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http://www.medscape.com/viewarticle/533461
Purpose: The use of anabolic androgenic steroids (AAS) to increase muscle size and strength is widespread. Information regarding self-administered AAS used nonmedically to enhance athletic performance or improve physical appearance is sparse and poorly documented. The purpose of this study is to identify current trends in the drug-taking habits of AAS users.
Methods: An anonymous self-administered questionnaire was posted on the message boards of Internet Web sites popular among AAS users.
Results: Of the 500 AAS users who participated in the survey, 78.4% (392/500) were noncompetitive bodybuilders and nonathletes; 59.6% (298/500) of the respondents reported using at least 1000 mg of testosterone or its equivalent per week. The majority (99.2%) of AAS users (496/500) self-administer injectable AAS formulations, and up to 13% (65/500) report unsafe injection practices such as reusing needles, sharing needles, and sharing multidose vials. In addition to using AAS, 25% of users admitted to the adjuvant use of growth hormone and insulin for anabolic effect, and 99.2% (496/500) of users reported subjective side effects from AAS use.
Conclusions: This survey reveals several trends in the nonmedical use of AAS. Nearly four out of five AAS users are nonathletes who take these drugs for cosmetic reasons. AAS users in this sample are taking larger doses than previously recorded, with more than half of the respondents using a weekly AAS dose in excess of 1000 mg. The majority of steroid users self-administer AAS by intramuscular injection, and approximately 1 in 10 users report hazardous injection techniques. Polypharmacy is practiced by more than 95% of AAS users, with one in four users taking growth hormone and insulin. Nearly 100% of AAS users reported subjective side effects.
AAS use is not a practice unique to elite athletes seeking to enhance performance. Four out of five steroid users (78.4%) in this study were noncompetitive athletes, recreational bodybuilders, and nonathletes who self-administered AAS for cosmetic reasons with the sole intention of improving physical appearance. Nearly 60% of steroid users in this sample were younger than 30 yr of age, and approximately one in four steroid users stated that they began using AAS during their teenage years. These findings suggest that body image presents a significant concern in young males who resort to AAS use as a means of enhancing physical appearance. Over 40% of this sample admitted to habitual steroid use for longer than 4 yr, and 10% report chronic AAS use lasting = 10 yr.
As might be expected with self-administered drug use, steroid doses reported in this survey varied widely, ranging from 70 to 6000 mg·wk-1 of testosterone or its equivalent. Remarkably, nearly 60% of steroid users this sample reported using a dose of at least 1000 mg·wk-1. Comparing current data with that from previous studies indicates that self-administered AAS doses may have increased during the past decade. The majority of AAS users in a survey published in 1997 (9) reported a weekly dose = 500 mg, whereas in the current sample, the majority of users take at least 1000 mg·wk-1. Although historical controls make comparisons difficult, there may be a trend among AAS users toward increasing doses that greatly exceed the recommended therapeutic doses used for testosterone replacement therapy.[1]
Of AAS users in the current sample, 95% reported combining two or more different formulations of AAS simultaneously, a practice known as steroid "stacking," in order to meet the large supraphysiological doses that are required to elicit a significant anabolic response in skeletal muscle. Recent scientific studies support AAS users' theory that "the bigger the dose, the bigger the muscle".[8] The anabolic effect of testosterone is dose dependent, and androgen receptors can be upregulated by exposure to exogenous AAS.[4,15,26] Nearly 100% of those surveyed reported using injectable formulations to facilitate their suprapharmacological dose regimens. Typical drug combinations reported by steroid users this sample are shown in Table 10 .
Nine out of 10 steroid users reported self-administering AAS in "drug cycles," typically using steroids for periods of 4-20 wk. The time interval between steroid cycles, or "off-cycle," is more variable. Whereas regular users take a 4- to 6-wk drug holiday to "clear the system," less frequent users may remain drug-free for several months. One half of steroid users this sample reported using the drugs for 6 months or more per year. Only a small proportion (6%) of steroid users admitted to a continuous drug use for 52 wk of the year.
