Germany.
| | | | | |
Collapse
|
29
|
Garzon LS, Ewald RE, Rutledge CM, Meadows T. The school nurse's role in prevention of student use of performance-enhancing supplements. THE JOURNAL OF SCHOOL HEALTH 2006; 76:159-63. [PMID: 16635198 DOI: 10.1111/j.1746-1561.2006.00088.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
An alarming trend in the United States is the use of performance-enhancing supplements by children and adolescents. These widely available over-the-counter products, often marketed as natural substances, are not regulated by the Food and Drug Administration and are thus widely available. High school and even middle school students are using these supplements because they are misled into thinking that supplements will enhance their athletic skills resulting in an improvement in their performance. Yet, the safety and long-term effects of these supplements have not been established in reputable or prevalent studies. School nurses have a unique opportunity and even an ethical responsibility to help in efforts to address this growing trend. Specific roles for the school nurse include serving as a student advocate for the health and safety of children and adolescents; identifying at-risk students; forming partnerships with teachers, parents, students, coaches, athletic trainers, and local health care providers; evaluating and refining health-oriented curricula; collecting and disseminating new knowledge; and staying abreast of new findings.
Collapse
Affiliation(s)
- Laurel S Garzon
- School of Nursing, Old Dominion University, Norfolk, VA 23529, USA.
| | | | | | | |
Collapse
|
30
|
|
31
|
Abstract
This review summarises the physiological and pharmacological effects of the anabolic steroids used to enhance performance in sports. The anabolic steroids promote muscle growth and protein synthesis. Side-effects of anabolic steroids include cardiomyopathy, atherosclerosis, hypercoagulopathy, hepatic dysfunction, and psychiatric and behavioural disturbances. It is therefore appropriate that the anaesthetist be familiar with the abuse of anabolic steroids, their potential adverse effects, and the peri-operative risk associated with the use of these drugs.
Collapse
Affiliation(s)
- P C A Kam
- University of New South Wales, Department of Anaesthesia, St George Hospital, Kogarah, NSW 2217, Australia.
| | | |
Collapse
|
32
|
Abstract
OBJECTIVE To describe opportunities and obligations for pharmacists regarding doping control in sports, and to present information and resources on drugs and dietary supplements that are popular among athletes for performance enhancement. DATA SOURCES Sports medicine journals and articles in English obtained from Medline (1966 through June 2003) using the search terms doping in sports, drugs in sports, dietary supplements, sports, amphetamine, stimulants, ephedrine, ephedra, caffeine, anabolic steroids, human growth hormone, erythropoietin, darbepoetin, androstenedione, dehydroepiandrosterone, and creatine. Information was also obtained from sports-governing agencies, such as the National Collegiate Athletic Association and the International Olympic Committee. STUDY SELECTION Studies and reports that were credible and scientifically sound that evaluated the ergogenic effects of drugs and dietary supplements. DATA EXTRACTION By the author. DATA SYNTHESIS Pharmacists can participate in doping control programs in a number of ways. Pharmacists also have an obligation when counseling, advising, and treating athletes to help them avoid banned substances. Athletes use a host of drugs for their performance-enhancing effects, many of which are banned by major sports-governing bodies. Myriad dietary supplements are marketed to athletes, claiming to have ergogenic effects. Some of these popular supplements have proven performance-enhancing effects, while others do not. Adverse effects of these drugs and dietary supplements are discussed. CONCLUSION A variety of drugs and dietary supplements have proven performance-enhancing effects in athletes. However, many of these substances have adverse effects and are banned by various sports-governing organizations. Pharmacists can play a key role in participating in doping control programs, and can prevent athletes from inadvertently consuming a banned substance.
Collapse
Affiliation(s)
- Peter J Ambrose
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, USA.
