Abstract
Anabolic-androgenic steroids (AAS), more colloquially termed anabolic steroids, consist of testosterone and synthetic testosterone derivatives. Unlike classic drugs of abuse which have been around for many decades or centuries, AAS initially started among athletes in the 1950s and spread to the general male population in the 1980s. The majority of AAS users classify themselves as recreational exercisers rather than athletes or bodybuilders and are primarily motivated to use AAS to increase muscle mass and strength and enhance appearance. AAS use is not without adverse effects, particularly when supraphysiologic doses are being used. The chapter goes on to discuss research detailing AAS users engaging in polypharmacy, risky injection practices, high-risk sexual behaviors, and illicit drugs as well as discussing the impact of AAS use on mental health and crime.
Running Title (Short Title): Anabolic Steroid Abuse
This is a preview of subscription content, log in via an institution to check access.
Abbreviations
- AAS:
-
Anabolic-androgenic steroids
- ADHD:
-
Attention-deficit/hyperactivity disorder
- HIV:
-
Human immunodeficiency virus
- HBV:
-
Hepatitis B virus
- HCV:
-
Hepatitis C virus
- HPT:
-
Hypothalamic-pituitary-testicular
- HPV:
-
Human papillomavirus
- PDE5-I:
-
Phosphodiesterase type 5 inhibitor
- PED:
-
Performance-enhancing drug
- PEP:
-
Postexposure prophylaxis
- PrEP:
-
Preexposure prophylaxis
- STI:
-
Sexually transmitted infection
- UAI:
-
Unprotected anal intercourse
- US:
-
United States
References
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington, pp 242–243
Bhasin S, Storer TW, Berman N et al (1996) The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med 335(1):1–7. https://doi.org/10.1056/NEJM199607043350101
Bhasin S, Brito JP, Cunningham GR et al (2018) Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 103(5):1715–1744. https://doi.org/10.1210/jc.2018-00229
Bolding G, Sherr L, Maguire M, Elford J (1999) HIV risk behaviours among gay men who use anabolic steroids. Addiction 94(12):1829–1835
Bolding G, Sherr L, Elford J (2002) Use of anabolic steroids and associated health risks among gay men attending London gyms. Addiction 97(2):195–203
Broz D, Wejnert C, Pham HT et al (2014) HIV infection and risk, prevention, and testing behaviors among injecting drug users – National HIV behavioral surveillance system, 20 U.S. cities, 2009. MMWR Surveill Summ 63(6):1–51
Burton C (1996) Anabolic steroid use among the gym population in Clwyd. Pharm J 256:557–559
Cafri G, Olivardia R, Thompson JK (2008) Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia. Compr Psychiatry 49(4):374–379. https://doi.org/10.1016/j.comppsych.2008.01.003
Carel JC, Butler G (2010) Safety of recombinant human growth hormone. Endocr Dev 18:40–54. https://doi.org/10.1159/000316126
Centers for Disease Control and Prevention (CDC) (2016a) HIV/AIDS. https://www.cdc.gov/msmhealth/HIV.htm. Accessed 28 June 2021.
Centers for Disease Control and Prevention (CDC) (2016b) Sexually transmitted diseases. https://www.cdc.gov/msmhealth/STD.htm. Accessed 28 June 2021.
Centers for Disease Control and Prevention (CDC) (2020) People who use or inject drugs and viral hepatitis. https://www.cdc.gov/hepatitis/populations/idu.htm. Accessed 14 June 2021.
