AAS – CNS Effects

[Michael Scally MD]

Is competitive body-building pathological?

Objectives Hundreds of thousands, if not millions, of individuals worldwide engage in competitive body-building. Body-building often attracts derogatory characterisations such as as ‘bizarre’ or ‘narcissistic,’ or a ‘freak show’, seemingly implying that it is associated with pathology. Few studies have compared psychological features in competitive bodybuilders versus recreational strength trainers.

Methods Using logistic regression with adjustment for age and race, we compared 96 competitive bodybuilders (‘competitors’) with 888 recreational strength trainers (‘recreationals’), assessed in a prior internet survey, regarding demographics; body image; use of anabolic–androgenic steroids (AAS), other appearance-enhancing and performance-enhancing drugs (APEDs), and classical drugs of abuse; history of psychiatric diagnoses; and history of childhood physical/sexual abuse.

Results Competitors reported a higher lifetime prevalence of AAS (61 (63.5%) vs 356 (10.1%), p<0.001) and other APED use than recreationals but showed very few significant differences on other survey measures. AAS-using competitors were more likely than AAS-using recreationals to have disclosed their AAS use to a physician (31 (50.8%) vs 107 (30.0%), p=0.003).

Both groups reported high levels of body image concerns but did not differ from one another (eg, ‘preoccupation with appearance’ caused significant reported distress or impairment in important areas of functioning for 18 (18.8%) competitors vs 132 (15.4%) recreationals, p=0.78).

No significant differences were found on the prevalence of reported childhood physical abuse (9 (9.4%) vs 77 (8.8%), p=0.80) or sexual abuse (4 (4.2%) vs 39 (4.5%), p=0.83). Competitors reported a lower lifetime prevalence of marijuana use than recreationals (38 (39.6%) vs 514 (57.9%), p=0.001).

Conclusion Aside from their APED use, competitive bodybuilders show few psychological differences from recreational strength trainers.

Steele I, Pope H, Ip EJ, et al. Is competitive body-building pathological? Survey of 984 male strength trainers. BMJ Open Sport & Exercise Medicine 2020;6:e000708. Is competitive body-building pathological? Survey of 984 male strength trainers

 

[Michael Scally MD]

[OA] Male Anabolic Androgenic Steroid Users with Personality Disorders Report More Aggressive Feelings, Suicidal Thoughts, and Criminality

Background and objectives: Anabolic androgenic steroids (AAS) are mainly used for aesthetic and performance-enhancing reasons. Their use is a growing public health problem and concern for society because of their adverse effects. The primary aim of this study was to identify psychiatric and personality disorders and to measure anxiety and depression in AAS users.

Materials and Methods: Fifty-six males who actively contacted the Anti-Doping Hot-Line and wished to stop using AAS were included. Structured Clinical Interviews Diagnosis-I and -II were used to diagnose psychiatric and personality disorders.

The Brief Scale for Anxiety and Montgomery Asberg Depression Rating Scale (subscales from the Comprehensive Psychopathological Rating Scale) were used to measure changes in anxiety and depression. Structured Clinical Interviews Diagnosis-I and -II were performed at one time point. Anxiety and depression were measured at inclusion and after six months. Urine samples were collected for an analysis of AAS and drugs of abuse.

Results: All participants reported some adverse effects that they associated with AAS use. In total, 56% and 52% of the cohort fulfilled the criteria for Structured Clinical Interviews Diagnosis-I and -II diagnoses, respectively.

A significantly increased risk of reporting aggressive feelings/behaviors (Odds Ratio (OR) = 4.9; Confidence Interval (CI) 0.99-25, p = 0.04), suicidal thoughts/attempts (OR = 4.6, CI 95; 0.99-21, p = 0.04) and criminality (OR = 6.5, CI 1-39, p = 0.03) was found among individuals with AAS use fulfilling the criteria for personality disorders compared with those without such AAS use. The Brief Scale for Anxiety score decreased from the median of 15 at inclusion to 10 at the follow-up visit six months later (p = 0.01, n = 19).

Conclusions: Our findings indicate that among individuals with AAS use, those with a personality disorder report more aggressive behaviors, suicidal thoughts/suicidal attempts, and criminality than those without a personality disorder.

Börjesson A, Möller C, Hagelin A, et al. Male Anabolic Androgenic Steroid Users with Personality Disorders Report More Aggressive Feelings, Suicidal Thoughts, and Criminality. Medicina (Kaunas). 2020;56(6):E265. Published 2020 May 28. doi:10.3390/medicina56060265 https://www.mdpi.com/1010-660X/56/6/265

 

[Michael Scally MD]

Testosterone Prescribing in Men with Depression and Anxiety Disorders

Purpose Testosterone Replacement Therapy (TRT) is posited to reduce the risk of depression and anxiety. To our knowledge, this is the first study to assess incident TRT prescribing patterns in a nationally representative sample of men with depression and anxiety in the US.

