Hidden Epidemic of Anabolic Steroid Use

[Michael Scally MD]

[Reform! Hmm ... I know someone that advocated and practiced that ... Changes are coming ... Let's hope ... A bit late for ... Or, are we talking more of same head in the sand ...]

The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders

Context - The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales.

Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AAS, and the need for an integrated health policy and regulatory response to stem these epidemics.

Evidence Acquisition - We searched for studies published in English language prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment.

Evidence Synthesis - Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from “muscle dysmorphia,” a form of body dysmorphic disorder characterized by pathological preoccupation with muscularity.

AAS has been associated with cardiovascular disorders (cardiomyopathy and accelerated coronary artery disease), psychiatric disorders (mania, hypomania, depression and suicidality), AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections.

Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated internet sales of AAS and selective androgen receptor modulators, which are easily purchased without a prescription is of great concern because of its potential to fuel the epidemic among adolescents and the military.

Conclusions - Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AAS and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.

Goldman AL, Pope JHG, Bhasin S. The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men. The Journal of Clinical Endocrinology & Metabolism 2018:jc.2018-01706-jc.2018-. http://dx.doi.org/10.1210/jc.2018-01706

 

[Michael Scally MD]

[Reform! Hmm ... I know someone that advocated and practiced that ... Changes are coming ... Let's hope ... A bit late for ... Or, are we talking more of same head in the sand ...]

The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders

Context - The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales.

Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AAS, and the need for an integrated health policy and regulatory response to stem these epidemics.

Evidence Acquisition - We searched for studies published in English language prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment.

Evidence Synthesis - Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from “muscle dysmorphia,” a form of body dysmorphic disorder characterized by pathological preoccupation with muscularity.

AAS has been associated with cardiovascular disorders (cardiomyopathy and accelerated coronary artery disease), psychiatric disorders (mania, hypomania, depression and suicidality), AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections.

Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated internet sales of AAS and selective androgen receptor modulators, which are easily purchased without a prescription is of great concern because of its potential to fuel the epidemic among adolescents and the military.

Conclusions - Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AAS and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.

Goldman AL, Pope JHG, Bhasin S. The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men. The Journal of Clinical Endocrinology & Metabolism 2018:jc.2018-01706-jc.2018-. http://dx.doi.org/10.1210/jc.2018-01706

Also, I find it particular worthy and of some import that AAS dependence/addiction is not mentioned. Rather, it is "AAS-withdrawal hypogonadism."

They are getting closer! "Withdraw hypogonadism" is one hell of an oxymoron. It is hypogonadism.

It sure looks like they have come about to someone who has been saying this for years [decades]. Is it too much for me to say, "I told you so."

 

[CensoredBoardsSuck]

Also, I find it particular worthy and of some import that AAS dependence/addiction is not mentioned. Rather, it is "AAS-withdrawal hypogonadism."

They are getting closer! "Withdraw hypogonadism" is one hell of an oxymoron. It is hypogonadism.

It sure looks like they have come about to someone who has been saying this for years [decades]. Is it too much for me to say, "I told you so."

Poor Harrison Pope. His dream of leaving behind a legacy is vanishing before his very eyes.

 

[Dr JIM]

And what is the origin of body dysmorphism that is a trite occurance in today’s youth esp those using PEDs.

Kids with far to much free time on their hands and enabling parents
that have encouraged “growth” in the absence of responsibility.

Thumb thru Meso pages and darn near all of our noobs are on a quest to be someone or something they are not.


Pity

 

[CensoredBoardsSuck]

And what is the origin of body dysmorphism that is a trite occurance in today’s youth esp those using PEDs.

Kids with far to much free time on their hands and enabling parents
that have encouraged “growth” in the absence of responsibility.

Thumb thru Meso pages and darn near all of our noobs are on a quest to be someone or something they are not.


Pity

I'd look beyond the kids and parents, who no doubt play a role. And I'd even look beyond a popular culture that constantly emphasizes youth and beauty over all else. I'd look squarely at the medical profession and their handlers at big pharma, who have enabled all of it.

Erectile dysfunction drugs for your limp dick; bleaches and porcelain veneers for your teeth; fillers and Botox to get rid of your wrinkles; weightloss drugs and liposuction to get rid of your fat; plugs and drugs to fix your receding hairline; hormones to make you feel like you're 16 again; plastic surgery to improve the appearance of your labia minora - or give you fuller lips, cheekbones, breasts, buttocks, jawlines, tight skin, a bleached anus, and virtually anything else you don't like about your appearance - all things that are perfectly normal, BTW. The medical profession is making a fortune by making people someone or something they are not.

