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Behavioural Manifestations of Anabolic Steroid Use

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Abstract

The use of anabolic androgenic steroids (AAS) for gains in strength and muscle mass is relatively common among certain subpopulations, including athletes, bodybuilders, adolescents and young adults.

Adverse physical effects associated with steroid abuse are well documented, but more recently, increased attention has been given to the adverse psychiatric effects of these compounds. Steroids may be used in oral, 17α-alkylated, or intramuscular, 17β-esterified, preparations. Commonly, steroid users employ these agents at levels 10- to 100-fold in excess of therapeutic doses and use multiple steroids simultaneously, a practice known as ‘stacking’. Significant psychiatric symptoms including aggression and violence, mania, and less frequently psychosis and suicide have been associated with steroid abuse. Long-term steroid abusers may develop symptoms of dependence and withdrawal on discontinuation of AAS.

Treatment of AAS abusers should address both acute physical and behavioural symptoms as well as long-term abstinence and recovery. To date, limited information is available regarding specific pharmacological treatments for individuals recovering from steroid abuse. This paper reviews the published literature concerning the recognition and treatment of behavioural manifestations of AAS abuse.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. National Institute on Drug Abuse Research report series: anabolic steroid abuse [online]. Available from URL: http://www.nida.nih.gov [Accessed 2002 Oct 16]

  2. Yesalis CE. Epidemiology and patterns of anabolic-androgenic steroid use. Psychiatr Ann 1992; 22: 7–18

    Google Scholar 

  3. Yesalis CE. Totally juiced. Sports Illustrated 2002; 96: 34–48

    Google Scholar 

  4. Berger K. Steroids sacked Gastineau: former Jet admits drug led to acts of violence off field. Newsday 2000 May 16 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Apr 23]

  5. Athlete says steroids nearly drove him to suicide. The Washington Post 1998 Oct 19 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Apr 23]

  6. Steroid abuse link to ‘rage’ murders. The Advertiser 1996 Aug 19 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Apr 23]

  7. Le Couteur J. Steroid abuse led to violent nature: bodybuilder jailed for road rage attack. Bristol Evening Post 2001 Feb 27 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Apr 8]

  8. Schailler R. Child beaten, weight lifter faces charges. The Tampa Tribune 1996 Jan 26 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Apr 23]

  9. Barr B. Law: the drugs that build bodies but dismantle minds: anabolic steroids can cause psychiatric disorder and may be associated with violent crime. The Independent (London) 1990 Oct 5 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Apr 23]

  10. Yesalis CE, Barsukiewicz CK, Kopstein AN, et al. Trends in anabolic-androgenic steroid use among adolescents. Arch Pediatr Adolesc Med 1997; 151: 1197–206

    Article  PubMed  CAS  Google Scholar 

  11. Monitoring the future. National results on adolescent drug use: overview of key findings 2002/2004. US Department of Health and Human Services [online]. Available from URL: http://www.monitoringthefuture.org [Accessed 2005 Jan 17]

  12. Yesalis CE, Kennedy NJ, Kopstein AN, et al. Anabolic-androgenic steroid use in the United States. JAMA 1993; 270: 1217–21

    Article  PubMed  CAS  Google Scholar 

  13. Middleman AB, Faulkner AH, Woods ER, et al. High-risk behaviors among high school students in Massachusetts who use anabolic steroids. Pediatrics 1995; 96: 268–72

    PubMed  CAS  Google Scholar 

  14. Gruber AJ, Pope HG. Compulsive weight lifting and anabolic drug abuse among women rape victims. Compr Psychiatry 1999; 40: 273–7

    Article  PubMed  CAS  Google Scholar 

  15. Kanayama G, Gruber AJ, Pope HG, et al. Over-the-counter drug use in gymnasiums: an underrecognized substance abuse problem? Psychother Psychosom 2001; 70: 137–40

    Article  PubMed  CAS  Google Scholar 

  16. Blue JG, Lombardo JA. Steroids and steroid-like compounds. Clin Sports Med 1999; 18: 667–89

    Article  PubMed  CAS  Google Scholar 

  17. Clancy C. Sports drugs of abuse. In: Viccellio P, Bania T, Brent J, et al. editors. Emergency toxicology. 2nd ed. Philadelphia (PA): Lippincott-Raven Publishers, 1998: 933–46

