AAS – CNS Effects

[Michael Scally MD]

Sagoe D, Mentzoni RA, Hanss D, Pallesen S. Aggression Is Associated With Increased Anabolic-Androgenic Steroid Use Contemplation Among Adolescents. Subst Use Misuse. An Error Occurred Setting Your User Cookie

We investigated the relationship between aggression and anabolic-androgenic steroid (AAS) use INTENT among adolescents.

A nationally representative sample of Norwegian 18-year-olds (N = 1,334, females = 58.7%) took part in a survey in 2013 (response rate = 64.9%). Participants completed the physical and verbal subscales of the Short-Form Buss-Perry Aggression Questionnaire, the Intent to use AAS Scale, the Alcohol Use Disorders Identification Test-Consumption, and the Hospital Anxiety and Depression Scale.

They also provided demographic information and answered questions about AAS use, gambling participation, as well as cigarette and snus use. Descriptive statistics and multinomial logistic regression were used to analyze the data.

Lifetime and past year prevalence of AAS use was 0.1%. Between 0.4% and 1.7% of participants disclosed intent to use while between 1.1% and 2.5% expressed neutral intent to initiate AAS use. Compared to persons low on aggression, individuals high on aggression were more likely to report INTENT and curiosity towards initiating AAS use.

Our findings indicate that aggression is a risk factor for AAS USE CONTEMPLATION among adolescents.

 

[Michael Scally MD]

Griffiths S, Murray SB, Mitchison D, Mond JM. Anabolic steroids: Lots of muscle in the short-term, potentially devastating health consequences in the long-term. Drug Alcohol Rev 2016;35(4):375-6. Anabolic steroids: Lots of muscle in the short-term, potentially devastating health consequences in the long-term - Griffiths - 2016 - Drug and Alcohol Review - Wiley Online Library

Why do people use anabolic steroids?

Most researchers and health professionals with an interest in this area could tell you, correctly, that the answer is increasingly ‘to be more muscular and attractive’ rather than ‘to compete better in my sport’ or ‘to do my job better’.

Embedded within this motivation, however, is a rarely acknowledged fact that has implications for researchers, health professionals and the public: steroids are extremely effective at building large amounts of muscle in a very short amount of time.

In contrast, the most significant health consequences of steroid use, including a twofold increase in mortality because of cardiovascular causes, appear only in the long-term, many years after the commencement of use.

Acknowledgement and understanding of the effectiveness of steroids are important for remedying users’ perceptions that health professionals ‘don’t know’ anything about steroids, improving aetiological models of steroid use, and for improving prevention and treatment efforts.

…

 

[Michael Scally MD]

[GMAFB] White Matter Abnormalities in Long-Term Anabolic-Androgenic Steroid Users: A Pilot Study

Highlights

• Anabolic-androgenic steroids (AAS) cause psychiatric and cognitive abnormalities.
• We performed the first Diffusion Tensor Imaging study of long-term AAS users.
• Fractional anisotropy (FA) was higher in AAS users in an amygdala network tract.
• Among AAS users, FA in this tract was positively associated with lifetime AAS dose.
• The FA abnormality is consistent with prior human and animal studies of AAS effects.

Recent studies of long-term anabolic-androgenic steroid (AAS) users reported amygdala structural and functional connectivity abnormalities.

We assessed white matter microstructure in the inferior-fronto-occipital fasciculus (IFOF), a major associative bundle of the amygdala network.

Diffusion weighted images acquired from 9 male long-term AAS users and 8 matched controls aged 36-51 years old were processed using a standardized pipeline (Tract-Based Spatial Statistics). Group differences were examined using linear regression with adjustment for age and current testosterone level.

Compared to nonusers, AAS users exhibited significantly higher fractional anisotropy (FA) in the IFOF. Users showed markedly greater FA than nonusers on the left IFOF but only a modest, nonsignificant difference on the right IFOF. Moreover, FA was positively associated with lifetime cumulative AAS dose.

Our results suggest that long-term AAS use alters IFOF white matter organization and integrity, which in turn might affect amygdala-related processes such as reward system function. Accordingly, further studies are needed to replicate findings in larger subject groups to determine the functional significance of the FA abnormality.

Seitz J, Lyall AE, Kanayama G, et al. White matter abnormalities in long-term anabolic-androgenic steroid users: A pilot study. Psychiatry Res 2016;260:1-5. http://www.psyn-journal.com/article/S0925-4927(16)30198-6/abstract

 

[Dr JIM]

Interesting but from a practical and or therapeutic perspective, as the authors mentions, the implications are UNKNOWN.