And then they actually wonder why body dysmorphia is becoming more prevalent. Funny though, body dysmorphia wasn't such a pressing issue until it involved young males who started using anabolic steroids to improve their appearance, which, ironically enough, is the one beautification treatment they can't profit from because, you know, taking drugs that might improve your athletic performance is "un-American," so it's illegal. Lol

 

[Dr JIM]

Providers as the origin of body dysmorphia you can’t be serious.

That’s analogous to suggesting Meso and forums like it, are forcing these kids to use PEDs.

Take a close look at those who are using PEDs, bc while some are adults making an adult decision the majority are lost kids with far to much free time, searching for a meaningful identity, bc they couldn’t find it in school, work or the pursuit of an occupacation.

 

[CensoredBoardsSuck]

Providers as the origin of body dysmorphia you can’t be serious.

I was trying to be facetious but if we're using Harrison Pope's definition of body dysmorphia, sure. If providers aren't the originators, they're certainly enablers. People have been conditioned to believe that if there's something they don't like about their physical appearance, they go to their doctor and get a procedure or pill to fix it. AAS users don't have that luxury so they self medicate.

That’s analogous to suggesting Meso and forums like it, are forcing these kids to use PEDs.

No it isn't. Most of the people that come here have already made the decision to use PEDs and they're either looking for a source, or they're looking for information on how to use them. Their body dysmorphia (again, using Pope's definition) pre-existed prior to joining Meso.

Almost everyone that has ever joined a gym and never touched a steroid could be said to have body dysmorphia if we use Pope's definition, because they want to improve their appearance. Gyms certainly don't cause people to suddenly develop body dysmorphia but they sure are full of people who have it.

Same with hairloss forums. Same with forums for breast augmentation or labiaplasty or anything that has to do with improving appearance.

Take a close look at those who are using PEDs, bc while some are adults making an adult decision the majority are lost kids with far to much free time, searching for a meaningful identity, bc they couldn’t find it in school, work or the pursuit of an occupacation.

They might be lost kids with too much free time, looking for an identity. But a lack of identity doesn't have anything to do with body dysmorphia, although eating disorders often co-occur in people with boderline personality disorder but that's beyond anything we're discussing here.

Regardless, all that misses the point I was trying to make (sorry, I'm on a phone and find it difficult to articulate my thoughts without being able to see what I've written), which is the article is misusing the term body dysmorphia for shock value. That's more of Harrison Pope's bullshit. Body dysmorphic disorder is a serious psychiatric disorder. Anorexia Nervosa is an example we're all familiar with. But Pope would have us believe the average guy using AAS because he wants to look better has body dysmorphia but the guy taking finasteride and minoxidil for years to keep his hair, doesn't. It's a ridiculous double standard. Of course it's highly unlikely that either of them have true body dysmorphia but Pope is a complete fraud that long ago sold whatever integrity he had in order to persue his silly agenda and make a name for himself.

 

[Dr JIM]

I was trying to be facetious but if we're using Harrison Pope's definition of body dysmorphia, sure. If providers aren't the originators, they're certainly enablers. People have been conditioned to believe that if there's something they don't like about their physical appearance, they go to their doctor and get a procedure or pill to fix it. AAS users don't have that luxury so they self medicate.



No it isn't. Most of the people that come here have already made the decision to use PEDs and they're either looking for a source, or they're looking for information on how to use them. Their body dysmorphia (again, using Pope's definition) pre-existed prior to joining Meso.

Almost everyone that has ever joined a gym and never touched a steroid could be said to have body dysmorphia if we use Pope's definition, because they want to improve their appearance. Gyms certainly don't cause people to suddenly develop body dysmorphia but they sure are full of people who have it.

Same with hairloss forums. Same with forums for breast augmentation or labiaplasty or anything that has to do with improving appearance.



They might be lost kids with too much free time, looking for an identity. But a lack of identity doesn't have anything to do with body dysmorphia, although eating disorders often co-occur in people with boderline personality disorder but that's beyond anything we're discussing here.

Regardless, all that misses the point I was trying to make (sorry, I'm on a phone and find it difficult to articulate my thoughts without being able to see what I've written), which is the article is misusing the term body dysmorphia for shock value. That's more of Harrison Pope's bullshit. Body dysmorphic disorder is a serious psychiatric disorder. Anorexia Nervosa is an example we're all familiar with. But Pope would have us believe the average guy using AAS because he wants to look better has body dysmorphia but the guy taking finasteride and minoxidil for years to keep his hair, doesn't. It's a ridiculous double standard. Of course it's highly unlikely that either of them have true body dysmorphia but Pope is a complete fraud that long ago sold whatever integrity he had in order to persue his silly agenda and make a name for himself.