    Google Scholar 

  18. Brower KJ. Clinical assessment and treatment of anabolic steroid users. Psychiatr Ann 1992; 22: 35–40

    Google Scholar 

  19. Dawson RT. Drugs in sport: the role of the physician. J Endocrinol 2001; 170: 55–61

    Article  PubMed  CAS  Google Scholar 

  20. Pope HG, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use: a controlled study of 160 athletes. Arch Gen Psychiatry 1994; 51: 375–82

    Article  PubMed  CAS  Google Scholar 

  21. Henderson J. Just say maybe: while the NFL and NCAA have imposed sanctions that have all but eliminated steroid use, players won’t shy away from untested nutritional and performance supplements. The Denver Post 1999 Oct 24 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Jun 3]

  22. IOC aims for wider Andro ban. The Record 1998 Sep 15 [online]. Available from URL: http://web.lexis-nexis.com/universe/ [Accessed 2002 Jun 3]

  23. Wolkowitz OM, Brizendine L, Reus VI. The role of dehydroepiandrosterone in psychiatry. Psychiatr Ann 2000; 30: 123–8

    Google Scholar 

  24. Kroboth PD, Salek FS, Pittenger AL, et al. DHEA and DHEAS: a review. J Clin Pharmacol 1999; 39: 327–48

    Article  PubMed  CAS  Google Scholar 

  25. Tourney G, Erb JL. Temporal variations in androgens and stress hormones in control and schizophrenic subjects. Biol Psychiatry 1979; 14: 395–404

    PubMed  CAS  Google Scholar 

  26. Oades RD, Schepker R. Serum gonadal steroid hormones in young schizophrenic patients. Psychoneuroendocrinology 1994; 19: 373–85

    Article  PubMed  CAS  Google Scholar 

  27. Fisher M, Appleby M, Rittoo D, et al. Myocardial infarction with extensive intracoronary thrombus induced by anabolic steroids. Br J Clin Pract 1996; 50: 222–3

    PubMed  CAS  Google Scholar 

  28. Huie MJ. An acute myocardial infarction occurring in an anabolic steroid user. Med Sci Sports Exerc 1994; 26: 408–13

    PubMed  CAS  Google Scholar 

  29. Kennedy MC, Lawrence CL. Anabolic steroid abuse and cardiac death. Med J Aust 1993; 158: 346–8

    PubMed  CAS  Google Scholar 

  30. Ferenchick GS, Adelman S. Myocardial infarction associated with anabolic steroid use in a previously healthy 37-year-old weight lifter. Am Heart J 1992; 124: 507–8

    Article  PubMed  CAS  Google Scholar 

  31. McNutt RA, Ferenchick GS, Kirlin PC, et al. Acute myocardial infarction in a 22-year-old world class weight lifter using anabolic steroids. Am J Cardiol 1988; 62: 164

    Article  PubMed  CAS  Google Scholar 

  32. Appleby M, Fisher M, Martin M. Myocardial infarction, hyperkalemia and ventricular tachycardia in a young male body-builder. Int J Cardiol 1994; 44: 171–4

    Article  PubMed  CAS  Google Scholar 

  33. Dickerman RD, Schaller F, Prather I, et al. Sudden cardiac death in a 20-year-old bodybuilder using anabolic steroids. Cardiology 1995; 86: 172–3

    Article  PubMed  CAS  Google Scholar 

  34. Fineschi V, Baroldi G, Monciotti F, et al. Anabolic steroid abuse and cardiac sudden death: a pathologic study. Arch Pathol Lab Med 2001; 125: 253–5

    PubMed  CAS  Google Scholar 

  35. Sullivan ML, Martinez CM, Gennis P, et al. The cardiac toxicity of anabolic steroids. Prog Cardiovasc Dis 1998; 41: 1–15

    Article  PubMed  CAS  Google Scholar 

  36. Sachtleben TR, Berg KE, Elias BA, et al. The effects of anabolic steroids on myocardial structure and cardiovascular fitness. Med Sci Sports Exerc 1993; 25: 1240–5

    PubMed  CAS  Google Scholar 

  37. Friedl KE, Hannan CJ, Jones RE, et al. High-density lipoprotein cholesterol is not decreased if an aromatizable androgen is administered. Metabolism 1990; 39: 69–74

    Article  PubMed  CAS  Google Scholar 

  38. Hurley BF, Seals DR, Hagberg JM. High-density lipoprotein cholesterol in bodybuilders vs powerlifters: negative effects of androgen use. JAMA 1984; 252: 507–28

    Article  PubMed  CAS  Google Scholar 

  39. Freed DLJ, Banks AJ, Longson D, et al. Anabolic steroids in athletics: crossover double-blind trial on weightlifters. BMJ 1975; 2: 471–3