Methods This study included 5,565,649 men, aged 40-65 years, who were enrolled in Clinformatics Data Mart between January 1, 2002 and December 31, 2016. For each calendar year, we reported incident TRT prescribing and testosterone laboratory testing rates in men diagnosed with depression and/or anxiety.

Results For each calendar year, incident TRT prescribing rates were higher for men with depression and anxiety, compared to men without these disorders. For both groups, TRT prescribing increased by 200% from 2002-2013 and decreased by over 50% from 2013-2016. Over 20% of men in either group did not have a lab test for testosterone levels prior to TRT initiation.

Conclusions In men with depression and anxiety, TRT prescribing increased significantly from 2002-2013 and decreased from 2013-2016. A significant proportion of men were prescribed TRT without prior lab test for testosterone levels. Further research is needed to better understand the extent to which these conditions influence physician prescribing practices and patient expectations.

Javed Z, Kuo Y-F, Temple JR, Urban RJ, Holmes H, Baillargeon J. Testosterone Prescribing in Men with Depression and Anxiety Disorders. Annals of Epidemiology 2020. Testosterone Prescribing in Men with Depression and Anxiety Disorders - ScienceDirect

 

[Michael Scally MD]

[OA] Androgens' Effects on Cerebrovascular Function in Health and Disease

Androgens affect the cerebral vasculature and may contribute to sex differences in cerebrovascular diseases. Men are at a greater risk for stroke and vascular contributions to cognitive impairment and dementia (VCID) compared to women throughout much of the lifespan.

The cerebral vasculature is a target for direct androgen actions, as it expresses several sex steroid receptors and metabolizing enzymes. Androgens' actions on the cerebral vasculature are complex, as they have been shown to have both protective and detrimental effects, depending on factors such as age, dose, and disease state.

When administered chronically, androgens are shown to be pro-angiogenic, promote vasoconstriction, and influence blood-brain barrier permeability. In addition to these direct effects of androgens on the cerebral vasculature, androgens also influence other vascular risk factors that may contribute to sex differences in cerebrovascular diseases.

In men, low androgen levels have been linked to metabolic and cardiovascular diseases including hypertension, diabetes, hyperlipidemia, and obesity, which greatly increase the risk of stroke and VCID. Thus, a better understanding of androgens' interactions with the cerebral vasculature under physiological and pathological conditions is of key importance.

Abi-Ghanem C, Robison LS, Zuloaga KL. Androgens' effects on cerebrovascular function in health and disease. Biol Sex Differ. 2020;11(1):35. Published 2020 Jun 30. doi:10.1186/s13293-020-00309-4 Androgens’ effects on cerebrovascular function in health and disease | Biology of Sex Differences | Full Text

 

[Michael Scally MD]

[OA] [WTF] [GMAFB] Theory of Mind in Users of Anabolic Androgenic Steroids

Rationale: Anabolic androgenic steroids are used to improve physical performance or increase lean muscle mass. About one-third of users develop a dependency syndrome, which is characterized by elevated rates of psychopathology, cognitive impairments, and aggressive and antisocial behaviors. The mechanisms behind these intra- and interpersonal problems are not known.

Objective: To examine theory of mind (ToM), i.e., the ability to infer the mental state of others, in users of anabolic androgenic steroids. Reduced ToM may be one factor underlying the interpersonal problems that have been reported with prolonged use of anabolic androgenic steroids.

Methods: The Movie for the Assessment of Social Cognition (MASC) was used to assess ToM. Study participants were male/female weightlifters who used anabolic androgenic steroids (AAS, n = 34/9), who were dependent on anabolic androgenic steroids (AASdep, n = 44/7), and a non-using weightlifting comparison group (WLC, n = 69/16).

Results: Analyses of variance showed that the AASdep group performed significantly worse than the WLC group, for all MASC measures (total ToM, cognitive ToM, affective ToM, overmentalizing/undermentalizing errors). Sex and sex x group interaction effects were non-significant.

Conclusions: Male and female weightlifters who were dependent on anabolic androgenic steroids had impaired ToM. Their reduced social cognition may be one contributing factor to the elevated rates of antisocial behavior reported in this population.

Vaskinn A, Hauger LE, Bjørnebekk A. Theory of mind in users of anabolic androgenic steroids [published online ahead of print, 2020 Jul 5]. Psychopharmacology (Berl). 2020;10.1007/s00213-020-05603-y. doi:10.1007/s00213-020-05603-y Theory of mind in users of anabolic androgenic steroids

 

[Michael Scally MD]

Testosterone, Mood, Behaviour and Quality of Life

Testosterone plays a pivotal role in maintaining balance within the multi-dimensional psychological network of mood, behaviour, self-perception and perceived quality of life in men of any age. Apart from classical forms of hypogonadism, low testosterone concentrations can also be seen in older men, described as an age- as well as comorbidity-driven functional hypogonadism and might relate to depressive symptoms exhibiting a wide array of clinical pictures ranging from dysthymia and fatigue over inertia, listlessness to hopelessness and suicidal thoughts.

