AAS – CNS Effects

[Michael Scally MD]

[OA] Exogenous Testosterone Increases Status-Seeking Motivation in Men with Unstable Low Social Status

Testosterone is associated with status-seeking behaviors such as competition, which may depend on whether one wins or loses status, but also on the stability of one’s status. We examined

(1) to what extent testosterone administration affects competition behavior in repeated social contests in men with high or low rank, and
(2), whether this relationship is moderated by hierarchy stability, as predicted by the status instability hypothesis.

Using a real effort-based design in healthy male participants (N = 173 males), we first found that testosterone (vs. placebo) increased motivation to compete for status, but only in individuals with a low unstable status.

A second part of the experiment, tailored to directly compare stable with unstable hierarchies, indicated that exogenous testosterone again increased competitive motivation in individuals with a low unstable status, but decreased competition behavior in men with low stable status.

Additionally, exogenous testosterone increased motivation in those with a stable high status. Further analysis suggested that these effects were moderated by individuals’ trait dominance, and genetic differences assessed by the androgen receptor (CAG-repeat) and dopamine transporter (DAT1) polymorphisms.

Our study provides evidence that testosterone specifically boosts status-related motivation when there is an opportunity to improve one’s social status. The findings contribute to our understanding of testosterone’s causal role in status-seeking motivation in competition behavior, and indicate that testosterone adaptively increases our drive for high status in a context-dependent manner. We discuss potential neurobiological pathways through which testosterone may attain these effects on behavior.

Losecaat Vermeer AB, Krol I, Gausterer C, Wagner B, Eisenegger C, Lamm C. Exogenous testosterone increases status-seeking motivation in men with unstable low social status [Internet]. 2019. https://psyarxiv.com/6bw3n/

 

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[OA] Exogenous Testosterone Increases Status-Seeking Motivation in Men with Unstable Low Social Status

Testosterone is associated with status-seeking behaviors such as competition, which may depend on whether one wins or loses status, but also on the stability of one’s status. We examined

(1) to what extent testosterone administration affects competition behavior in repeated social contests in men with high or low rank, and
(2), whether this relationship is moderated by hierarchy stability, as predicted by the status instability hypothesis.

Using a real effort-based design in healthy male participants (N = 173 males), we first found that testosterone (vs. placebo) increased motivation to compete for status, but only in individuals with a low unstable status.

A second part of the experiment, tailored to directly compare stable with unstable hierarchies, indicated that exogenous testosterone again increased competitive motivation in individuals with a low unstable status, but decreased competition behavior in men with low stable status.

Additionally, exogenous testosterone increased motivation in those with a stable high status. Further analysis suggested that these effects were moderated by individuals’ trait dominance, and genetic differences assessed by the androgen receptor (CAG-repeat) and dopamine transporter (DAT1) polymorphisms.

Our study provides evidence that testosterone specifically boosts status-related motivation when there is an opportunity to improve one’s social status. The findings contribute to our understanding of testosterone’s causal role in status-seeking motivation in competition behavior, and indicate that testosterone adaptively increases our drive for high status in a context-dependent manner. We discuss potential neurobiological pathways through which testosterone may attain these effects on behavior.

Losecaat Vermeer AB, Krol I, Gausterer C, Wagner B, Eisenegger C, Lamm C. Exogenous testosterone increases status-seeking motivation in men with unstable low social status [Internet]. 2019. https://psyarxiv.com/6bw3n/

Points of interest:

1. T affects motivation/competition only in people with'unstable social status'
2. Fewer AR CAG repeats enhances the effect (thus race enters)
3. DAT polymorphism affects the effect
4. Since T affects dopamine, this opens the door for potential addiction ... and claims of androgens being addictive

 

[Michael Scally MD]

[OA] Exogenous Testosterone Increases Status-seeking Motivation in Men with Unstable Low Social Status

Testosterone is associated with status-seeking behaviors such as competition, which may depend on whether one wins or loses status, but also on the stability of one’s status.

We examined

(1) to what extent testosterone administration affects competition behavior in repeated social contests in men with high or low rank, and

(2), whether this relationship is moderated by hierarchy stability, as predicted by the status instability hypothesis.

Using a real effort-based design in healthy male participants (N = 173 males), we first found that testosterone (vs. placebo) increased motivation to compete for status, but only in individuals with a low unstable status.

