Illicit anabolic–androgenic steroid use

Abstract

The anabolic-androgenic steroids (AAS) are a family of hormones that includes testosterone and its derivatives. These substances have been used by elite athletes since the 1950s, but they did not become widespread drugs of abuse in the general population until the 1980s. Thus, knowledge of the medical and behavioral effects of illicit AAS use is still evolving. Surveys suggest that many millions of boys and men, primarily in Western countries, have abused AAS to enhance athletic performance or personal appearance. AAS use among girls and women is much less common. Taken in supraphysiologic doses, AAS show various long-term adverse medical effects, especially cardiovascular toxicity. Behavioral effects of AAS include hypomanic or manic symptoms, sometimes accompanied by aggression or violence, which usually occur while taking AAS, and depressive symptoms occurring during AAS withdrawal. However, these symptoms are idiosyncratic and afflict only a minority of illicit users; the mechanism of these idiosyncratic responses remains unclear. AAS users may also ingest a range of other illicit drugs, including both "body-image" drugs to enhance physical appearance or performance, and classical drugs of abuse. In particular, AAS users appear particularly prone to opioid use. There may well be a biological basis for this association, since both human and animal data suggest that AAS and opioids may share similar brain mechanisms. Finally, AAS may cause a dependence syndrome in a substantial minority of users. AAS dependence may pose a growing public health problem in future years, but remains little studied.

Nephrotoxic Effects of Common and Emerging Drugs of Abuse

“…Damage from years of androgen excess, often 50-100 times physiologic levels (4), may become an increasingly important cause of CKD. A wide range of prevalence estimates generally suggest that at least 3% of young men in Western countries use AASs at some time in their lives (5). In selected populations, such as weightlifters, up to 44% of those surveyed admit to AAS abuse (6).…”

“…The cardiac, neuroendocrine, and neuropsychiatric effects of AAS abuse are well documented in other reviews (4,5). Renal effects of AAS abuse in humans are primarily described in case reports (12)(13)(14) and a single small series (8).…”

Doping in sport: A review of medical practitioners’ knowledge, attitudes and beliefs

“…For example, anabolic androgenic steroid users have been reluctant to engage with medical professionals in relation to their AAS use (Dawson, 2001). Kanayama et al (2010) suggests this may be due to the historical reluctance of the science and medicine community to recognise the efficacy of AAS use.…”

A qualitative exploration of the motivations underlying anabolic-androgenic steroid use from adolescence into adulthood

“…Further, Nilsson, Baigi, Marklund, and Fridlund (2001) provided strong evidence for patterned, multiple drug use, which excluded cannabis and tobacco (Dodge & Hoagland, 2011). Kanayama, Hudson, and Pope (2010) introduced biological evidence for this association, explaining that both human and animal research indicates both AAS and other illicit drugs involve similar brain structures and mechanisms. Adopting a similar theoretical position to Miller, Barnes, Sabo, Melnick, and Farrell (2002), Wichstrøm and Pederson (2001) proposed that AAS use reflects only an alternative form of problem behaviour with only a secondary association with sport.…”