Also various traits of anxiety, from unfocussed fear to phobic anxiousness and open panic syndromes are influenced by testosterone. Correspondingly, anxiolysis is likely to be modulated by testosterone via stress resilience, threat vigilance and reward processing. The steroid modulates pro-active and re-active dimensions of aggression, which has to be seen within the context of gaining or maintaining status.

This may also include other strategies impacting the social position: heroic or parochial altruism and non-aggressive paths of assertiveness, such as posture and social vigilance. Independent rather than relationship-associated self-construal and self-esteem influence risk-taking traits under the modulation of testosterone.

In addition, the genetic setting of the androgen receptor modulates the role of testosterone in aspects regarding mood and personality. Dimensions of sexuality are rather important in this context, but are not target of this article and covered in another part of this special edition. Overall, the quality of life in older hypogonadal men can be positively influenced by testosterone substitution, as has been demonstrated in large placebo-controlled trials.

Zitzmann M. Testosterone, Mood, Behaviour and Quality of Life [published online ahead of print, 2020 Jul 13]. Andrology. 2020;10.1111/andr.12867. doi:10.1111/andr.12867 Error - Cookies Turned Off

 

[Michael Scally MD]

[OA] [LMAO] Anabolic-Androgenic Steroids and Brain Injury: miRNA Evaluation in Users Compared to Cocaine Abusers and Elderly People

Anabolic-androgenic steroids (AASs) can be used to treat both hormonal diseases and other pathologies characterized by muscle loss (aging, cancer, and AIDS). Even if the adverse effects related to the misuse of AASs have been well studied in different systems and apparatuses, knowledge about brain damage is poor.

In this scenario, this experimental study aimed to analyze the role of several microRNAs (miRNAs) in brain damage after AAS misuse, to better comprehend the underlying mechanisms. The research hypothesis at the base of this experimental study is that the chronic use of AASs may be associated to brain damage with a dysregulation of these miRNAs.

Moreover, miRNA expression values were compared among three different groups, "AAS" group, "Cocaine" group and "Aging" group, in order to define if AAS brain damage can be compared with the brain impairment linked to aging and/or cocaine assumption.

This experimental study revealed that the tested miRNAs (hsa-miR-21-5p, hsa-miR-34a-5p, hsa-miR-124-5p, hsa-miR-132-3p, and hsa-miR-144-3p) were overexpressed in all enrolled groups. In the light of the presented results, the identification of specific circulating and/or tissue biomarkers is challenging for the scientific community.

Further studies with larger samples are needed to confirm these interesting findings.

Sessa F, Salerno M, Cipolloni L, et al. Anabolic-androgenic steroids and brain injury: miRNA evaluation in users compared to cocaine abusers and elderly people [published online ahead of print, 2020 Aug 3]. Aging (Albany NY). 2020;12:10.18632/aging.103512. doi:10.18632/aging.103512 https://www.aging-us.com/article/103512/text

 

[Michael Scally MD]

[OA] [GMAFB] [ROTFLMAOPIMP] Effective Treatment and Prevention of Attempted Suicide, Anxiety and Aggressiveness with Fluoxetine, Despite Proven Use of Androgenic Anabolic Steroids

We describe the treatment of a man who attempted suicide after experiencing symptoms of anxiety and aggressiveness associated with the use of androgenic-anabolic steroids (AAS).

This report includes 30 days of inpatient treatment and a 6-month follow-up.

Regular use of fluoxetine apparently prevented the onset of anxiety, depression, aggressiveness and suicide ideation, even with concurrent use of AAS.

The urinary concentration of androgens, metabolites of AAS and fluoxetine were monitored through analysis of urinary samples by the Brazilian Laboratory of Doping Control.

Our results are congruent with previous findings describing the risk of suicide prompted by AAS use as well as the efficacy of fluoxetine in the treatment of mood disorders associated with the use of anabolic steroids.

Amaral JMX, Padilha MC, Chagas SV, et al. Effective treatment and prevention of attempted suicide, anxiety and aggressiveness with fluoxetine, despite proven use of androgenic anabolic steroids [published online ahead of print, 2020 Aug 17]. Drug Test Anal. 2020;10.1002/dta.2912. doi:10.1002/dta.2912 Error - Cookies Turned Off

 

[Michael Scally MD]

Anabolic Steroids-Induced Delirium: A Case Report

Introduction: Anabolic steroids are commonly used by athletes, body builders, and young adults to improve muscle strength. Deleterious effects of anabolic steroids on physical health are well-established. Psychiatric aspects are of particular importance and include psychosis, delirium, mania, depression, and aggression. We describe the case of a young gentleman who was managed as a case of androgenic steroid induced delirium.