A second part of the experiment, tailored to directly compare stable with unstable hierarchies, indicated that exogenous testosterone again increased competitive motivation in individuals with a low unstable status, but decreased competition behavior in men with low stable status. Additionally, exogenous testosterone increased motivation in those with a stable high status.

Further analysis suggested that these effects were moderated by individuals’ trait dominance, and genetic differences assessed by the androgen receptor (CAG-repeat) and dopamine transporter (DAT1) polymorphisms.

Our study provides evidence that testosterone specifically boosts status-related motivation when there is an opportunity to improve one’s social status. The findings contribute to our understanding of testosterone’s causal role in status-seeking motivation in competition behavior, and indicate that testosterone adaptively increases our drive for high status in a context-dependent manner. We discuss potential neurobiological pathways through which testosterone may attain these effects on behavior.

Losecaat Vermeer, Annabel B., Isabelle Krol, Christian Gausterer, Bernhard Wagner, Christoph Eisenegger, and Claus Lamm. 2019. “Exogenous Testosterone Increases Status-seeking Motivation in Men with Unstable Low Social Status.” PsyArXiv. October 7. https://psyarxiv.com/6bw3n/

 

[Michael Scally MD]

How Stories in Memory Perpetuate the Continued Influence of False Information

Imagine a pharmaceutical advertisement that presents a testimonial of a consumer’s experience using a drug. Such narratives are often followed by a list of factual information about the drug, including benefits, possible side effects, and potential interactions with other drugs.

Now imagine that a piece of this information about the drug is later retracted or publicly discredited. Could the consumer testimonial which preceded the discredited information make a difference in whether the information continues to influence viewers’ beliefs?

Hamby A, Ecker U, Brinberg D. How Stories in Memory Perpetuate the Continued Influence of False Information. Journal of Consumer Psychology 2019. https://doi.org/10.1002/jcpy.1135
https://tinyurl.com/y6tqd5kz

People often encounter information that they subsequently learn is false. Past research has shown that people sometimes continue to use this misinformation in their reasoning, even if they remember that the information is false, which researchers refer to as the continued influence effect.

The current work shows that the continued influence effect depends on the stories people have in memory: corrected misinformation was found to have a stronger effect on people's beliefs than information that was topically related to the story if it helped to provide a causal explanation of a story they had read previously.

We argue this effect occurs because information that can fill a causal “gap” in a story enhances comprehension of the story event, which allows people to build a complete (if inaccurate) event model that they prefer over an accurate but incomplete event model.

This effect is less likely to occur for stories in memory that end in a negative way, presumably because people are more motivated to accurately understand negative outcome events.

 

[Michael Scally MD]

Muscle Dysmorphia [MD] and Self-Esteem in Former and Current Users of Anabolic-Androgenic Steroids

Highlights
· AAS use within the UK is on the rise.
· It is estimated that as many as 10 % of male gym-goers in the UK experience Muscle dysmorphia.
· Low self-esteem leads to AAS use in both current and former users.

Given the contradictory results on the role of self-esteem and MD in AAS use, it would seem pertinent to examine the extent of and relationship between these concepts in current, former and non-users. Additionally, asking men why they started using AAS,the reasons behind continued use and cessation may contribute to the recent literature that aims to understand what motivates men to use AAS.

Notwithstanding the need for further examination and replication of findings in order that health professionals and policy-makers can begin to provide appropriate preventative models for AAS users, at present AAS use does not feature within the UK Clinical Guidelines for the Management of Drug Misuse and Dependence nor in the National Treatment Agency for Substance Misuse (2006). Instead, it is left to needle exchange programmes (NEP) providers to manage harm reduction approaches, rather than strategies to aid cessation or prevent initial use.

Hence, it is essential to gain a deeper understanding of AAS use to
(1) help prevent those considering AAS use in the future
(2) to encourage those who no longer use AAS to remain abstinent, and
(3) to decrease the potential negative impact of AAS on current users.

Research questions
1. What is the extent of low self-esteem in current, former and non-users, and how does this relate to their motivations?
2. How do self-esteem levels and MD symptomology differ between current, former and non-users?
3. What are the motivations behind the initiation, cessation (for former users) and continued use of AAS (for current users) and do motivations differ between current and former users?
4. What do these motivations suggest about the direction of causality?

