Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters

Abstract

Background Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls. Methods A sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use. Results In a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified. Conclusions AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.

Psychological traits associated with anabolic androgenic steroid use and dependence among female athletes

“…Half of the women in our sample reported spending a significant amount of time on activities surrounding AAS use, while only two (14.3%) reported having experienced withdrawal symptoms. By comparison, we previously published findings among male AAS using weightlifters where a similar proportion (41.7%) reported spending significant time on AAS, but a much larger proportion (50.4%) reported withdrawal symptoms (Scarth et al, 2023). However, it is important to note that time spent includes many aspects of the lifestyle surrounding AAS use, including time training and managing diet and supplement use (Kanayama, Brower, et al, 2009).…”

“…However, it is important to note that time spent includes many aspects of the lifestyle surrounding AAS use, including time training and managing diet and supplement use (Kanayama, Brower, et al, 2009). We have previously demonstrated that time spent may not be a central symptom in a network of AAS dependence symptoms (Scarth et al, 2023). Sex differences in AAS dependence symptoms likely reflect sex-based differences in the experience of using AAS, where females may not experience as serious withdrawal due to lower endogenous testosterone.…”

Psychological traits associated with anabolic androgenic steroid use and dependence among female athletes

“…Half of the women in our sample reported spending a signi cant amount of time on activities surrounding AAS use, while only two (14.3%) reported having experienced withdrawal symptoms. By comparison, we previously published ndings among male AAS using weightlifters where a similar proportion (41.7%) reported spending signi cant time on AAS, but a much larger proportion (50.4%) reported withdrawal symptoms (43). However, it is important to note that time spent includes many aspects of the lifestyle surrounding AAS use, including time training and managing diet and supplement use (27).…”

“…However, it is important to note that time spent includes many aspects of the lifestyle surrounding AAS use, including time training and managing diet and supplement use (27). We have previously demonstrated that time spent may not be a central symptom in a network of AAS dependence symptoms (43). Sex differences in AAS dependence symptoms likely re ect sex-based differences in the experience of using AAS, where females may not experience as serious withdrawal due to lower endogenous testosterone.…”

Prevalence and correlates of androgen dependence: a meta-analysis, meta-regression analysis and qualitative synthesis

“…Moreover, dependents exhibited lower levels of inhibition, higher levels of opioid abuse or dependence and other performance-enhancing drug use, other substance disorder, and polypharmacy compared to nondependents. Furthermore, dependents reported more perceived negative effects of androgens on their mental health, sexual performance, and social life than nondependents [10,22,23 ▪▪ ,25 ▪▪ ,26,27 ▪▪ ,28 ▪ ,29−31,33,35,38].…”