Patient concern: A 33-year-old gentleman presented with increased aggression, hostility, and destructive impulses. He was a regular user of testosterone propionate, testosterone cyprionate and trenbolone acetate up to 200 mg daily in injectable form. His mental status examination showed labile effect, flight of ideas and persecutory delusions.

Physical examination was positive for atrophic testes. Laboratory results showed a decreased plasma testosterone level of 9.59 nmol/l (10.4-37.4 nmol/l). Sex Hormone Binding Globulin was 23.8 nmol/l (18.3-54.1 nmol/l) and bioavailable testosterone was 5.110 nmol/l (4.36-14.30 nmol/l).

Diagnosis: He was diagnosed as a case of anabolic steroids induced delirium.

Interventions and outcome: Patient was treated with regular haloperidol and quetiapine after which his sensorium, speech and behavior improved. He was discharged on haloperidol 7.5 mg and quetiapine 700 mg daily.

Conclusion: The purpose of this case report is to emphasize on the neuropsychiatric effects and management of anabolic steroids manifested by delirium, increased aggression, hostility, and destructive impulses.

Khoodoruth MAS, Khan AA. Anabolic steroids-induced delirium: A case report. Medicine (Baltimore). 2020;99(33):e21639. doi:10.1097/MD.0000000000021639 https://journals.lww.com/md-journal/FullText/2020/08140/Anabolic_steroids_induced_delirium__A_case_report.61.aspx

 

[Michael Scally MD]

µ-Opioid Receptor-Induced Synaptic Plasticity in Dopamine Neurons Mediates the Rewarding Properties Of Anabolic Androgenic Steroids

The dopamine system in the brain mediates feelings of “reward” and is implicated in addiction to various drugs, including anabolic androgenic steroids. Bontempi and Bonci found that the neurological and behavioral effects of androgenic steroids were mediated not by androgen receptors but indirectly by opioid receptors on dopaminergic neurons.

A single subcutaneous injection of the steroids nandrolone or testosterone in mice stimulated the release of β-endorphins in a dopaminergic neuron-rich brain region. β-Endorphins activated mu (μ)–opioid receptor (MOR) signaling, which induced excitatory synaptic plasticity in neurons. Blocking MOR activation prevented drug-seeking behavior in steroid-injected mice. The findings may explain the addictive nature of anabolic steroid use.

Bontempi L, Bonci A. µ-Opioid receptor-induced synaptic plasticity in dopamine neurons mediates the rewarding properties of anabolic androgenic steroids. Sci Signal. 2020;13(647):eaba1169. Published 2020 Sep 1. doi:10.1126/scisignal.aba1169 µ-Opioid receptor–induced synaptic plasticity in dopamine neurons mediates the rewarding properties of anabolic androgenic steroids

Anabolic androgenic steroids (AAS) have medical utility but are often abused, and the effects of AAS on reward circuits in the brain have been suggested to lead to addiction. We investigated the previously reported correlations between AAS and the endogenous μ-opioid system in the rewarding properties of AAS in mice.

We found that a single injection of a supraphysiological dose of natural or synthetic AAS strengthened excitatory synaptic transmission in putative ventral tegmental area (VTA) dopaminergic neurons. This effect was associated with the activation of μ-opioid receptors (MORs) and an increase in β-endorphins released into the VTA and the plasma. Irreversible blockade of MORs in the VTA counteracted two drug-seeking behaviors, locomotor activity and place preference.

These data suggest that AAS indirectly stimulate a dopaminergic reward center of the brain through activation of endogenous opioid signaling and that this mechanism mediates the addictive effects of AAS.

 

[Michael Scally MD]

Sixty young-adults Swiss mice were used (30 males and 30 females, 90 days old) weighing between 40 and 50 grams. Animals were housed in plastic boxes containing 5 animals each, with commercial mice chaw and water ad libitum, and submitted to a 12-hour light-dark cycle.

The animals were divided into three groups: Control group, TC-group, and S-group. The treatments consisted of intraperitoneal (IP) application of physiological solution (Control group), Deposteron® (testosterone cypionate-0.8mg / kg) and Winstrol Depot® (stanozolol-1.8mg / kg) in the respective groups. The treatment lasted one month, with injections performed twice a week, on Tuesdays and Thursdays. The amount of AS used was calculated from doses used by attendees of academies in Alfenas city (Brazil - Minas Gerais), using Allometric Extrapolation method.