Greenway CW, Price C. Muscle dysmorphia and self-esteem in former and current users of anabolic-androgenic steroids. Performance Enhancement & Health 2019:100154. http://www.sciencedirect.com/science/article/pii/S2211266919300817

 

[Michael Scally MD]

Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression.

Highlights
· Baseline testosterone is positively (but weakly) correlated with human aggression. The relationship between baseline testosterone and aggression is significantly stronger in male vs. Females samples.
· Context-dependent changes in testosterone are positively (but weakly) correlated with human aggression. The relationship between changes in testosterone and aggression is significantly stronger in male vs. Females samples.
· No strong evidence for a causal role of testosterone in promoting human aggression

Testosterone is often considered a critical regulator of aggressive behaviour. There is castration/replacement evidence that testosterone indeed drives aggression in some species, but causal evidence in humans is generally lacking and/or—for the few studies that have pharmacologically manipulated testosterone concentrations—inconsistent.

More often researchers have examined differences in baseline testosterone concentrations between groups known to differ in aggressiveness (e.g., violent vs non-violent criminals) or within a given sample using a correlational approach. Nevertheless, testosterone is not static but instead fluctuates in response to cues of challenge in the environment, and these challenge-induced fluctuations may more strongly regulate situation-specific aggressive behaviour.

Here, we quantitatively summarize literature from all three approaches (baseline, change, and manipulation), providing the most comprehensive meta-analysis of these testosterone-aggression associations/effects in humans to date.

Baseline testosterone shared a weak but significant association with aggression (r = 0.054, 95% CIs [0.028, 0.080]), an effect that was stronger and significant in men (r = 0.071, 95% CIs [0.041, 0.101]), but not women (r = 0.002, 95% CIs [−0.041, 0.044]). Changes in T were positively correlated with aggression (r = 0.108, 95% CIs [0.041, 0.174]), an effect that was also stronger and significant in men (r = 0.162, 95% CIs [0.076, 0.246]), but not women (r = 0.010, 95% CIs [−0.090, 0.109]). The causal effects of testosterone on human aggression were weaker yet, and not statistically significant (r = 0.046, 95% CIs [−0.015, 0.108]).

We discuss the multiple moderators identified here (e.g., offender status of samples, sex) and elsewhere that may explain these generally weak effects. We also offer suggestions regarding methodology and sample sizes to best capture these associations in future work.

Geniole SN, Bird BM, McVittie JS, Purcell RB, Archer J, Carré JM. Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression. Hormones and Behavior 2019:104644. Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression - ScienceDirect

 

[Michael Scally MD]

[OA] Treatments for People Who Use Anabolic Androgenic Steroids: A Scoping Review

Background: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems.

Methods: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible.

Results: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided.

Conclusion: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base.

Bates G, Van Hout MC, Teck JTW, McVeigh J. Treatments for people who use anabolic androgenic steroids: a scoping review. Harm Reduct J. 2019;16(1):75. Published 2019 Dec 30. Treatments for people who use anabolic androgenic steroids: a scoping review | Harm Reduction Journal | Full Text

 

[Michael Scally MD]

[OA] Drive for Muscularity Behaviors in Male Bodybuilders: A Trans-Contextual Model of Motivation

Background: The drive for muscularity behaviors are very common in male athletes, especially in male bodybuilders. Studies have related drive for muscularity behaviors to body dissatisfaction, eating disorders and muscle dysmorphia.

Methods: This study applied the trans-contextual model of motivation to the drive for muscularity behaviors of male bodybuilders at risk of developing muscle dysmorphia. The relationships between self-determination theory constructs and drive for muscularity behaviors, via the theory of planned behavior variables (i.e., attitude, subjective norm, perceived behavioral control, and intention) were examined.

A total of 175 Swiss male bodybuilders (M age = 27.34; SD age = 7.53) completed measures on motivation for sport, theory of planned behavior variables, and drive for muscularity behaviors. They practiced bodybuilding from three to 24 h per week (Mhours per week = 6.59; SDhours per week = 3.45) and had done so for 7.19 years on average (SDnumber of years = 6.91).

Using bootstrapped maximum likelihood estimation with the AMOS 7.0 program, a series of confirmatory factor analyses was performed on each subscale and a series of path analyses was performed to determine the final model.