Christoffersen T, Andersen JT, Dalhoff KP, Horwitz H (2019) Anabolic-androgenic steroids and the risk of imprisonment. Drug Alcohol Depend 203:92–97. https://doi.org/10.1016/j.drugalcdep.2019.04.041
Cohen J, Collins R, Darkes J, Gwartney D (2007) A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. J Int Soc Sports Nutr 4:12. https://doi.org/10.1186/1550-2783-4-12
Day CA, Topp L, Iversen J, Maher L, Collaboration of Australian NSPs (2008) Blood-borne virus prevalence and risk among steroid injectors: results from the Australian Needle and Syringe Program Survey. Drug Alcohol Rev 27(5):559–561. https://doi.org/10.1080/09595230801956132
de Ronde W, Smit DL (2020) Anabolic androgenic steroid abuse in young males. Endocr Connect 9(4):R102–R111. https://doi.org/10.1530/EC-19-0557
Decensi A, Maisonneuve P, Rotmensz N et al (2005) Effect of tamoxifen on venous thromboembolic events in a breast cancer prevention trial. Circulation 111(5):650–656. https://doi.org/10.1161/01.CIR.0000154545.84124.AC
Drumright LN, Patterson TL, Strathdee SA (2006) Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review. Subst Use Misuse 41(10-12):1551–1601. https://doi.org/10.1080/10826080600847894
Elkin SL, Brady S, Williams IP (1997) Bodybuilders find it easy to obtain insulin to help them in training. BMJ 314(7089):1280. https://doi.org/10.1136/bmj.314.7089.1280
Evans PJ, Lynch RM (2003) Insulin as a drug of abuse in body building. Br J Sports Med 37(4):356–357. https://doi.org/10.1136/bjsm.37.4.356
Flynn RW, Bonellie SR, Jung RT, MacDonald TM, Morris AD, Leese GP (2010) Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab 95(1):186–193. https://doi.org/10.1210/jc.2009-1625
Gestsdottir S, Kristjansdottir H, Sigurdsson H, Sigfusdottir ID (2020) Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals [published online ahead of print, 2020 Dec 7]. Scand J Public Health. 1403494820973096. https://doi.org/10.1177/1403494820973096
Glass R, Hope VD, Njoroge J et al (2019) Secondary distribution of injecting equipment obtained from needle and syringe programmes by people injecting image and performance enhancing drugs: England and Wales, 2012-15. Drug Alcohol Depend 195:40–44. https://doi.org/10.1016/j.drugalcdep.2018.11.021
Griffiths S, Murray SB, Dunn M, Blashill AJ (2017) Anabolic steroid use among gay and bisexual men living in Australia and New Zealand: associations with demographics, body dissatisfaction, eating disorder psychopathology, and quality of life. Drug Alcohol Depend 181:170–176. https://doi.org/10.1016/j.drugalcdep.2017.10.003
Griffiths S, Jacka B, Degenhardt L, Murray SB, Larance B (2018) Physical appearance concerns are uniquely associated with the severity of steroid dependence and depression in anabolic-androgenic steroid users. Drug Alcohol Rev 37(5):664–670. https://doi.org/10.1111/dar.12688
Hauger LE, Havnes IA, Jørstad ML, Bjørnebekk A (2021) Anabolic androgenic steroids, antisocial personality traits, aggression and violence. Drug Alcohol Depend 221:108604. https://doi.org/10.1016/j.drugalcdep.2021.108604
Hoffman JR, Kraemer WJ, Bhasin S et al (2009) Position stand on androgen and human growth hormone use [published correction appears in J Strength Cond Res. 2010 Feb;24(2):585]. J Strength Cond Res 23(5 Suppl):S1–S59. https://doi.org/10.1519/JSC.0b013e31819df2e6
Hope VD, McVeigh J, Marongiu A et al (2013) Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open 3(9):e003207
Hope VD, McVeigh J, Marongiu A et al (2015) Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking. Epidemiol Infect 143(1):132–140. https://doi.org/10.1017/S0950268814000727
Hope VD, McVeigh J, Smith J et al (2017) Low levels of hepatitis C diagnosis and testing uptake among people who inject image and performance enhancing drugs in England and Wales, 2012-15. Drug Alcohol Depend 179:83–86. https://doi.org/10.1016/j.drugalcdep.2017.06.018
Ip EJ, Barnett MJ, Tenerowicz MJ, Kim JA, Wei H, Perry PJ (2010) Women and anabolic steroids: an analysis of a dozen users. Clin J Sport Med 20(6):475–481. https://doi.org/10.1097/JSM.0b013e3181fb5370
Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ (2011) The Anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy 31(8):757–766. https://doi.org/10.1592/phco.31.8.757
Ip EJ, Lu DH, Barnett MJ, Tenerowicz MJ, Vo JC, Perry PJ (2012a) Psychological and physical impact of anabolic-androgenic steroid dependence. Pharmacotherapy 32(10):910–919. https://doi.org/10.1002/j.1875-9114.2012.01123
Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ (2012b) Weightlifting’s risky new trend: a case series of 41 insulin users. Curr Sports Med Rep 11(4):176–179. https://doi.org/10.1249/JSR.0b013e31825da97f
Ip EJ, Trinh K, Tenerowicz MJ, Pal J, Lindfelt TA, Perry PJ (2015) Characteristics and behaviors of older male anabolic steroid users. J Pharm Pract 28(5):450–456. https://doi.org/10.1177/0897190014527319
Ip EJ, Yadao MA, Shah BM, Lau B (2016) Infectious disease, injection practices, and risky sexual behavior among anabolic steroid users. AIDS Care 28(3):294–299. https://doi.org/10.1080/09540121.2015.1090539
Ip EJ, Doroudgar S, Shah-Manek B et al (2019a) The CASTRO study: unsafe sexual behaviors and illicit drug use among gay and bisexual men who use anabolic steroids. Am J Addict 28(2):101–110. https://doi.org/10.1111/ajad.12865
Ip EJ, Doroudgar S, Lau B, Barnett MJ (2019b) Anabolic steroid users’ misuse of non-traditional prescription drugs. Res Soc Adm Pharm 15(8):949–952. https://doi.org/10.1016/j.sapharm.2018.07.003
Jagim AR, Harty PS, Fischer KM, Kerksick CM, Erickson JL (2020) Adverse events reported to the united states food and drug administration related to caffeine-containing products. Mayo Clin Proc 95(8):1594–1603. https://doi.org/10.1016/j.mayocp.2020.02.033
Kanayama G, Pope HG Jr (2011) Gods, men, and muscle dysmorphia. Harv Rev Psychiatry 19(2):95–98. https://doi.org/10.3109/10673229.2011.565250
Kanayama G, Pope HG Jr (2018) History and epidemiology of anabolic androgens in athletes and non-athletes. Mol Cell Endocrinol 464:4–13. https://doi.org/10.1016/j.mce.2017.02.039
Kanayama G, Barry S, Hudson JI, Pope HG Jr (2006) Body image and attitudes toward male roles in anabolic-androgenic steroid users. Am J Psychiatry 163(4):697–703. https://doi.org/10.1176/appi.ajp.163.4.697
Kanayama G, Hudson JI, Pope HG Jr (2009a) Features of men with anabolic-androgenic steroid dependence: a comparison with nondependent AAS users and with AAS nonusers. Drug Alcohol Depend 102(1-3):130–137. https://doi.org/10.1016/j.drugalcdep.2009.02.008
Kanayama G, Brower KJ, Wood RI, Hudson JI, Pope HG Jr (2009b) Issues for DSM-V: clarifying the diagnostic criteria for anabolic-androgenic steroid dependence. Am J Psychiatry 166(6):642–645. https://doi.org/10.1176/appi.ajp.2009.08111699
Kanayama G, Brower KJ, Wood RI, Hudson JI, Pope HG Jr (2010) Treatment of anabolic-androgenic steroid dependence: emerging evidence and its implications. Drug Alcohol Depend 109(1-3):6–13. https://doi.org/10.1016/j.drugalcdep.2010.01.011
Kanayama G, Hudson JI, Pope HG Jr (2020) Anabolic-androgenic steroid use and body image in men: a growing concern for clinicians. Psychother Psychosom 89(2):65–73. https://doi.org/10.1159/000505978
Kaptein EM, Beale E, Chan LS (2009) Thyroid hormone therapy for obesity and nonthyroidal illnesses: a systematic review. J Clin Endocrinol Metab 94(10):3663–3675. https://doi.org/10.1210/jc.2009-0899
Kierzkowska B, Stańczyk J, Kasprzak JD (2005) Myocardial infarction in a 17-year-old body builder using clenbuterol. Circ J 69(9):1144–1146. https://doi.org/10.1253/circj.69.1144
Kimergård A, McVeigh J (2014) Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J 11:19. Published 2014 Jul 2. https://doi.org/10.1186/1477-7517-11-19
Knox DC, Anderson PL, Harrigan PR, Tan DH (2017) Multidrug-Resistant HIV-1 Infection despite Preexposure Prophylaxis. N Engl J Med 376(5):501–502. https://doi.org/10.1056/NEJMc1611639
Kuhn CM (2002) Anabolic steroids. Recent Prog Horm Res 57:411–434. https://doi.org/10.1210/rp.57.1.411
Levitt A, Mermin J, Jones CM, See I, Butler JC (2020) Infectious diseases and injection drug use: public health burden and response. J Infect Dis 222(Suppl 5):S213–S217. https://doi.org/10.1093/infdis/jiaa432
Libecco JF, Bergfeld WF (2004) Finasteride in the treatment of alopecia. Expert Opin Pharmacother 5(4):933–940. https://doi.org/10.1517/14656566.5.4.933
Liu M, Goss PE, Ingle JN et al (2014) Aromatase inhibitor-associated bone fractures: a case-cohort GWAS and functional genomics. Mol Endocrinol 28(10):1740–1751. https://doi.org/10.1210/me.2014-1147
Marrazzo JM, Cates W (2011) Interventions to prevent sexually transmitted infections, including HIV infection. Clin Infect Dis 53(Suppl 3):S64–S78. https://doi.org/10.1093/cid/cir695
Mayr FB, Domanovits H, Laggner AN (2012) Hypokalemic paralysis in a professional bodybuilder. Am J Emerg Med 30(7). https://doi.org/10.1016/j.ajem.2011.06.029
National Institute on Drug Abuse (NIDA) (2020) Health Consequences of Drug Misuse. https://www.drugabuse.gov/drug-topics/health-consequences-drug-misuse/introduction. Accessed 18 June 2021.