Damião B, Rossi-Junior WC, Guerra FDR, Marques PP, Nogueira DA, Esteves A. Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice [published online ahead of print, 2020 Aug 14]. Braz J Biol. 2020;S1519-69842020005022202. doi:10.1590/1519-6984.224642 Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice

Anabolic substances have been increasingly used by bodybuilders and athletes with the goal of improving performance and aesthetics. However, this practice has caused some concern to physicians and researchers because of unknowledge of consequences that the indiscriminate and illicit use of these substances can cause.

Thus, this study analyzed the effects of two commercially available anabolic steroids (AS), Winstrol Depot® (Stanozolol) and Deposteron® (Testosterone Cypionate), in the neuronal density of limbic, motor and sensory regions on the cerebral cortex and in CA1, CA2, CA3 regions of the hippocampus.

A total of 60 Swiss mice were used (30 males and 30 females), separated into three groups: control and two experimental groups, which received the AAS. From each brain, homotypic and semi-serial samples were taken in frontal sections from areas established for the study. The results showed that females treated with testosterone cypionate presented a reduction in all regions tested and the ones treated with Stanozolol showed a decrease in some hippocampal areas. Regarding male animals, stanozolol led to a decrease in neuron number in one hippocampal region.

These data allow us to conclude that supra-physiological doses of steroids used in this study, can cause considerable damage to nervous tissue with ultrastructural and consequently behavioral impairment. These changes could interfere with the loss of physical yield and performance of athletes and non-athletes and may cause irreparable damage to individuals making irresponsible use of anabolic steroids.

 

[Michael Scally MD]

[GMAFB] Involvement of Kynurenine Pathway in Depressive-Like Behaviour Induced By Nandrolone Decanoate In Mice

[ND treatment (10 mg/kg/day/ s.c., for 28 days.]

Highlights
· Activation of IDO/KP contributes to ND-induced depressive-like behavior in mice.
· ND caused IDO/KP activation in the hippocampus, striatum and prefrontal cortex.
· ND elicited neurotrophic and 5-HT deficiency in the brain.
· Nandrolone increased corticosterone levels and reduced NA+,K+-ATPase activity.
· IDO inhibitor (1-MT) abrogated ND-induced neurotoxicity and depressive symptoms.

Nandrolone decanoate (ND) belongs to the classe II of anabolic-androgenic steroids (AAS), which is composed of 19-nor-testosterone-derivatives. AAS represent a group of synthetic testosterone that is used in clinical treatment. However, these drugs are widely abused among individuals as a means of promoting muscle growth or enhancing athletic performance.

AAS in general and ND in particular have been associated with several behavioral disturbances, such as anxiety, aggressiveness and depression. A factor that contributes to the development of depression is the brain activation of indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme of kynurenine pathway (KP).

In the present study, we examined the involvement of KP in depressive phenotype induced by a ND treatment (10 mg/kg/day/ s.c., for 28 days) that mimics human abuse system (e.g. supraphysiological doses) in C57B/6J mice.

Our results showed that ND caused depressive like-behavior in the tail suspension test and anhedonic-like state measured in the sucrose preference test. ND administration decreased the levels of brain-derived neurotrophic factor and neurotrophin-3 and reduced Na+,K+-ATPase activity in the hippocampus, striatum and prefrontal cortex.

We also found that ND elicited KP activation, as reflected by the increase of IDO activity and kynurenine levels in these brain regions. Moreover, ND decreased serotonin levels and increased 5-hydroxyindoleacetic acid levels in the brain. Treatment with IDO inhibitor 1-methyl-DL-trypthophan (1 mg/kg/i.p.) reversed the behavioral and neurochemical alterations induced by ND.

These results indicate for the first time that KP plays a key role in depressive-like behavior and neurotoxicity induced by supraphysiologicaldoses of ND in mice.

Souza LC, de Brito MLO, Jesse CR, et al. Involvement of kynurenine pathway in depressive-like behaviour induced by nandrolone decanoate in mice [published online ahead of print, 2020 Sep 3]. Steroids. 2020;108727. doi:10.1016/j.steroids.2020.108727 Involvement of kynurenine pathway in depressive-like behaviour induced by nandrolone decanoate in mice - ScienceDirect

 

[Michael Scally MD]

A Sentinel Population: The Public Health Benefits of Monitoring Enhanced Body Builders

There is heightened recognition of the public health implications of anabolic androgenic steroids (AAS) for the use of image and performance enhancement; with increasing evidence of their long-term negative health impacts, the hazards associated with their administration (often via injection), and the variability and unpredictability of their contents.

In order to optimise the effects of these drugs, together with strict dietary and training regimes, AAS users typically supplement their use with an expansive and continually evolving range of ancillary drugs. The discovery and subsequent adoption of these drugs by the broader AAS user population is largely dependent upon a minority of social influencers within the bodybuilding community.