Results: The fit indices of the final model were satisfactory: χ2 (11) = 13.81; p = .244; TLI = .98; CFI = .99; RMSEA = .04. The model explained 29% of the variance of drive for muscularity behaviors. The final path analysis supported the motivational sequence, with autonomous motivation for sport showing a positive, significant and indirect association with the drive for muscularity behaviors via perceived behavioral control and intention to gain muscle mass, and controlled motivation for sport showing a positive association with the drive for muscularity behaviors both directly and via attitude and intention to gain muscle mass.

Conclusions: It was concluded that the trans-contextual model of motivation applies only partially to the drive for muscularity behaviors in male bodybuilders.

Perspective: The motivational mechanisms explaining the development of drive for muscularity behaviors might be better understood through complementary analyses of motivational profiles. Such investigations would guide the design of programs to lower the risks associated with these behaviors.

Chaba L, d'Arripe-Longueville F, Lentillon-Kaestner V, Scoffier-Mériaux S. Drive for muscularity behaviors in male bodybuilders: a trans-contextual model of motivation. J Eat Disord. 2019;7:44. Published 2019 Dec 31. Drive for muscularity behaviors in male bodybuilders: a trans-contextual model of motivation

 

[Michael Scally MD]

[OA] Supporting Men Who Use Anabolic Steroids

Background An increasing amount of research exploring use of anabolic androgenic steroids (AAS) has been undertaken over the past three decades and, in recent years, there has been a growing awareness of this form of substance use on a societal level and as a public health problem in the UK. However, there have been few public health interventions aiming to respond to this and there is little evidence-based guidance available to support health professionals working with users.

Aim The aim of the research was to identify ways that intervention providers can influence men who use AAS and support them to improve their health and manage risk. To achieve this the research explored factors that influence users’ choices, and identified priorities and opportunities for interventions.

Methodology The research followed a sequential design over four studies, where findings informed the development of subsequent studies.

• Study 1 was a systematic review examining the content and effectiveness of interventions with the intention of influencing AAS use.

• Study 2 was the development of an evidence-based socioecological framework through which to explore factors that influence AAS users’ behaviours and to identify opportunities for interventions.

• Study 3 used largely unstructured interviews with 33 stakeholders with a range of expertise and experiences with AAS to identify priorities to address and potential interventions in response to these.

• Semi-structured interviews in study 4 followed up these findings with 12 men who use AAS who ranged from new users to very experienced users.

These qualitative studies were analysed using thematic analysis, which moved from an initial inductive and data driven approach to one that was more deductive as interviews became more structured. The Behaviour Change Wheel model informed the research and in particular the principle of developing an in depth understanding of a behaviour in order to influence it.

The findings from the four studies supported the development of a conceptual map exploring the provision of support and information to users. A complex systems approach to understanding health behaviours underpinned the map and identification of potential interventions in response to the priorities identified.

Results A range of priorities to support users to improve their health and manage risk emerged. Opportunities to respond to these were identified, supported by the development of the conceptual map of support and information provision. This map is intended for stakeholders to use in the development of effective responses in their local communities. Applying a systems approach to the provision of support to AAS users helps recognise the competing and complex influences on users across the socioecological spectrum and supports a thorough understanding of their behaviours.

The findings indicate the need to go beyond the current provision of support services in the form of needle and syringe programmes and steroids clinics to respond to the priorities identified. Involving influential individuals or role models as change agents within users’ social networks and important environments such as gyms will increase opportunity to influence AAS choices and norms, and subsequently reduce risk of poor health outcomes amongst this population.

Bates, G (2019) Supporting men who use anabolic steroids: A sequential multi-methods study. Doctoral thesis, Liverpool John Moores University. Supporting men who use anabolic steroids: A sequential multi-methods study | LJMU Research Online

 

[Michael Scally MD]

They separated AAS used into dependent and NON dependent based on a checklist! But, isn’t something amiss when one says AAS are dependent causing and NOT!

Hauger LE, Westlye LT, Bjørnebekk A. Anabolic androgenic steroid dependence is associated with executive dysfunction. Drug and alcohol dependence 2020;208:107874. http://www.sciencedirect.com/science/article/pii/S0376871620300399

Highlights
· Steroid dependence is associated with executive dysfunction in test setting and everyday life.
· Executive dysfunction might be related to continued abuse despite adverse side-effects.
· Increased awareness of executive function is important for treatment and rehabilitation.

Background Anabolic androgenic steroid (AAS) dependence is associated with a high prevalence of intra- and interpersonal problems, hence it is central to identify cognitive factors related to the development and maintenance of dependence.