    Article  PubMed  CAS  Google Scholar 

  40. Thompson PD, Sadaniantz A, Cullinane EM, et al. Left ventricular function is not impaired in weight-lifters who use anabolic steroids. J Am Coll Cardiol 1992; 19: 278–82

    Article  PubMed  CAS  Google Scholar 

  41. Urhausen A, Holpes R, Kindermann W. One- and two-dimensional echocardiography in bodybuilders using anabolic steroids. Eur J Appl Physiol 1989; 58: 633–40

    Article  CAS  Google Scholar 

  42. Cabasso A. Peliosis hepatis in a young adult bodybuilder. Med Sci Sports Exerc 1994; 26: 2–4

    PubMed  CAS  Google Scholar 

  43. Wakabayashi T, Onda H, Tada T, et al. High incidence of peliosis hepatis in autopsy cases of aplastic anemia with special reference to anabolic therapy. Acta Pathol Jpn 1984; 34: 1079–86

    PubMed  CAS  Google Scholar 

  44. Narducci WA, Wagner JC, Hendrickson TP, et al. Anabolic steroids: a review of the clinical toxicology and diagnostic screening. Clin Toxicol 1990; 28: 287–310

    Article  CAS  Google Scholar 

  45. Catlin DH, Hatten CK, Starcevic SH. Issues in detecting abuse of xenobiotic anabolic steroids and testosterone by analysis of athletes’ urine. Clin Chem 1997; 43: 1280–8

    PubMed  CAS  Google Scholar 

  46. Snyder PJ. Androgens. In:Hardman JG, Limbird LE, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. 10th ed. New York: McGraw Hill, 2001: 1635–48

    Google Scholar 

  47. Corcoran JP, Longo ED. Psychological treatment of anabolic-androgenic steroid-dependent individuals. J Subst Abuse Treat 1992; 9: 229–35

    Article  PubMed  CAS  Google Scholar 

  48. Pope HG, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men. Arch Gen Psychiatry 2000; 57: 133–40

    Article  PubMed  CAS  Google Scholar 

  49. Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol 1992; 63: 452–9

    Article  PubMed  CAS  Google Scholar 

  50. Cherek DR, Schnapp W, Moeller FG, et al. Laboratory measures of aggressive responding in male parolees with violent and nonviolent histories. Aggress Behav 1996; 22: 27–36

    Article  Google Scholar 

  51. Su TP, Pagliaro M, Schmidt PJ, et al. Neuropsychiatric effects of anabolic steroids in male normal volunteers. JAMA 1993; 269: 2760–4

    Article  PubMed  CAS  Google Scholar 

  52. Spielberger CB, Gorsuch RL, Luschene RE. STAI manual for the state-trait anxiety inventory. Palo Alto (CA): Consulting Psychologists Press, 1970

    Google Scholar 

  53. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-III-R. 3rd rev. ed., Washington (DC): American Psychiatric Association, 1987

    Google Scholar 

  54. Tricker R, Casaburi R, Storer TW, et al. The effects of supraphysiological doses of testosterone on angry behavior in healthy eugonodal men: a clinical research center study. J Clin Endocrinol Metab 1996; 81: 3754–8

    Article  PubMed  CAS  Google Scholar 

  55. Siegel JM. The multidimensional anger inventory. J Pers Soc Psychol 1986; 51: 191–200

    Article  PubMed  CAS  Google Scholar 

  56. Yates WR, Perry PJ, MacIndoe J, et al. Psychosexual effects of three doses of testosterone cycling in normal men. Biol Psychiatry 1999; 45: 254–60

    Article  PubMed  CAS  Google Scholar 

  57. Buss AH, Fischer H, Simmons AJ. Aggression and hostility in psychiatric patients. J Consult Psychol 1962; 26: 84–9

    Article  PubMed  CAS  Google Scholar 

  58. Buss AH, Durkee A. An inventory for assessing different kinds of hostility. J Consult Psychol 1957; 21: 343–9

    Article  PubMed  CAS  Google Scholar 

  59. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Res 1962; 10: 799–812

    Google Scholar 

  60. Blackburn IM, Loudon JB, Ashworth CM. A new scale for measuring mania. Psychol Med 1977; 7(3): 453–8

    Article  PubMed  CAS  Google Scholar 

  61. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 278–96

    Article  PubMed  CAS  Google Scholar 

  62. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Text revision, 4th ed. Washington (DC): American Psychiatric Association, 2000