I realized that somewhere in between an ankle sprain, a CHF gal and a dude with DKA

 

[CensoredBoardsSuck]

I realized that somewhere in between an ankle sprain, a CHF gal and a dude with DKA

What? No 24 hour priapism or foreign onjects lodged in the rectum cases? Sounds like a slow Friday night.

 

[Dr JIM]

What? No 24 hour priapism or foreign onjects lodged in the rectum cases? Sounds like a slow Friday night.

A busy night for any ED/Trauma Doc is defined by the number of ambulance rather than patient visits.

And all three of the above arrived by ambulance —— but that’s another story, arg

 

[ickyrica]

I'd look beyond the kids and parents, who no doubt play a role. And I'd even look beyond a popular culture that constantly emphasizes youth and beauty over all else. I'd look squarely at the medical profession and their handlers at big pharma, who have enabled all of it.

Erectile dysfunction drugs for your limp dick; bleaches and porcelain veneers for your teeth; fillers and Botox to get rid of your wrinkles; weightloss drugs and liposuction to get rid of your fat; plugs and drugs to fix your receding hairline; hormones to make you feel like you're 16 again; plastic surgery to improve the appearance of your labia minora - or give you fuller lips, cheekbones, breasts, buttocks, jawlines, tight skin, a bleached anus, and virtually anything else you don't like about your appearance - all things that are perfectly normal, BTW. The medical profession is making a fortune by making people someone or something they are not.

And then they actually wonder why body dysmorphia is becoming more prevalent. Funny though, body dysmorphia wasn't such a pressing issue until it involved young males who started using anabolic steroids to improve their appearance, which, ironically enough, is the one beautification treatment they can't profit from because, you know, taking drugs that might improve your athletic performance is "un-American," so it's illegal. Lol

Love it.

 

[Michael Scally MD]

Poor Harrison Pope. His dream of leaving behind a legacy is vanishing before his very eyes.

I agree. As a coauthor, you think Pope is trying the ole switcheroo! IIRC, Brower has long since retired. That "withdrawal" is as much as dead wrt addiction/dependency. And, Bhasin came to fame from his NEJM 1996 on supraphysiological TE. Oops, Bhasin did not follow up. The focus will become on ASIH. BTW: It is almost 20 years since my first publication on the subject.

 

[Michael Scally MD]

The "withdrawal" / "addiction" canard is now called the "vicious cycle of AAS-withdrawal hypogonadism, relapse, and dependence." IOW, Pope tries desperately to hold onto AAS addiction by mixing/confusing the diagnosis with ASIH.


[AAS] Steps to Bridge the Gaps in Our Knowledge and Health Policy—the Path Forward

Despite the health threats posed by the rapid growth of AAS use among young people, there is a surprising dearth of studies on the long-term health consequences of AASs. Hardly any major national or regional initiatives have addressed this looming public health crisis. Several expert panels have emphasized the urgent need for AAS research, with particular emphasis on prospective longitudinal studies to gather outcome data on the health effects of these drugs.

Randomized trials cannot ethically duplicate the large doses of AASs used by nonathlete weightlifters, the multiplicity of drugs used, and the many high-risk behaviors associated with AAS use. Therefore, the highest priority should be assigned to prospective observational studies, which may be the only feasible approach to collecting valid outcome data on the health risks associated with AAS use.

In addition, we need further studies regarding the prevalence of AAS use in children, adults, and among men and women in the armed forces; the mechanisms by which AASs and other appearance- and performance-enhancing drugs exert their adverse health effects; and the interactive effects of AASs with sports injuries and other high-risk behaviors.

We also need randomized trials to assess therapeutic interventions for treating the adverse effects these drugs. It seems particularly important to assess treatment strategies for the AAS-withdrawal syndrome, because such treatment is often necessary to break the vicious cycle of AAS-withdrawal hypogonadism, relapse, and dependence.

Although human chorionic gonadotropin and selective estrogen receptor modulators such as clomiphene citrate have been used to empirically hasten recovery of testicular function, the efficacy and durability of such therapeutic interventions have not been evaluated rigorously.

Furthermore, integration of cognitive and behavioral interventions into a holistic treatment plan to address the body image disorder and the psychosocial contributors that render men susceptible to AAS abuse is necessary to prevent relapse. Integrated nationwide efforts to raise public awareness of the serious health consequences of AASs are urgently needed.

Finally, it is time to review a whole range of national and international laws governing the manufacturing, distribution, and sales of these compounds on the Internet and through other blackmarket avenues, to stem this looming threat to public health.