Methods The study explores executive functions (EFs) in a sample of 174 male weightlifters, divided into three groups;
1) AAS dependents; n = 58,
2) AAS non-dependents; n = 38 and
3) AAS non-users; n = 78,

using a targeted battery of neuropsychological (NP) tests, and self-report questionnaires assessing EFs in everyday life, ADHD symptoms and psychological distress.

Results Multivariate analysis of variance showed significant between-group differences on several EFs, including working memory [F (2, 169) = 13.79, p < .001, ηp² = 0.14], mental flexibility [F (2, 169) = 4.82, p = .009, ηp² = 0.05], problem-solving [F (2, 169) = 4.77 p = .010, ηp² = 0.05] and inhibition [F (2, 163) = 4.15, p = .017, ηp² = 0.05].

Additionally, significant between-group differences were seen for self-reported problems with EFs [F (2, 124) = 4.38 p = .015, ηp² = 0.07], ADHD symptoms [F (2, 124) = 7.02 p = .001, ηp² = 0.10], and psychological distress [F (2, 124) = 4.11 p = .019, ηp² = 0.06].

Post hoc tests showed that AAS dependents exhibited poorer EFs and reported more psychological distress compared to non-users.

Conclusion AAS dependence is associated with executive dysfunction, which might be related to continued abuse despite adverse side-effects and social consequences. Increased awareness of executive dysfunction could have important implications for treatment and rehabilitation.

 

[Michael Scally MD]

Anabolic Androgenic Steroid Abuse in The United Kingdom; An Update the Increasing Popularity of Anabolic Androgenic Steroids

Anabolic androgenic steroids (AASs) are prescribed for medical conditions related to low testosterone. Abuse of AASs has surged as they become increasingly recognised as potent image enhancement drugs.

The primary goal of most abusers is to obtain what they consider to be a more attractive outward appearance. Abuse is complex.

There are a vast range of AAS substances available, although due to their illicit nature, the true composition of AAS substances is difficult to evaluate. Users follow dosing patterns which incorporate a number of different AASs, in addition to other pharmaceutical substances believed to complement the desired physical effects or manage unwanted effects.

Studies to support the harms of AASs are limited. Animal work and medical case reports suggest potential to cause serious hepatotoxicity, in addition to possible neurotoxicity, nephrotoxicity and damage to the cardiovascular and reproductive systems.

As the long term AAS using cohort reach maturity, further controlled experimentation, with larger sample sizes, is required. Data gathering should be directed towards establishing knowledge related to the most vulnerable AAS users, which is inclusive of females and adolescent boys.

Mullen C, Whalley BJ, Schifano F, Baker JS. Anabolic Androgenic Steroid Abuse in the United Kingdom; An Update The increasing popularity of anabolic androgenic steroids [published online ahead of print, 2020 Jan 28]. Br J Pharmacol. 2020;10.1111/bph.14995. BPS Publications

 

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They separated AAS used into dependent and NON dependent based on a checklist! But, isn’t something amiss when one says AAS are dependent causing and NOT!

'Dependence' and 'Addiction' are words awash in the media (and medical community). People emotionally repeat what they don't really know. There is more prejudice than anything else in these attitudes. Often at the root is fear about others being different.

To illustrate:

• Type I diabetics are dependent on insulin. They will even die without it.
• Chronic pain sufferers are dependent on pain management (usually opioids)
• People are dependent on food, but some eat too much thus demonstrating 'addiction'. Physical dependence vs psychological addiction. These often become type II diabetics which is reversible in the beginning - but they usually lack the will.
• Terminally ill who people suffering intractable pain

1. Jack Kevorkian?
2. Dope them up with naughty opioids?
3. Just let them suffer in the corner out of sight with no hope ... eventually they will die.
4. Keep them alive longer to bilk money.

As for dependent and non-dependent, in what way? Physically? Psychologically? Quality of life?

It is notable that the 'dependents' in the study used a lot more AAS and for twice as long compared to the 'non-dependents'. [ 1196.9mg/wk for 13.3 years vs 692mg/wk for 6.4 years ]. One could argue the potential health problems of higher+longer validates 'unreasonable' use, therefore 'dependent' - a typical criteria used in defining physical addiction (continuing in spite of harm).