O’Sullivan AJ, Kennedy MC, Casey JH, Day RO, Corrigan B, Wodak AD (2000) Anabolic-androgenic steroids: medical assessment of present, past and potential users. Med J Aust 173(6):323–327. https://doi.org/10.5694/j.1326-5377.2000.tb125667.x
Or F, Kim Y, Simms J, Austin SB (2019) Taking stock of dietary supplements’ harmful effects on children, adolescents, and young adults. J Adolesc Health 65(4):455–461
Petrosky E, Bocchini JA Jr, Hariri S et al (2015) Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 64(11):300–304
Pfisterer N, Stöllberger C, Finsterer J (2020) Severe acquired hypokalemic paralysis in a bodybuilder after self-medication with triamterene/hydrochlorothiazide. Clin J Sport Med 30(5):e172–e174. https://doi.org/10.1097/JSM.0000000000000763
Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S (2014a) Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 35(3):341–375. https://doi.org/10.1210/er.2013-1058
Pope HG Jr, Kanayama G, Athey A, Ryan E, Hudson JI, Baggish A (2014b) The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates. Am J Addict 23(4):371–377. https://doi.org/10.1111/j.1521-0391.2013.12118.x
Pope HG Jr, Khalsa JH, Bhasin S (2017) Body image disorders and abuse of anabolic-androgenic steroids among men. JAMA 317(1):23–24. https://doi.org/10.1001/jama.2016.17441
Pope HG Jr, Kanayama G, Hudson JI, Kaufman MJ (2021) Review article: anabolic-androgenic steroids, violence, and crime: two cases and literature review [published online ahead of print, 2021 Apr 19]. Am J Addict. https://doi.org/10.1111/ajad.13157
Sagoe D, Molde H, Andreassen CS, Torsheim T, Pallesen S (2014) The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol 24(5):383–398. https://doi.org/10.1016/j.annepidem.2014.01.009
Shapiro B, Coffa D, McCance-Katz EF (2013) A primary care approach to substance misuse. Am Fam Physician 88(2):113–121
Spiller HA, James KJ, Scholzen S, Borys DJ (2013) A descriptive study of adverse events from clenbuterol misuse and abuse for weight loss and bodybuilding. Subst Abus 34(3):306–312. https://doi.org/10.1080/08897077.2013.772083
Striegel H, Simon P, Frisch S et al (2006) Anabolic ergogenic substance users in fitness-sports: a distinct group supported by the health care system. Drug Alcohol Depend 81(1):11–19. https://doi.org/10.1016/j.drugalcdep.2005.05.013
van Bokhorst QNE, Krul-Poel YHM, Smit DL, de Ronde W (2021) A 29-year-old bodybuilder with Liothyronine-induced Thyrotoxic Hypokalaemic periodic paralysis. Eur J Case Rep Intern Med 8(3):002362. https://doi.org/10.12890/2021_002362
Van de Ven K, Maher L, Wand H, Memedovic S, Jackson E, Iversen J (2018) Health risk and health seeking behaviours among people who inject performance and image enhancing drugs who access needle syringe programs in Australia. Drug Alcohol Rev 37(7):837–846. https://doi.org/10.1111/dar.12831
Wheeler KM, Sharma D, Kavoussi PK, Smith RP, Costabile R (2019) Clomiphene citrate for the treatment of hypogonadism. Sex Med Rev 7(2):272–276. https://doi.org/10.1016/j.sxmr.2018.10.001
Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015) Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep 64(33):924]. MMWR Recomm Rep 64(RR-03):1–137
Yaturu S, Harrara E, Nopajaroonsri C, Singal R, Gill S (2003) Gynecomastia attributable to human chorionic gonadotropin-secreting giant cell carcinoma of lung. Endocr Pract 9(3):233–235. https://doi.org/10.4158/EP.9.3.233
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry
Ip, E.J., Silva, M.D. (2022). Unsafe Behaviors and Anabolic Steroid Use. In: Patel, V.B., Preedy, V.R. (eds) Handbook of Substance Misuse and Addictions. Springer, Cham. https://doi.org/10.1007/978-3-030-67928-6_134-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-67928-6_134-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-67928-6
Online ISBN: 978-3-030-67928-6
eBook Packages: Springer Reference MedicineReference Module Medicine