That is of course unless one chooses to extrapolate such data as the mechanism of "roid rage"!

 

[Sworder]

Of course AAS are "addicting." Hence PCT...

 

[Matty G]

Coming from a recovering heroin/cocaine addict (13 months fully sober), I can tell you that I do enjoy the feeling when on a cycle, but to me it is mostly psychological and honestly not a bad thing. I love the feeling that I am doing something FOR my body and not putting shit into my veins for my mind (getting high). At first I was worried that it might make me relapse on narcotics, but it only has me more focused on the prize (a healthy lifestyle and good looking body). Different sponsors say different things though. My current (AA) sponsor isn't thrilled about my AAS use, but I can honestly say that I doubt it will contribute to any relapse that might be in my future (I hope to fuck not). idk, I probably should have read the entire thread before posting, but I saw the word addiction, and figured I'd give my $.02!


Looked at title after I posted, and my post doesn't seem very relevant, but oh well, I'll leave it up.

 

[Michael Scally MD]

[OA] Bertozzi G, Sessa F, Albano GD, et al. The Role of Anabolic Androgenic Steroids in Disruption of the Physiological Function in Discrete Areas of the Central Nervous System. Mol Neurobiol. https://link.springer.com/article/10.1007%2Fs12035-017-0774-1

Anabolic-androgenic steroids (AAS) abuse is often associated with a wide spectrum of adverse effects. These drugs are frequently abused by adolescents and athletes for esthetic purposes, as well as for improvement of their endurance and performances.

In this literature review, we evaluated the correlation between AAS and anxiety or aggression. Two pathways are thought to be involved in AAS-induced behavioral disorders.

Direct pathway via the amygdalo-fugal pathway, which connects the central nucleus of the amygdala to the brainstem, is involved in cognitive-emotive and homeostatic processes. The latter is modified by chronic AAS use, which subsequently leads to increased anxiety.

Indirect pathways via the serotonergic, dopaminergic, and glutamatergic signals which are modified by AAS abuse in latero-anterior hypothalamus and can mediate the aggressive behavior.

In conclusion, the molecular mechanisms underlying the behavioral alterations following AAS abuse is unclear and remains ambiguous as additional long-term studies aimed to understand the precise mechanisms are required.

 

[Michael Scally MD]

[One more out to lunch “expert’ who knows nothing of what they speak/write. And, this writer is so far out there as to cite his own paper stating AAS down-regulate the AR as proof of tolerance! To use the oft used and abused phrase, AAS politicization is “on steroids.”

Steroid abuse can cause downregulation of androgen receptors, thereby reducing the effects of testosterone and other androgens [7]. 7. Milhorn HT. Anabolic steroids: another form of drug abuse. J Miss State Med Assoc. 1991;32:293–7.]

Milhorn HT, Milhorn HT. Anabolic Steroid Dependence. In: Substance Use Disorders: A Guide for the Primary Care Provider. Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-319-63040-3_13

Anabolic steroids are more accurately called anabolic-androgenic steroids because they produce an anabolic effect, which is protein synthesis for building muscle, and an androgenic effect, which is masculinization. The drugs are used illicitly in an attempt to increase muscle mass and athletic performance.

Key Chapter Points
· Anabolic steroids are more accurately called anabolic-androgenic steroids because they produce an anabolic effect, which is protein synthesis for building muscle, and an androgenic effect, which is masculinization.
· Common patterns of illegal steroid use include cycling, stacking, and pyramiding.
· Anabolic steroids are synthetic derivatives of testosterone with enhanced anabolic activity and reduced androgenic activity.
· Users of anabolic steroids can become both physically and psychologically dependent on the drugs as evidenced by drug-seeking behavior, continued use even with adverse effects, and physical withdrawal symptoms.
· Denial plays a major role in illegal steroid dependence. They do not believe that the drugs are causing harm to anyone—a “victimless crime.”
· The anabolic-steroid abstinence syndrome consists primarily of depression, which may be severe.
· The 10–25 pounds they lose on cessation of anabolic steroid use takes on an exaggerated importance, a phenomenon that has been termed megarexia.
· A number of drugs are used as alternatives to anabolic steroids.

 

[Michael Scally MD]

Anabolic Steroids: Did Popeye Use Them Too?