The dependents had lower IQ and started earlier. So are they just stupid to use so much so long? Or are they dependent? Or is this 'proof' that AAS makes you stupid? (even though they started earlier)

Did not readily see this checklist but noted, "Adequate psychometric properties have been found" by none other than Dr Pope [ A Diagnostic Interview Module for Anabolic-Androgenic Steroid Dependence: Preliminary Evidence of Reliability and Validity ] - Isn't he the one that invented a diagnosis for bodybuilders who deny they have body dysmorphism? There were other references as well.

Seems a fundamental issues is who decides what quality of life another is suppose to live.

And checklist questions are often couched in an individual's own conflict about their conduct ... if they confident then they are not dependent but if they have doubts/distresses, then they are dependent.

Examine the posts on this forum. Doubts and distresses are expressed - even by some who have yet to try AAS.

A psychologist once told me: "Medicine is not an exact science. Unfortunately, psychology is even less exact". So in murky waters the above study lies [ pun intended ].

 

[Michael Scally MD]

The Anabolic Androgenic Steroid Treatment Gap: A National Study of Substance Use Disorder Treatment

Background: Anabolic androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use among people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment.

Methods: This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences.

Results: Lifetime AAS use was reported by 156 (28.3%) SUD patients, thereof 35.6% of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS using men. AAS users reported more severe substance use than non-AAS users. More than half (58%) of all patients had not been asked about AAS use, and 42.4% of those who were asked, experienced that treatment providers lacked expertise about AAS.

Conclusion: Lifetime AAS use in this sample of SUD patients is common practice and comprise an underrecognized problem in SUD treatment. Given the deleterious implications to the individual and society that concomitant use of AAS may cause, it would be essential to raise the awareness about AAS use among SUD patients, and the level of competence among health professionals.

Havnes IA, Jørstad ML, McVeigh J, Van Hout M-C, Bjørnebekk A. The Anabolic Androgenic Steroid Treatment Gap: A National Study of Substance Use Disorder Treatment. Substance Abuse: Research and Treatment 2020;14:1178221820904150. SAGE Journals: Your gateway to world-class research journals

 

[Michael Scally MD]

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

Background: Anabolic-androgenic steroids (AASs), when taken in supraphysiologic doses, increase muscle strength and athletic performance. Evidence suggests that long-term use of AAS in supraphysiologic doses have adverse effects on health.

Therefore, the study was conducted to find crude estimate of the prevalence of AAS use among attendees of the gymnasium, the factors that could have influenced them for AAS abuse and to assess the short- and long-term side effects as perceived by them.

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

Results: Of 84 bodybuilders approached, 74 participants used AAS. All users were male with mean age of 26.5 + 0.55 years. The mean age of initiation of AAS abuse was 23 years, and 66.2% (49) were unmarried. Eighty-five percent (63) preferred injectable. Seventy percent (52) abusers were influenced by trainers for abuse. Most commonly abused was Nandrolone decanoate (55.4%).

Seventy-three percent were not aware of any legal ban on steroids. Reported benefits include increased strength, muscle size, and power, while harms were increased acne, deepening of voice, swelling of feet, increased irritability, depressive thoughts, impaired judgment, panic disorder, and withdrawal effect.

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

Pany S, Panigrahi SK, Rao EV, Patnaik L, Sahu T. Anabolic Androgenic Steroid Abuse and their Health Impacts: A Cross-sectional Study among Body Builders in a City of Eastern India. Int J Prev Med. 2019;10:178. Published 2019 Oct 9. doi:10.4103/ijpvm.IJPVM_524_17 Anabolic Androgenic Steroid Abuse and their Health Impacts: A Cross-sectional Study among Body Builders in a City of Eastern India

 

[Michael Scally MD]

[OA] [GMAFB] Anabolic-Androgenic Steroid Use and Body Image in Men: A Growing Concern for Clinicians. Psychotherapy and Psychosomatics

Recent decades have seen increasing attention to disorders of body image [1]. In the past, most body-image studies have focused on women [2], and especially women with eating disorders [3], but now a growing literature has also begun to address body image disorders in men [4]. In particular, it appears that today’s men have become increasingly preoccupied with having a lean and muscular body, perhaps as a result of constant exposure to lean and muscular male images in movies, television, advertising, and elsewhere [1, 5].