Goldman AL, Pope JHG, Bhasin S. The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men. The Journal of Clinical Endocrinology & Metabolism 2018:jc.2018-01706-jc.2018-. http://dx.doi.org/10.1210/jc.2018-01706

 

[Turbo charged]

Brother u dont know a epidemic come to my city fucking heroin addicts walking around like zombies. I sit on the corner and every 10 minutes another user walks by. Steriods are a joke compared to what's going on out there. Steriods a epidemic not even close. Fucking clinics to shoot up now popping up. Government has a real problem and steroids are not it. And fucking crack coming back on the scenes.

 

[Ohiopower]

How about the Lazy Fat Ass Epidemic or LFAE. Feed kids crap loaded with soy in school, encourage them not to eat meat, and don’t ever do any physical activity. I bet that being a Lazy Fat Ass is worse on cardiovascular system than reasonable AAS use. Maybe they should crack down on ingredients in school lunches like high fructose corn syrup and soy. Maybe there should be a REAL RDA for protein based on body weight and height. Don’t let me get started on BHA plastic bottles.

 

[MindlessWork]

Brother u dont know a epidemic come to my city fucking heroin addicts walking around like zombies. I sit on the corner and every 10 minutes another user walks by. Steriods are a joke compared to what's going on out there. Steriods a epidemic not even close. Fucking clinics to shoot up now popping up. Government has a real problem and steroids are not it. And fucking crack coming back on the scenes.

Would love to see a clinic for pinning gear not those damned street drugs.

 

[MindlessWork]

Get swole not high

 

[Silentlemon1011]

Education around AAS needs to centre around PCT and moderation.

Education can solve 90% of issues with Steroids.

For example, I didnt even know what PCT was 12ISH years ago. (I forget what year it was)
My buddy said "Yo, want some fucking steroids and get huge" my answer was obviously "Fuck yes"

I PCTd using tribulus lol.

Aas is safer than most Prescription drugs, unfortunately these kids are running crazy 4 substance stacks on their first run with no PCT and no understanding.

Let's get some real harm prevention into place.

I'm sick of watching heroin junkies ODing on corners while getting free places to pin and free case workers and nurses.

All I want is two things

1. Blood work that doesnt go on any medical records.
2. Leave me the fuck alone.

There are also nee methods that make PCT easier.
I will be running Fareston on my next cycle (with lower test than usual)
My goal is to prevent full shutdown of the HPT axis to facilitate faster and more effective PCT.

Some individual studies have shown this to be very effective.
Yet most sources dont even carry Fareston.

Education

 

[Dead]

Steroids epidemic lmao. Ya. I’ll tell u an epidemic.

Weed Xanax and molly. That’s the real thing these days. Heard of the fentanyl epidemic?

And no I don’t mean weed is o bad what I mean is it’s constant indulgence. I’m part of the youth I’ll comment. “Nobody does fuckin steroids” nobody.

It’s all about recreational drugs these days most don’t give a shit about bodybuilding

All of my previous friends do drugs. Not heroin or meth but coke ketamine etc all of that. They don’t give a damn shit about the gym.
In fact they are SCARED OF STEROIDS.
Yes. Scared shitless of em. They’ll make ur dick small.

Fuckin steroid epidemic you are to far out the age bracket to have any clue dr jim

Steroids equal heroin to these fuckin retards

These studies are never going to be accurate in anyway it’s not the same environment

 

[Uglyrichie]

Steroids epidemic lmao. Ya. I’ll tell u an epidemic.

Weed Xanax and molly. That’s the real thing these days. Heard of the fentanyl epidemic?

And no I don’t mean weed is o bad what I mean is it’s constant indulgence. I’m part of the youth I’ll comment. “Nobody does fuckin steroids” nobody.

It’s all about recreational drugs these days most don’t give a shit about bodybuilding

All of my previous friends do drugs. Not heroin or meth but coke ketamine etc all of that. They don’t give a damn shit about the gym.
In fact they are SCARED OF STEROIDS.
Yes. Scared shitless of em. They’ll make ur dick small.

Fuckin steroid epidemic you are to far out the age bracket to have any clue dr jim

Steroids equal heroin to these fuckin retards

These studies are never going to be accurate in anyway it’s not the same environment

My kid is in high school and a lot of her friends go to different schools they all say it's a joke drugs in the open kids don't care and it's like a Bazaar at times. And roids are bad because one kid killed himself from a baseball town where parents put so much stress on playing even when they don't want to. I wonder what happened if you wanted to quit I doubt it was hey be you kid.