Pioneering enhanced bodybuilders who self-experiment with a diverse range of image and performance enhancing drugs (IPEDs) and ancillary drugs have been the forerunners in the development of an underground user-led literature, online discussion forums, and were early adopters of internet-facilitated drug markets.

Yet the impact of their self-experimentations extends well beyond the enhanced bodybuilding community, particularly in their use of ancillary drugs. Most significantly has been their role in the diffusion of various enhancement and psychoactive drugs to the wider population.

Using the theoretical framework of the 'diffusion of innovation' we consider the role that pioneering enhanced bodybuilders have played in the diffusion of various enhancement and psychoactive drugs to the wider population through a focus on three substances: dinitrophenol (DNP), melanotan II and gamma-hydroxybtyrate (GHB).

With an increasing range of drugs used by bodybuilders, coupled with an expansion in the use of online forums and online platforms to purchase pharmacological and new psychoactive drugs, we anticipate this trend of diffusion amongst the wider population will continue to flourish. Therefore, we highlight the need for policy makers to monitor emergent trends, not only in the general AAS population but particularly amongst enhanced bodybuilders.

McVeigh J, Salinas M, Ralphs R. A sentinel population: The public health benefits of monitoring enhanced body builders [published online ahead of print, 2020 Sep 7]. Int J Drug Policy. 2020;102890. doi:10.1016/j.drugpo.2020.102890 A sentinel population: The public health benefits of monitoring enhanced body builders - ScienceDirect

 

[Michael Scally MD]

Use of Anabolic-Androgenic Steroids and Other Substances Prior To and During Imprisonment

Highlights
· Lifetime AAS use was reported by 30.0% of male and 6.4% of female prisoners.
· AAS users had earlier debuts and use of more drug types than non-AAS substance users.
· Among 1499 prisoners, 120 (8%) used AAS during the six months prior to incarceration.
· 110 of the 120 participants ceased use at current incarceration.
· Inmates with AAS withdrawal symptoms after incarceration may need tailored treatment.

Background: Anabolic-androgenic steroid (AAS) use is associated with health problems and substance use. Substance use is common among inmates. This study aims to estimate lifetime and prison use of AAS and other substances, compare characteristics of groups of inmates, and describe factors associated with AAS use in a national prison population.

Methods: Data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of people in prisons, included sociodemographic variables and lifetime and prison use of AAS and other substances. Altogether 1,499 inmates, including 96 (6.4%) women, were divided into three mutually exclusive groups according to lifetime AAS use, non-AAS substance use and no substance use.

Results: Lifetime AAS use was reported by 427 (28.5%) inmates; 6 women and 421 men. Non-AAS substance use was reported by 593 (39.6%) and 479 (31.9%) had never used AAS or non-AAS substances. Compared to the non-AAS substance group, the AAS group reported younger debut ages for nearly all non-AAS substances, higher mean number of non-AAS substances used in their lifetime (8.9, 6.6, p < 0.001), during the six months prior to incarceration (5.2, 3.1, p < 0.001), and during (2.3, 1.3, p < 0.001) imprisonment. Although 120 (8.0%) inmates used AAS during the six months prior to incarceration, only ten continued during imprisonment.

Conclusions: Lifetime AAS use is common among inmates and may be an indicator of more severe substance use problems. Screening for previous and present AAS use at incarceration and increased staff awareness are needed to tailor treatment approaches appropriately.

Havnes IA, Bukten A, Rognli EB, Muller AE. Use of anabolic-androgenic steroids and other substances prior to and during imprisonment - Results from the Norwegian Offender Mental Health and Addiction (NorMA) study [published online ahead of print, 2020 Aug 29]. Drug Alcohol Depend. 2020;217:108255. doi:10.1016/j.drugalcdep.2020.108255 https://www.sciencedirect.com/science/article/pii/S0376871620304208?via%3Dihub

 

[ERIC WIGGINS]

Wish you would not post wikipedia's stuff. I'm not sure if you understand what you're posting. We are all aware of the risks that we take with steroids and hGH and it's a gamble. But going in knowing the risks makes you better able to mitigate any deleterious consequences before they become too great. No one wants to live forever because believe me in your 40s you lose everything.

IMO, the signs and symptoms attributed to AAS dependency are due to Anabolic-Androgenic Steroid Induced hypogonadism (ASIH). In order for studies on AAS dependency to be minimally credible, they must include for the monitoring of hypogonadism. Further, treatments aimed at preventing or mitigating ASIH will prove beneficial to stop AAS use. There are added benefits, including the retention of muscle mass and strength important for many chronic diseases and ageing.