In the addiction treatment field, when we refer to “steroid use,” we are referring to those compounds known as anabolic steroids—those whose primary use is to cause skeletal muscle hyperplasia or enhancement and that are therefore sought after for the main purposes of muscle growth and physical performance. We distinguish anabolic steroids from corticosteroids and female gonadotrophic hormones; neither of which is found to be abused. Most steroids also have androgenic properties and thus are generally referred to as anabolic–androgenic steroids.


Anabolic Steroids: Did Popeye Use Them Too? Journal of addictions nursing 2017;28:224-5. Anabolic Steroids: Did Popeye Use Them Too? : Journal of Addictions Nursing

 

[Dr JIM]

Rather than “addiction”per se, the last paragraph provides an excellent synopsis of why use often morphs into AAS ABUSE.

“In light (or because) of the current environment of experimentation, impulsiveness, and the need for immediate gratification among the emerging young adult population” .... !

JIM

 

[Michael Scally MD]

Kanayama G, Kaufman MJ, Pope HG, Jr. Public health impact of androgens. Current opinion in endocrinology, diabetes, and obesity 2018. Public health impact of androgens : Current Opinion in Endocrinology, Diabetes and Obesity

PURPOSE OF REVIEW: To summarize recent findings regarding the public health impact of androgen abuse.

RECENT FINDINGS: Abuse of androgens (also called 'anabolic-androgenic steroids') has grown into a major worldwide substance abuse problem involving tens of millions of individuals, of whom about 98% are men. Most androgen abusers are still under age 50 today, and thus, the long-term effects of these drugs are only beginning to be understood. Recent studies confirm that long-term supraphysiologic androgen exposure produces cardiovascular toxicity, characterized especially by cardiomyopathy and atherosclerotic disease. Withdrawal from androgens after long-term use may produce prolonged and sometimes irreversible hypogonadism in men. Supraphysiologic androgen levels may sometimes cause irritability, aggressiveness, and violence, whereas androgen withdrawal may cause depression. However, these psychiatric effects are idiosyncratic, affecting only a minority of users. Emerging evidence now also suggests that long-term androgen exposure may cause neurotoxicity, raising the possibility that aging androgen abusers may be at increased risk for dementia. Several recent studies have also described androgen-induced hepatotoxicity, nephrotoxicity, and adverse musculoskeletal effects.

SUMMARY: Recent studies have demonstrated marked adverse effects of long-term androgen abuse. As increasing numbers of androgen abusers reach middle age, these effects will likely represent an emerging public health problem.

 

[Michael Scally MD]

Sagoe D, Pallesen S. Androgen abuse epidemiology. Current opinion in endocrinology, diabetes, and obesity 2018. Androgen abuse epidemiology : Current Opinion in Endocrinology, Diabetes and Obesity

PURPOSE OF REVIEW: To systematically review current epidemiological literature on androgen abuse. Estimates from 32 empirical epidemiological articles were reviewed.

RECENT FINDINGS: Generally, androgen abuse epidemiology and prevalence is higher in Europe, the Middle East, North America (the USA), Oceania (Australia and New Zealand), and South America (Brazil) and lower in Africa and Asia. In contrast to the general population, androgen abuse epidemiology and prevalence is higher among athletes, injection drug users, recreational sportspeople, and sexual and gender minorities.

SUMMARY: From the 1970s, androgen abuse spread from athletes into the general population. Consistent with previous evidence, reviewed studies suggest that androgen abuse epidemiology and prevalence is higher in Western cultural contexts, the Middle East, and South America (Brazil) and lower in Africa and Asia. Evidence also corroborates indications that androgen abuse is less prevalent among women (vs. men), and in the general population in contrast to particular subpopulations consisting of athletes, injection drug users, recreational sportspeople, and sexual and gender minorities. Adolescents' androgen abuse should be of special concern. Androgen abuse in some nonsports occupations (e.g. security workers) requires further exploration. Polypharmacy and the Internet proliferation of androgens and other PIEDs require surveillance for prevention and harm reduction.

 

[Michael Scally MD]

Ostovar A, Haerinejad MJ, Akbarzadeh S, Keshavarz M. Comparison of the Prevalence of Psychiatric Disorders in Performance-Enhancing Drug Users and Nonuser Bodybuilders. Iranian journal of psychiatry 2017;12:223-8. Comparison of the Prevalence of Psychiatric Disorders in Performance-Enhancing Drug Users and Nonuser Bodybuilders

Objective: The present study aimed at comparing the prevalence of major psychiatric disorders including major depressive disorder, bipolar disorder, schizophrenia, and generalized anxiety disorder between performance-enhancing drug users and nonuser bodybuilders. Moreover, the prevalence of major psychiatric disorders in bodybuilders was also reported.

