Elsevier

Hormones and Behavior

Volume 58, Issue 1, June 2010, Pages 111-121
Hormones and Behavior

Illicit anabolic–androgenic steroid use

https://doi.org/10.1016/j.yhbeh.2009.09.006Get rights and content

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.

Introduction

The anabolic–androgenic steroids (AAS) are a family of hormones that includes the natural male hormone testosterone, together with numerous closely related chemical relatives (Pope and Brower, 2009). All AAS possess both anabolic (muscle building) and androgenic (masculinizing) properties, and they affect a wide range of physiological systems. As a result, the AAS have become the subject of a vast literature of medical and behavioral studies in humans and animals, too large to cover here in its entirety. Therefore this review will concentrate primarily on the illicit use of supraphysiologic doses of AAS by humans. We begin with a short history of the development of AAS and the evolution of illicit AAS use over the last several decades. We also discuss current knowledge regarding the prevalence of AAS abuse in both men and women in various countries. We then briefly review the growing literature on the adverse medical effects of illicit supraphysiologic AAS use, followed by a more detailed review of the behavioral effects of these drugs. Finally, we discuss the associations between AAS abuse and other drugs of abuse, together with the related issue of AAS dependence.

Section snippets

AAS as therapeutic agents

In 1889, the renowned investigator Brown-Séquard injected himself with an extract that he had prepared from the testicles of dogs and guinea pigs (Brown-Séquard, 1889). He thought that he felt a boost of vitality — but in fact, his preparation probably lacked genuine biological activity (Katz and Pope, 1989). Several more decades passed before testosterone was first isolated and characterized in Germany in the 1930s (David et al., 1935, Wettstein, 1935). In the following years, numerous

The prevalence of AAS use in boys and men

By the late 1980s and early 1990s, surveys of American teenage students first began to inquire about AAS; these early studies reported that 3% and 11% of male high school students acknowledged having used AAS at some time (Buckley et al., 1988, Johnson et al., 1989, Johnston et al., 2006). Studies of the prevalence of AAS use in other countries first began to appear some years later, but by the end of the 1990s, epidemiologic evidence of illicit AAS use had begun to appear in British

Cardiac effects

Although this review focuses primarily on behavioral features of illicit AAS use, it is important to note in passing that these drugs may produce various adverse medical effects, especially on the heart – as suggested by the growing number of anecdotal reports of death attributable to apparent cardiac problems among AAS users as young as their 20s and 30s (Kanayama et al., 2008). The prevalence and underlying mechanisms of AAS-induced cardiovascular toxicity remain poorly understood, but it

Mood disorders

For some 30 years, naturalistic studies have described psychiatric symptoms associated with illicit AAS use. These began with early anecdotal reports of psychosis (Annitto and Layman, 1980), hypomania (Freinhar and Alvarez, 1985), and major depression (Brower et al., 1989a, Tennant et al., 1988) in individual AAS users. In the late 1980s, our group published the first large psychiatric study of illicit AAS users, reporting interview data from 41 users recruited in the field (Pope and Katz, 1987

Body image drugs

Illicit AAS users often use a wide range of other drugs, and these may cause additional psychiatric and medical effects. First, users often ingest other “body image drugs” to gain muscle, lose fat, and counteract the side effects of AAS or other body image drugs that they are taking (Kanayama et al., 2001b). These drugs include other hormones (human growth hormone, insulin-like growth factor-1 [IGF-1], thyroid hormones, human chorionic gonadotropin, and insulin), stimulants (amphetamine,

AAS dependence

A growing literature, which we have recently reviewed (Kanayama et al., 2010), has also documented that AAS can cause a dependence syndrome. Briefly, individual case reports of AAS dependence have appeared as far back as the late 1980s, describing men who developed chronic and maladaptive AAS use despite adverse medical or psychosocial effects (Brower et al., 1989a, Brower et al., 1990, Hays et al., 1990, Tennant et al., 1988). Over the last 20 years, eight field studies of AAS users (Brower et

Acknowledgments

Supported in part by NIDA grant DA 016744 (to Drs. Pope, Kanayama, and Hudson).

References (253)

  • FryeC.A.

    Some rewarding effects of androgens may be mediated by actions of its 5alpha-reduced metabolite 3alpha-androstanediol

    Pharmacol. Biochem. Behav.

    (2007)
  • GaldurozJ.C. et al.

    Household survey on drug abuse in Brazil: study involving the 107 major cities of the country — 2001

    Addict. Behav.

    (2005)
  • HallR.C. et al.

    Psychiatric complications of anabolic steroid abuse

    Psychosomatics

    (2005)
  • HannanC.J. et al.

    Psychological and serum homovanillic acid changes in men administered androgenic steroids

    Psychoneuroendocrinology

    (1991)
  • HendersonL.P.

    Steroid modulation of GABAA receptor-mediated transmission in the hypothalamus: effects on reproductive function

    Neuropharmacology

    (2007)
  • IrvingL.M. et al.

    Steroid use among adolescents: findings from Project EAT

    J. Adolesc. Health

    (2002)
  • JohanssonP. et al.

    Anabolic androgenic steroids affects alcohol intake, defensive behaviors and brain opioid peptides in the rat

    Pharmacol. Biochem. Behav.