The association of AAS with adverse psychological and behavioral effects is extensive. Historically, researchers went so far as to categorically state that AAS are without any evidence upon muscle going so far as to argue that there is saturation of the androgen receptor with eugonadal levels of testosterone. This attitude spurned the concept that the large doses commonly used by nonprescription AAS users indicate that the drug use is for actions other than their normal physiological effects, implying an addictive nature to AAS, with the signs and symptoms after AAS cessation indications of AAS withdrawal. Upon nonprescription AAS cessation, psychological disturbances include aggressiveness, depression, anxiousness, potency problems (libido), sleep disorders, violent behavior, rage, and suicidal ideation.

The two most widely-accepted standards for defining, classifying and diagnosing drug abuse and dependence are the Diagnostic Statistical Manual IV (DSM-IV) and the International Classification of Diseases, Volume 10 (ICD-10). The Diagnostic Statistical Manual IV (DSM IV) and the International Classification of Diseases, Volume 10 (ICD 10) differ in the way they regard Anabolic-Androgenic Steroids' (AAS) potential for producing dependence. DSM IV regards AAS as potentially dependence producing (this is true for ALL drugs) and ICD 10 regards them as non-dependence producing.

This difference in approach towards AAS prompts debate as to whether or not AAS are dependence-producing substances. The main work in this area has been conducted by Brower et al. who investigated the existence of a "steroid dependency syndrome" and classified subjects as dependent on AAS using an adaptation of the DSM-III-R criteria for dependence on psychoactive substances, which differ only slightly from those of DSM-IV.

In 2002, Brower summarizes the literature on AAS abuse and dependence and reports of at least 165 cases of addiction or dependence in the medical literature. Brower also concludes no cases of dependence have been associated with legitimate prescriptions of AAS used at therapeutic doses for medical purposes. According to Brower, individuals who use high doses of AAS over prolonged periods may develop withdrawal symptoms that include fatigue, depressed mood, restlessness, anhedonia, impaired concentration, increased aggression, anorexia, insomnia, decreased libido, self-image dissatisfaction, androgen desire, headaches, suicidal ideation, decrease in size/weight/strength, and feeling depressed/down/unhappy due to size loss when they stop taking AAS and these withdrawal effects may contribute to a syndrome of dependence. The patient with hypogonadism may experience almost all of these above symptoms. Rather than diagnosing substance abuse or dependence the criteria in use by these investigators is the patient examination for hypogonadism.

In 1990, the National Institute of Drug Abuse (NIDA) published an extensive monograph on anabolic steroid abuse (45). This monograph represents a “state-of-the-art” information resource concerning anabolic steroid abuse. "It must be concluded at this time that the use of steroids by humans does not meet the criteria necessary to establish that steroids have significant abuse liability as defined in pharmacological terms." The conclusion from this monograph is anabolic steroids do not satisfy the criteria for abuse potential. Echoing this opinion is a report from President’s Council on Physical Fitness. In 1994, evidence review of the published literature states, "Despite increasing clinical descriptive data on anabolic steroid withdrawal, dependence, and abuse, there are insufficient substantial basic or clinical research data to support the inclusion of these syndromes in DSM-IV." In the intervening eighteen years since the original findings, there is nothing in the published scientific literature to change these conclusions. There are few, if any, well-controlled investigations or studies on the dependence potential of AAS. IMO, AAS dependency/addiction is a myth/fiction.

 

[Michael Scally MD]

 

[Michael Scally MD]

Prevalence, Mental Health and Substance Use of Anabolic Steroid Users

Aims: The use of anabolic androgen steroids to enhance performance is not a modern phenomenon. However, the majority of today's anabolic androgen steroid users are not competitive athletes, but individuals who want to look leaner and muscular.

This study aimed to examine the prevalence of anabolic androgen steroid use among young individuals and assess whether their mental health, lifestyle and substance use differ from non-anabolic androgen steroid users.

Methods: A population-based study conducted in secondary schools, mean age was 17.3 years. A total of 10,259 participants (50% young women, 1% reported gender as 'other', 49% young men) answered questions on mental health, anabolic androgen steroid use, substance use and sports participation. Statistical analysis included descriptive statistics, t-test, χ2 and logistic regression.

Results: The prevalence of anabolic androgen steroid use was 1.6%, and 78% of users were young men. Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users (P<0.05). A larger proportion of anabolic androgen steroid users, 30%, had attempted suicide compared to 10% of non-users (χ2 (1, 9580) = 57.5, P<0.001).

Proportionally, anabolic androgen steroid users were more likely to take medicine for mental health problems and misuse substances than non-users. Participation in non-organised sports, increased anger and body image were associated with increased odds of using anabolic androgen steroids.

Conclusions: Anabolic androgen steroid use is a public health threat. It had an alarming effect on the life of individuals who report having used anabolic androgen steroids. Authorities, healthcare workers, parents and others working with young people need to be informed of the signs and risks of anabolic androgen steroid use to reduce future negative implications.