Modern mental health professionals are very likely to encounter male patients who harbor such concerns. Importantly, many of these men use drugs (or “dietary supplements” containing drugs) in order to gain muscle or lose body fat. The use of these “body image drugs” had already surfaced as a clinical issue 20 years ago [6] and has generated increasing attention in recent years [7]. From a public health standpoint, the most concerning of these substances are the anabolic-androgenic steroids (AAS) – the family of hormones that includes testosterone and its synthetic derivatives. In this paper, we present a clinical update on AAS use.

…

Kanayama G, Hudson JI, Pope JHG. Anabolic-Androgenic Steroid Use and Body Image in Men: A Growing Concern for Clinicians. Psychotherapy and Psychosomatics 2020;89:65-73. Anabolic-Androgenic Steroid Use and Body Image in Men: A Growing Concern for Clinicians

Laboratory abnormalities in anabolic-androgenic steroid users



A diagram of three pathways that may lead to anabolic-androgenic steroid dependence, together with possible therapeutic strategies to address each pathway. ECT, electroconvulsive therapy; HPG, hypothalamic-pituitary-gonadal; RNA, ribonucleic acid. Note that the term “anabolic effects” in the figure refers to the muscle-building effects of AAS, and “androgenic effects” refers to the masculinizing effects of these hormones. Note also that the types of antidepressants effective for body dysmorphic disorder are primarily serotonin reuptake inhibitors, whereas antidepressants from a wider range of chemical families may be effective for treating depression associated with hypogonadism. Reprinted from Kanayama et al. [66], with permission from Elsevier.

 

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[OA] [GMAFB] Anabolic-Androgenic Steroid Use and Body Image in Men: A Growing Concern for Clinicians. Psychotherapy and Psychosomatics

Recent decades have seen increasing attention to disorders of body image [1]. In the past, most body-image studies have focused on women [2], and especially women with eating disorders [3], but now a growing literature has also begun to address body image disorders in men [4]. In particular, it appears that today’s men have become increasingly preoccupied with having a lean and muscular body, perhaps as a result of constant exposure to lean and muscular male images in movies, television, advertising, and elsewhere [1, 5].

Modern mental health professionals are very likely to encounter male patients who harbor such concerns. Importantly, many of these men use drugs (or “dietary supplements” containing drugs) in order to gain muscle or lose body fat. The use of these “body image drugs” had already surfaced as a clinical issue 20 years ago [6] and has generated increasing attention in recent years [7]. From a public health standpoint, the most concerning of these substances are the anabolic-androgenic steroids (AAS) – the family of hormones that includes testosterone and its synthetic derivatives. In this paper, we present a clinical update on AAS use.

…

Kanayama G, Hudson JI, Pope JHG. Anabolic-Androgenic Steroid Use and Body Image in Men: A Growing Concern for Clinicians. Psychotherapy and Psychosomatics 2020;89:65-73. Anabolic-Androgenic Steroid Use and Body Image in Men: A Growing Concern for Clinicians

Laboratory abnormalities in anabolic-androgenic steroid users

View attachment 129479

A diagram of three pathways that may lead to anabolic-androgenic steroid dependence, together with possible therapeutic strategies to address each pathway. ECT, electroconvulsive therapy; HPG, hypothalamic-pituitary-gonadal; RNA, ribonucleic acid. Note that the term “anabolic effects” in the figure refers to the muscle-building effects of AAS, and “androgenic effects” refers to the masculinizing effects of these hormones. Note also that the types of antidepressants effective for body dysmorphic disorder are primarily serotonin reuptake inhibitors, whereas antidepressants from a wider range of chemical families may be effective for treating depression associated with hypogonadism. Reprinted from Kanayama et al. [66], with permission from Elsevier.

View attachment 129480

Another classic:

• Testosterone has "Classical addiction via pathways similar to opioid addiction". So testosterone is as dangerous as heroin. *
• Depression from hypogonadism should be treated with "antidepressants" and "electroconvulsive therapy" **

With information this skewed, it is credulous to take any part of the article seriously.

Body image disorder (e.g., muscle dysmorphia) [ BAD ]

Healthy body image [ GOOD ]

* According to the National Institute of Drug Abuse, Anabolic Steroids

"Anabolic steroids work differently from other drugs of abuse; they do not have the same short-term effects on the brain. The most important difference is that steroids do not directly activate the reward system to cause a “high”; they also do not trigger rapid increases in the brain chemical dopamine, which reinforces most other types of drug taking behavior."​

** Electroconvulsive therapy: Benefits and risks

"ECT is not a first-line treatment. Most practitioners do not consider referral for ECT until many months or years of medication and other therapy without results."​

 

[Havah]

Another classic:

• Testosterone has "Classical addiction via pathways similar to opioid addiction". So testosterone is as dangerous as heroin. *
• Depression from hypogonadism should be treated with "antidepressants" and "electroconvulsive therapy" **

With information this skewed, it is credulous to take any part of the article seriously.