Method: In this study, 453 athletes were recruited from Bushehr bodybuilding gyms from February to May 2015. A structured questionnaire was used to collect the participants' information, including demographic characteristics, sports' status and performance-enhancing drug use. According to the condition of performance-enhancing drug use, the participants were divided into current users, non-current users, and nonusers. The psychiatric status of the participants was evaluated using DSM-IV diagnostic criteria for major depressive disorder, bipolar disorder, generalized anxiety disorder, and schizophrenia. We also asked about the acute psychotic disturbances after using performance-enhancing drugs, alcohol use, and history of aggressive behavior in bodybuilders. Data were analyzed using one-way analysis of variance and chi-square tests.

Results: Prevalence of major depressive disorder, bipolar disorder, schizophrenia, generalized anxiety disorder, and the overall prevalence of psychiatric disorders in the bodybuilders was 19.7%, 3.8%, 1.5%, 16.6%, and 26.7%, respectively. After using performance-enhancing drugs, 33% of the bodybuilders had experienced acute psychological disturbances. There were no significant differences between current, non-current, and nonuser bodybuilding athletes in the measured psychiatric disorders.

Conclusion: Prevalence of psychiatric disorders was not significantly different in performance-enhancing drug users and nonusers. Thus, it can be concluded that performance-enhancing drugs do not increase the risk of psychiatric disorders in bodybuilders.

 

[anonymous_475692]

@Michael Scally MD so this is saying men who were non-current users expierence these psychiatric disorders more and the current users and non-users?

so you’re saying if one was “on” for a long time and tried to come off that these psychiatric symptoms would be severe and irreversible?

Edit: so aas dependence and addiction are not false correct?

 

[Michael Scally MD]

@Michael Scally MD so this is saying men who were non-current users expierence these psychiatric disorders more and the current users and non-users?

so you’re saying if one was “on” for a long time and tried to come off that these psychiatric symptoms would be severe and irreversible?

Edit: so aas dependence and addiction are not false correct?

No.

 

[Dr JIM]

Ostovar A, Haerinejad MJ, Akbarzadeh S, Keshavarz M. Comparison of the Prevalence of Psychiatric Disorders in Performance-Enhancing Drug Users and Nonuser Bodybuilders. Iranian journal of psychiatry 2017;12:223-8. Comparison of the Prevalence of Psychiatric Disorders in Performance-Enhancing Drug Users and Nonuser Bodybuilders

Objective: The present study aimed at comparing the prevalence of major psychiatric disorders ........ between performance-enhancing drug users and nonuser bodybuilders.

Conclusion: Thus, it can be concluded that performance-enhancing drugs do not increase the risk of psychiatric disorders in bodybuilders.

@Michael Scally MD so this is saying men who were non-current users expierence these psychiatric disorders more and the current users and non-users?

so you’re saying if one was “on” for a long time and tried to come off that these psychiatric symptoms would be severe and irreversible?

Edit: so aas dependence and addiction are not false correct?

And your questions are based upon WHAT data ?

Here’s a suggestion that may help you read TO better understand evidence based research.

First - thoroughly understand the OBJECTIVE of any study

Second - read the AUTHORS conclusion

Third - critically appraise the study to determine IF the authors “conclusion” is supported based upon the data alone.

Finally since a variety of behaviors or “feelings” can be viewed as signs or symptoms of “addiction” the use of such terms must be explicitly defined on a contextual basis.

IMO the use of trite terminology such as “addiction” is far to nonspecific, understanding the involved substances are also endogenouly secreted compounds such as AAS, GH, Thyroxine etc.

Jim

 

[Michael Scally MD]

[GMAFB] [TOTAL CRAP] The Central Effects of Androgenic-Anabolic Steroid Use

[FUCKING IDIOTS: “When making the decision to stop the use of AAS, severely symptomatic patients should be offered a 4-week tapered course of testosterone replacement therapy.”]

Millions of men use androgenic-anabolic steroids (AAS) to stimulate muscle growth and improve physical appearance.

Although 1 out of 3 people who uses androgenic-anabolic steroids develops a steroid use disorder, the effects of the drugs on the central nervous system and the psyche are still not well understood.

Although most addictive substances improve mood immediately after administration, AAS exert less pronounced euphoric effects.

Instead, they are primarily taken for the delayed gratification of increased muscle mass.