    Google Scholar 

  63. Parrott AC, Choi PYL, Davies M. Anabolic steroid use by amateur athletes: effects upon psychological mood states. J Sports Med Phys Fitness 1994; 34: 292–49

    PubMed  CAS  Google Scholar 

  64. Pope HG, Katz DL. Homicide and near-homicide by anabolic steroid users. J Clin Psychiatry 1990; 51: 28–31

    PubMed  Google Scholar 

  65. Conacher GN, Workman DG. Violent crime possibly associated with anabolic steroid use [letter]. Am J Psychiatry 1989; 146: 679

    PubMed  CAS  Google Scholar 

  66. Porcerelli JH, Sandler BA. Anabolic-androgenic steroid abuse and psychopathology. Psychiatr Clin North Am 1998; 21: 829–33

    Article  PubMed  CAS  Google Scholar 

  67. Freinhar JP, Alvarez W. Androgen-induced hypomania. J Clin Psychiatry 1985; 46: 354–5

    PubMed  CAS  Google Scholar 

  68. Markowitz JS, Carson WH, Jackson CW. Possible dihydroepiandrosterone-induced mania. Biol Psychiatry 1999; 45: 241–2

    Article  PubMed  CAS  Google Scholar 

  69. Kline MD, Jaggers ED. Mania onset while using dehydroepiandrosterone [letter]. Am J Psychiatry 1999; 156: 971

    PubMed  CAS  Google Scholar 

  70. Dean CE. Prasterone (DHEA) and mania. Ann Pharmacother 2000; 34: 1419–22

    PubMed  CAS  Google Scholar 

  71. Pope HG, Katz DL. Bodybuilder’s psychosis [letter]. Lancet 1987; I(8537): 863

    Article  Google Scholar 

  72. Brower KJ, Blow FC, Beresford TP, et al. Anabolic-androgenic steroid dependence. J Clin Psychiatry 1989; 50: 31–3

    PubMed  CAS  Google Scholar 

  73. Tennant F, Black DL, Voy RO. Anabolic steroid dependence with opioid-type features [letter]. N Engl J Med 1988; 319: 578

    Article  PubMed  CAS  Google Scholar 

  74. Allnut S, Chaimowitz G. Anabolic steroid withdrawal depression: a case report [letter]. Can J Psychiatry 1994; 39: 317–8

    Google Scholar 

  75. Boyadjiev NP, Georgieva KN, Massaldjieva RI, et al. Reversible hypogonadism and azoospermia as a result of anabolic-androgenic steroid use in a bodybuilder with personality disorder. J Sports Med Phys Fitness 2000; 40: 271–4

    PubMed  CAS  Google Scholar 

  76. Cooper CJ, Noakes TD. Psychiatric disturbances in users of anabolic steroids. South Afr Med J 1994; 84: 509–12

    CAS  Google Scholar 

  77. Gruber AJ, Pope HG. Psychiatric and medical effects of anabolic-androgenic steroid use in women. Psychother Psychosom 2000; 69: 19–26

    Article  PubMed  CAS  Google Scholar 

  78. Fava GA, Freyberger HJ, Bech P, et al. Diagnostic criteria for use in psychosomatic research. Psychother Psychosom 1995; 63: 1–8

    Article  PubMed  CAS  Google Scholar 

  79. Pope HG, Kouri EM, Powell KF, et al. Anabolic-androgenic steroid use among 133 prisoners. Compr Psychiatry 1996; 37: 322–7

    Article  PubMed  Google Scholar 

  80. Choi PYL, Pope HG. Violence toward women and illicit androgenic-anabolic steroid use. Ann Clin Psychiatry 1994; 6: 21–5

    Article  PubMed  CAS  Google Scholar 

  81. Thiblin I, Lindquist O, Rajs J. Cause and manner of death among users of anabolic androgenic steroids. J Forensic Sci 2000; 45: 16–23

    PubMed  CAS  Google Scholar 

  82. Thiblin I, Runeson B, Rajs J. Anabolic androgenic steroids and suicide. Ann Clin Psychiatry 1999; 11: 223–31

    PubMed  CAS  Google Scholar 

  83. Pope HG, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry 1998; 145: 487–90

    Google Scholar 

  84. Annitto WJ, Layman WA. Anabolic steroids and acute schizophrenic episode. J Clin Psychiatry 1980; 41: 143–4

    PubMed  CAS  Google Scholar 

  85. Malone DA, Dimeff RJ, Lombardo JA, et al. Psychiatric effects and psychoactive substance use in anabolic androgenic steroid users. Clin J Sports Med 1995; 5: 25–31