| |
Collapse
|
33
|
Urhausen A, Torsten A, Wilfried K. Reversibility of the effects on blood cells, lipids, liver function and hormones in former anabolic-androgenic steroid abusers. J Steroid Biochem Mol Biol 2003; 84:369-75. [PMID: 12711025 DOI: 10.1016/s0960-0760(03)00105-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In contrast to the acute effects of anabolic-androgenic steroid (AAS) abuse, the long-term risk profile of former long-term abusers (ExA) is less clear. METHODS Blood parameters of 32 male bodybuilders and powerlifters were studied. Fifteen ExA had not been abusing AAS for at least 12-43 months on average (mean dosage 700 mg for 26 weeks per year over 9 years), 17 athletes (A) were still abusing AAS (750 mg for 33 weeks per 8 years). FINDINGS Hemoglobin (+5%), leucocytes (+33%) and platelets (+38%) were significantly higher in A. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were higher, cholinesterase activity (CHE) lower in A (65+/-55, 38+/-27 and 3719+/-1528U/l) compared to ExA (24+/-10, 18+/-11 and 6345+/-975U/l; each P<0.001) with normal values for gamma-glutamyl transpeptidase (gamma-GT) and bilirubin. ALT, AST and CHE correlated significantly with the extent (duration and weekly dosage, expressed as a point score) of AAS abuse in A (r=0.68, 0.57 and -0.62; each P<0.01). Total and LDL-cholesterol were similar, HDL-cholesterol was distinctly lower in A than in ExA (17+/-11 and 43+/-11 mg/dl; P<0.001) and correlated negatively with the extent of AAS abuse (r=-0.50; P<0.05). Testosterone and estradiol were significantly higher, while LH, FSH and the sexual-hormone-binding (SHB) protein were lower in A than in ExA (each P<0.001). Two ExA had testosterone levels below the normal range. INTERPRETATION The alterations in cell counts, HDL-cholesterol, liver function and most hormones of the pituitary-testicular axis induced by a long-term abuse of AAS were reversible after stopping the medication for over 1 year. In some ExA, an increased ALT activity and a depressed testosterone synthesis were found.
Collapse
Affiliation(s)
- Axel Urhausen
- Faculty of Clinical Medicine, Institute of Sports and Preventive Medicine, University of Saarland, Germany.
| | | | | |
Collapse
|
34
|
Abstract
Anabolic-androgenic steroids (AAS) are mainly used to treat androgen deficiency syndromes and, more recently, catabolic states such as AIDS-associated wasting. There is no evidence in the reviewed literature that AAS abuse or dependence develops from the therapeutic use of AAS. Conversely, 165 instances of AAS dependence have been reported among weightlifters and bodybuilders who, as part of their weight training regimens, chronically administered supraphysiologic doses, often including combinations of injected and oral AAS as well as other drugs of abuse. A new model is proposed in which both the "myoactive" and psychoactive effects of AAS contribute to the development of AAS dependence. The adverse consequences of AAS are reviewed, as well as their assessment by means of a history and physical, mental status examination, and laboratory testing. When patients with AAS use disorders are compared with patients with other substance use disorders, both similarities and differences become apparent and have implications for treatment.
Collapse
Affiliation(s)
- Kirk J Brower
- Department of Psychiatry and Addiction Research Center, The University of Michigan, Ann Arbor 48108, USA.
| |
Collapse
|
35
|
Aitken C, Delalande C, Stanton K. Pumping iron, risking infection? Exposure to hepatitis C, hepatitis B and HIV among anabolic-androgenic steroid injectors in Victoria, Australia. Drug Alcohol Depend 2002; 65:303-8. [PMID: 11841901 DOI: 10.1016/s0376-8716(01)00174-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS To measure exposure to the hepatitis C and B viruses and HIV among Victorian steroid injectors and evaluate associations between exposure and risk behaviour, and report other characteristics of the study group. DESIGN Seroprevalence study using a convenience sample. SETTING Victoria, Australia. PARTICIPANTS Current injectors of illicit anabolic steroids. MEASUREMENTS Prevalences of exposure to HIV and the hepatitis B and C viruses; associations of characteristics and behaviours with exposure; descriptive statistics for the sample. FINDINGS Six of 63 blood samples (9.5%) contained hepatitis C virus antibodies; 12.0% tested positive for hepatitis B core antibody; none contained anti-HIV. Hepatitis C virus exposure was associated with heroin injection, imprisonment, sharing needles to inject other drugs, number of tattoos, and hepatitis B virus exposure. No significant differences existed in the steroid-related risk behaviour of exposed and non-exposed individuals. Hepatitis B virus exposure was associated only with hepatitis C virus exposure, past imprisonment and age of first injection. CONCLUSIONS Exposure to the hepatitis B and C viruses was detected; hepatitis C virus exposure was at much lower prevalence than normally found among other drug injectors. Factors other than steroid injecting were associated with exposure. Nonetheless, the hepatitis C-exposed reported many steroid-related and other risk behaviours which could spread the virus. Steroid injectors should not be neglected in blood-borne virus prevention efforts.
Collapse
Affiliation(s)
- Campbell Aitken
- The Macfarlane Burnet Centre for Medical Research, P.O. Box 254, Fairfield, 3078, Victoria, Australia.
| | | | | |
Collapse
|
36
|
|