Purpose: The use of anabolic androgenic steroids (AAS) to increase muscle size and strength is widespread. Information regarding self-administered AAS used nonmedically to enhance athletic performance or improve physical appearance is sparse and poorly documented. The purpose of this study is to identify current trends in the drug-taking habits of AAS users.
Methods: An anonymous self-administered questionnaire was posted on the message boards of Internet Web sites popular among AAS users.
Results: Of the 500 AAS users who participated in the survey, 78.4% (392/500) were noncompetitive bodybuilders and nonathletes; 59.6% (298/500) of the respondents reported using at least 1000 mg of testosterone or its equivalent per week. The majority (99.2%) of AAS users (496/500) self-administer injectable AAS formulations, and up to 13% (65/500) report unsafe injection practices such as reusing needles, sharing needles, and sharing multidose vials. In addition to using AAS, 25% of users admitted to the adjuvant use of growth hormone and insulin for anabolic effect, and 99.2% (496/500) of users reported subjective side effects from AAS use.
Conclusions: This survey reveals several trends in the nonmedical use of AAS. Nearly four out of five AAS users are nonathletes who take these drugs for cosmetic reasons. AAS users in this sample are taking larger doses than previously recorded, with more than half of the respondents using a weekly AAS dose in excess of 1000 mg. The majority of steroid users self-administer AAS by intramuscular injection, and approximately 1 in 10 users report hazardous injection techniques. Polypharmacy is practiced by more than 95% of AAS users, with one in four users taking growth hormone and insulin. Nearly 100% of AAS users reported subjective side effects.
AAS use is not a practice unique to elite athletes seeking to enhance performance. Four out of five steroid users (78.4%) in this study were noncompetitive athletes, recreational bodybuilders, and nonathletes who self-administered AAS for cosmetic reasons with the sole intention of improving physical appearance. Nearly 60% of steroid users in this sample were younger than 30 yr of age, and approximately one in four steroid users stated that they began using AAS during their teenage years. These findings suggest that body image presents a significant concern in young males who resort to AAS use as a means of enhancing physical appearance. Over 40% of this sample admitted to habitual steroid use for longer than 4 yr, and 10% report chronic AAS use lasting = 10 yr.
As might be expected with self-administered drug use, steroid doses reported in this survey varied widely, ranging from 70 to 6000 mg·wk-1 of testosterone or its equivalent. Remarkably, nearly 60% of steroid users this sample reported using a dose of at least 1000 mg·wk-1. Comparing current data with that from previous studies indicates that self-administered AAS doses may have increased during the past decade. The majority of AAS users in a survey published in 1997 (9) reported a weekly dose = 500 mg, whereas in the current sample, the majority of users take at least 1000 mg·wk-1. Although historical controls make comparisons difficult, there may be a trend among AAS users toward increasing doses that greatly exceed the recommended therapeutic doses used for testosterone replacement therapy.[1]
Of AAS users in the current sample, 95% reported combining two or more different formulations of AAS simultaneously, a practice known as steroid "stacking," in order to meet the large supraphysiological doses that are required to elicit a significant anabolic response in skeletal muscle. Recent scientific studies support AAS users' theory that "the bigger the dose, the bigger the muscle".[8] The anabolic effect of testosterone is dose dependent, and androgen receptors can be upregulated by exposure to exogenous AAS.[4,15,26] Nearly 100% of those surveyed reported using injectable formulations to facilitate their suprapharmacological dose regimens. Typical drug combinations reported by steroid users this sample are shown in Table 10 .
Nine out of 10 steroid users reported self-administering AAS in "drug cycles," typically using steroids for periods of 4-20 wk. The time interval between steroid cycles, or "off-cycle," is more variable. Whereas regular users take a 4- to 6-wk drug holiday to "clear the system," less frequent users may remain drug-free for several months. One half of steroid users this sample reported using the drugs for 6 months or more per year. Only a small proportion (6%) of steroid users admitted to a continuous drug use for 52 wk of the year.