Body image disorder (e.g., muscle dysmorphia) [ BAD ]

Healthy body image [ GOOD ]

* According to the National Institute of Drug Abuse, Anabolic Steroids

"Anabolic steroids work differently from other drugs of abuse; they do not have the same short-term effects on the brain. The most important difference is that steroids do not directly activate the reward system to cause a “high”; they also do not trigger rapid increases in the brain chemical dopamine, which reinforces most other types of drug taking behavior."​

** Electroconvulsive therapy: Benefits and risks

"ECT is not a first-line treatment. Most practitioners do not consider referral for ECT until many months or years of medication and other therapy without results."​

You re discussing matters you have zero knowledge about and it shows

 

[Old]

You re discussing matters you have zero knowledge about and it shows

These are quotes from the article - why don't you actually read it?

• Do you honestly believe testosterone is as addictive as opiods?
• Do you believe AAS users should consider electroconvulsive therapy?
• Do you thing that bodybuilders are not 'normal' people and thus exhibiting mental illness?

The article clearly presents those views. I disagree with them whether you think I have zero knowledge about the topic or otherwise.

 

[Michael Scally MD]

Competitive Bodybuilding: Fitness, Pathology, or Both?

The sport of competitive bodybuilding requires an intense regimen of weightlifting and dieting, often aided with muscle-building or fat-burning drugs, and culminating in an on-stage posing competition. Despite these rigorous demands, competitive bodybuilding is popular, with thousands of competitions performed annually around the world.

Although many studies have addressed the psychological features of various sports and the athletes who compete in them, few have examined the psychological aspects of bodybuilding. Even fewer studies have specifically examined competitive bodybuilders, as opposed to the much larger group of "recreational" bodybuilders who do not compete.
The limited available literature suggests that competitive bodybuilders may show an increased risk for four categories of psychopathology:

1. muscle dysmorphia,

2. eating disorders,

3. abuse of appearance- and performance-enhancing drugs, and

4. exercise dependence.

However, in each of these categories, one must carefully distinguish between the planned and dedicated behaviors required for success in the sport, as opposed to frankly pathological behaviors that impair social or occupational function, cause subjective distress, or lead to adverse health consequences.

Future work should attempt to better assess the nature and prevalence of these conditions among competitive bodybuilders, with perhaps greatest attention to the issue of drug use.

Steele IH, Pope HG Jr, Kanayama G. Competitive Bodybuilding: Fitness, Pathology, or Both?. Harv Rev Psychiatry. 2019;27(4):233‐240. doi:10.1097/HRP.0000000000000211 https://journals.lww.com/hrpjournal/Abstract/2019/07000/Competitive_Bodybuilding__Fitness,_Pathology,_or.3.aspx

 

[Michael Scally MD]

Muscle Dysmorphia: Appearance, Diagnostic Approaches, Research and Treatment

Fitness training and corresponding forms of health centered lifestyles have been integrated into everyday life as a common and societal accepted phenomenon nowadays. It is furthermore associated with being healthy and through societal and industrial influences, a specific muscular and lean body image has become synonymous with fitness, sports and health. This has foremost affected male body image concerns.

In recent years, the diagnostic concept of Muscle Dysmorphia (MD) emerged, addressing this relatively new, male oriented psychological disorder. Key features of MD are excessive resistance training routines combined with rigid eating or dietary habits, body image dissatisfaction, distorted body perception and in many cases androgenic anabolic steroid abuse.

While the number of men affected by eating- and body image disorders are rising, societal acceptance and understanding of male body issues is still low. At the same time, research, treatment strategies and prevention programs are underdeveloped compared to efforts in female counterparts.

This article highlights the current discussion about diagnostic features of MD, its appearance, state of research, prevention and treatment.

Roland Müller. “Muscle Dysmorphia: Appearance, Diagnostic Approaches, Research and Treatment”. EC Psychology and Psychiatry 9.3 (2020): 01-09. Welcome to ECronicon