Gestsdottir S, Kristjansdottir H, Sigurdsson H, Sigfusdottir ID. Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals. Scand J Public Health. 2020 Dec 7:1403494820973096. doi: 10.1177/1403494820973096. Epub ahead of print. PMID: 33280527. https://journals.sagepub.com/doi/full/10.1177/1403494820973096

 

[Michael Scally MD]

Long-Term Anabolic Androgenic Steroid Use Is Associated with Deviant Brain Aging

Background High-dose long-term use of anabolic-androgenic steroids (AAS) may cause a range of adverse effects, including brain and cognitive abnormalities. We performed age prediction based on brain scans to test whether prolonged AAS use is associated with accentuated brain aging.

Methods T1-weighted MRI (3D MPRAGE) scans were obtained from male weightlifters with a history of prolonged (n=130) or no (n=99) AAS use. We trained machine learning models on combinations of regional brain volumes, cortical thickness and surface area in an independent training set of 1838 healthy males (18-92 years) and predicted brain age for each participant in our study. Including cross-sectional and longitudinal (mean interval 3.5 years, n=76) MRI data, we used linear mixed effects (LME) models to compare the gap between chronological age and predicted brain age (the brain age gap, BAG) between the two groups, and tested for group differences in the rate of change in BAG. We tested for associations between apparent brain aging and AAS use duration, pattern of administration and dependence.

Results AAS users had higher BAG compared to weightlifting controls, which was associated with dependency and longer history of use. Group differences in BAG could not be explained by other substance use, general cognitive abilities or depression. While longitudinal analysis revealed no evidence of increased brain aging in the overall AAS group, accelerated brain aging was seen with longer AAS exposure.

Conclusions The findings suggest that long-term high dose AAS use may have adverse effects on brain aging, potentially linked to dependency and exaggerated use of AAS.

Bjørnebekk A, Kaufmann T, Hauger LE, Klonteig S, Hullstein IR, Westlye LT. Long-term anabolic androgenic steroid use is associated with deviant brain aging. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 2021. http://www.sciencedirect.com/science/article/pii/S2451902221000197

 

[Michael Scally MD]

[OA] Polydrug Use and Drug Market Intersections Within Powerlifting Cultures

With the rising use of Image and Performance Enhancing Drugs (IPEDs), research has increasingly pointed to a need for in-depth understanding of users' consumption behaviours, in order to form effective harm reduction policy. With polydrug use prevalent in IPED-using cultures, both among ‘hardcore’ and non-competitive trainers, it is clear there is a need to understand this use, and its socio-cultural contexts, as well as how drug access and supply occurs within these cultures.

This paper offers an exploration of the motivations and contexts of hardcore powerlifters' polydrug use, as well as their experiences of IPED and other illicit drug market intersections, through findings drawn from 18 qualitative interviews with participants involved in these lifting cultures and gyms in South-West England, supported by ethnographic fieldwork conducted in nine gyms in the region over a four year period, including five ‘hardcore’ powerlifting and bodybuilding gyms, as well as four commercial gym establishments.

Results first demonstrate how cultural narratives around what is drug ‘use’ versus ‘abuse’ influenced powerlifters' consumption and perceptions of polydrugs, with a number of illicit drugs and other medicines used by these sportsmen, despite cultural opposition to other drug consumption considered to be harmful, and associated by powerlifters with ‘gym rats’, or YOLO type trainers. This leads into exploration of where powerlifters' polydrug consumption behaviours present the greatest risk, particularly in relation to the acceptance of benzodiazepine use as a form of ‘steroid accessory drug’ for long periods, as well as the common sharing and use of opioid painkillers to allow continued training through injury, and discussion of where harm reduction policy might therefore be most appropriately targeted for this population.

Findings then turn to an exploration of how polydrug supply occurs within powerlifting culture and gyms, and the intersections between IPED markets and other illicit drug markets perceived to exist in the region. This documents the prevalence of social supply norms of polydrugs following patterns observed for IPEDs in the existing literature, before discussing the extent to which individuals with links to criminal organisations may be ‘pushing out’ culturally-embedded IPED suppliers in the region, and the impacts this is having on risk for IPED buyers. This is followed by further discussion of relevance to policy, and avenues for future research into polydrug use and supply from a harm reduction perspective, as well as the limitations of this study as specific to a remote region of the UK.

Turnock LA. Polydrug use and drug market intersections within powerlifting cultures in remote South-West England. Performance Enhancement & Health 2021:100186. Polydrug use and drug market intersections within powerlifting cultures in remote South-West England

 

[Millard]

Long-Term Anabolic Androgenic Steroid Use Is Associated with Deviant Brain Aging

"Deviant brain aging". That's the first time I've heard the term. Is it some fancy new medical condition created for steroid users?