    Article  Google Scholar 

  86. Brower KJ, Blow FC, Young JP, et al. Symptoms and correlates of anabolic-androgenic steroid dependence. Br J Addict 1991; 86: 759–68

    Article  PubMed  CAS  Google Scholar 

  87. Brower KJ, Eliopulos GA, Blow FC, et al. Evidence for physical and psychological dependence on anabolic androgenic steroids in eight weight lifters. Am J Psychiatry 1990; 147: 510–2

    PubMed  CAS  Google Scholar 

  88. Kashkin KB, Kleber HD. Hooked on hormones?; aAn anabolic steroid addiction hypothesis. JAMA 1989; 262: 3166–70

    Article  PubMed  CAS  Google Scholar 

  89. Brower KJ. Withdrawal from anabolic steroids. Curr Ther Endocrinol Metab 1994; 5: 291–6

    PubMed  CAS  Google Scholar 

  90. Negus SS, Pope HG, Kanayama G, et al. Lack of evidence for opioid tolerance or dependence in rhesus monkeys following high-dose anabolic-androgenic steroid administration. Psychoneuroendocrinology 2001; 26: 789–96

    Article  PubMed  CAS  Google Scholar 

  91. Malone DA, Dimeff RJ. The use of fluoxetine in depression associated with anabolic steroid withdrawal: a case series. J Clin Psychiatry 1992; 53: 130–2

    PubMed  Google Scholar 

  92. Porcerelli JH, Sandler BA. Narcissism and empathy in steroid users. Am J Psychiatry 1995; 152: 1672–4

    PubMed  CAS  Google Scholar 

  93. Raskin R, Terry H. A principal-components analysis of the Narcissistic Personality Inventory and further evidence of its construct validity. J Pers Soc Psychol 1988; 54: 890–902

    Article  PubMed  CAS  Google Scholar 

  94. Pope HG, Katz DL, Hudson JI. Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Compr Psychiatry 1993; 34: 406–9

    Article  PubMed  Google Scholar 

  95. Arvary D, Pope HG. Anabolic-androgenic steroids as a gateway to opioid dependence [letter]. N Engl J Med 2000; 342: 1532

    Article  PubMed  CAS  Google Scholar 

  96. Kanayama G, Cohane GH, Weiss RD, et al. Past anabolic-androgenic steroid use among men admitted for substance abuse treatment: an underrecognized problem? J Clin Psychiatry 2003; 64: 156–60

    Article  PubMed  Google Scholar 

  97. McBride AJ, Williamson K, Petersen T. Three cases of nalbuphine hydrochloride dependence associated with anabolic steroid use. Br J Sports Med 1996; 30: 69–70

    Article  PubMed  CAS  Google Scholar 

  98. Wines JD, Gruber AJ, Pope HG, et al. Nalbuphine hydrochloride dependence in anabolic steroid users. Am J Addict 1999; 8: 161–4

    Article  PubMed  Google Scholar 

  99. Allen MH, Currier GW, Hughes DH, et al. The Expert Consensus Guideline Series. Treatment of behavioral emergencies. Postgrad Med 2001; (Spec No): 1–88

    Google Scholar 

  100. Giannini AJ, Miller N, Kocjan DK. Treating steroid abuse: a psychiatric perspective. Clin Pediatr 1991; 30: 538–42

    Article  CAS  Google Scholar 

  101. Alen M, Reinila M, Vihko R. Response of serum hormones to androgen administration in power athletes. Med Sci Sports Exerc 1985; 17: 354–9

    PubMed  CAS  Google Scholar 

  102. Brower KJ, Blow FC, Eliopulos GA, et al. Anabolic steroids and suicide [letter]. Am J Psychiatry 1989; 146: 1075

    PubMed  CAS  Google Scholar 

  103. Currier GW. Atypical antipsychotic medications in the psychiatric emergency service. J Clin Psychiatry 2000; 61Suppl. 14: 21–6

    PubMed  CAS  Google Scholar 

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Acknowledgements

No external funding was used in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA

    Adam J. Trenton

  2. Department of Psychiatry and Emergency Medicine, University of Rochester School of Medicine, Rochester, New York, USA

    Glenn W. Currier

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Trenton, A.J., Currier, G.W. Behavioural Manifestations of Anabolic Steroid Use. CNS Drugs 19, 571–595 (2005). https://doi.org/10.2165/00023210-200519070-00002

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