Withdrawal from AAS may lead to a range of somatic and psychiatric symptoms, and, in many cases, comprehensive treatment supervised by an endocrinologist and a psychiatrist is required.

Medras M, Brona A, Jozkow P. The Central Effects of Androgenic-anabolic Steroid Use. Journal of addiction medicine 2018. https://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/The_Central_Effects_of_Androgenic_anabolic_Steroid.99491.aspx

 

[Dr JIM]

“Withdrawal” from AAS should NEVER be likened to that of
street drugs or their Schedule II
or I pharmacologic equivalents, as the addictive potential of the latter pales in comparison to “steroids”.

That being said, bc some folk running HIGH DOSAGE AAS for prolonged periods find “cold turkey” an impossible task, bridging TRT may be helpful in that patient population IME.

(Heck many of these folk end up on TRT anyway)

Contrarily, there’s reason to believe many of today’s youth are unnecessarily being prescribed TRT bc of uncomplicated AIH, and that’s where the fallacy lies IMO.

Jim

 

[Michael Scally MD]

Miner M, Morgentaler A, Khera M, Traish AM. The state of testosterone therapy since the fda's 2015 labeling changes: indications and cardiovascular risk. Clin Endocrinol (Oxf) 2018. The state of testosterone therapy since the fda's 2015 labeling changes: indications and cardiovascular risk

OBJECTIVE: A label change for testosterone (T) products in March 2015 followed a highly-publicized FDA advisory committee meeting in September 2014. Changes included a warning of possible increased cardiovascular (CV) risks and restriction of indicated populations to younger men with a limited set of known etiologies of testosterone deficiency (TD). These changes greatly impacted clinical practice and public perception of T therapy (TTh). Our aim was to review these changes in light of subsequently published studies.

DESIGN: We identified 23 studies through June 2017, including 12 clinical trials and 11 observational studies. The Testosterone Trials included 790 men 65y and older with TD without known etiology, assigned to 1y T gel or placebo.

RESULTS: Demonstrated benefits of T included sexual activity and desire, physical activity, and mood. There were 9 major adverse CV events (MACE) in the T arm and 16 in the placebo arm. No study reported increased MACE with TTh. A 3y RCT showed no difference in carotid atherosclerosis. Several large observational studies reported reduced CV events with TTh, including one showing progressively reduced CV and mortality risk with greater duration of TTh. Men whose serum T normalized with TTh had reduced risk of MI and death compared with men whose T levels failed to normalize.

CONCLUSION: We conclude that existing evidence fails to support increased CV risk with TTh; on the contrary, there is evidence suggestive of real-world CV benefits. Finally, existing evidence provides benefits of TTh in older men without known etiology for T deficiency.

 

[Michael Scally MD]

Griffiths S, Jacka B, Degenhardt L, Murray SB, Larance B. Physical appearance concerns are uniquely associated with the severity of steroid dependence and depression in anabolic-androgenic steroid users. Drug and alcohol review 2018. http://onlinelibrary.wiley.com/doi/10.1111/dar.12688/abstract

INTRODUCTION AND AIMS: Emerging research suggests that the sub-population of anabolic-androgenic steroid (AAS) users who experience physical appearance concerns may suffer greater psychological dysfunction than other sub-populations, including users with athletic or occupational concerns. Thus, among current AAS users, we sought to determine whether, and to what extent, social physique anxiety-an established measure of appearance concern-was associated with psychological dysfunction.

DESIGN AND METHODS: Interviews were conducted with a sample of 74 male AAS users living in Australia. Users completed self-report instruments of the severity of AAS dependence, depression, hazardous and risky drinking, use of non-AAS illicit drugs, psychological side-effects due to AAS use and abnormal test results due to AAS use.

RESULTS: Multivariate analyses revealed that greater social physique anxiety was uniquely associated with more severe symptoms of both AAS dependence and depression. Moreover, the effect size of these relationships was large. Social physique anxiety was not associated with hazardous or risky drinking, non-AAS illicit drug use, psychological side-effects or abnormal test results.

DISCUSSION AND CONCLUSIONS: Limitations notwithstanding, the study is consistent with the notion that AAS users who experience appearance concerns are at heightened risk of co-morbid psychological dysfunction. Given trends indicating an increase in the prevalence of AAS use in Australia and elsewhere, the findings suggest that health-care systems may need to consider prioritising the sub-population of AAS users who experience appearance concerns. Further investigation of the clinical syndrome of AAS dependence is required, including its relation to body image and eating disorders.