    (2000)
  • KafrouniM.I. et al.

    Hepatotoxicity associated with dietary supplements containing anabolic steroids

    Clin. Gastroenterol. Hepatol.

    (2007)
  • AlexanderG.M. et al.

    Testosterone has rewarding affective properties in male rats: implications for the biological basis of sexual motivation

    Behav. Neurosci.

    (1994)
  • AllnuttS. et al.

    Anabolic steroid withdrawal depression: a case report

    Can. J. Psychiatry

    (1994)
  • AltschuleM.D. et al.

    The use of testosterone in the treatment of depressions

    N. Engl. J. Med.

    (1948)
  • Diagnostic and Statistical Manual of Mental Disorders

    (1987)
  • Diagnostic and statistical manual of mental disorders

    (1994)
  • AnnittoW.J. et al.

    Anabolic steroids and acute schizophrenic episode

    J. Clin. Psychiatry

    (1980)
  • ArvaryD. et al.

    Anabolic–androgenic steroids as a gateway to opioid dependence

    N. Engl. J. Med.

    (2000)
  • BagatellC.J. et al.

    Metabolic and behavioral effects of high-dose, exogenous testosterone in healthy men

    J. Clin. Endocrinol. Metab.

    (1994)
  • BagiaS. et al.

    Anabolic steroid-induced hepatic adenomas with spontaneous haemorrhage in a bodybuilder

    Aust. N. Z. J. Surg.

    (2000)
  • BahrkeM.S. et al.

    Weight training. A potential confounding factor in examining the psychological and behavioural effects of anabolic–androgenic steroids

    Sports Med.

    (1994)
  • BahrkeM.S. et al.

    Psychological moods and subjectively perceived behavioral and somatic changes accompanying anabolic–androgenic steroid use

    Am. J. Sports Med.

    (1992)
  • BahrkeM.S. et al.

    Psychological and behavioural effects of endogenous testosterone and anabolic–androgenic steroids. An update

    Sports Med.

    (1996)
  • BahrkeM.S. et al.

    Risk factors associated with anabolic–androgenic steroid use among adolescents

    Sports Med.

    (2000)
  • BarahalH.

    Testosterone in male involutional melancholia: preliminary report

    Psychiatr. Q.

    (1938)
  • BasariaS. et al.

    Clinical review 138: anabolic–androgenic steroid therapy in the treatment of chronic diseases

    J. Clin. Endocrinol. Metab.

    (2001)
  • BhasinS. et al.

    The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men

    N. Engl. J. Med.

    (1996)
  • BjörkqvistK. et al.

    Testosterone intake and aggressiveness: real effect or anticipation?

    Aggress. Behav.

    (1994)
  • BoyadjievN.P. et al.

    Reversible hypogonadism and azoospermia as a result of anabolic–androgenic steroid use in a bodybuilder with personality disorder. A case report

    J. Sports Med. Phys. Fitness

    (2000)
  • BrowerK.J.

    Withdrawal from anabolic steroids

    Curr. Ther. Endocrinol. Metab.

    (1997)
  • BrowerK.J.

    Anabolic steroid abuse and dependence

    Curr. Psychiatry Rep.

    (2002)
  • BrowerK.J. et al.

    Anabolic–androgenic steroid dependence

    J. Clin. Psychiatry

    (1989)
  • BrowerK.J. et al.

    Anabolic androgenic steroids and suicide

    Am. J. Psychiatry

    (1989)
  • BrowerK.J. et al.

    Evidence for physical and psychological dependence on anabolic androgenic steroids in eight weight lifters

    Am. J. Psychiatry

    (1990)
  • BrowerK.J. et al.

    Symptoms and correlates of anabolic–androgenic steroid dependence

    Br. J. Addict.

    (1991)
  • Brown-SéquardC.

    Des effets produits chez l'homme par des injections souscutanées d'un liquide retiré des testicules frais de cobaye et de chien

    C. R. Séance Soc. Biol.

    (1889)
  • BuckleyW.E. et al.

    Estimated prevalence of anabolic steroid use among male high school seniors

    JAMA

    (1988)
  • CasnerS.W. et al.

    Anabolic steroid effects on body composition in normal young men

    J. Sports Med. Phys. Fitness

    (1971)
  • Centers for Disease Control and Prevention (CDC), 2004. Youth risk behavior surveillance – United States, 2003....
  • Centers for Disease Control and Prevention (CDC), 2008. Youth risk behavior surveillance – United States, 2007....
  • ChoiP.Y. et al.

    Violence toward women and illicit androgenic-anabolic steroid use

    Ann. Clin. Psychiatry

    (1994)
  • ChoiP.Y. et al.

    High-dose anabolic steroids in strength athletes: effects upon hostility and aggression

    Hum. Psychopharmacol.

    (1990)
  • ClarkB.M. et al.

    Dilated cardiomyopathy and acute liver injury associated with combined use of ephedra, gamma-hydroxybutyrate, and anabolic steroids

    Pharmacotherapy

    (2005)
  • Cited by (197)

    • Adenosine receptors participate in anabolic-androgenic steroid-induced changes on risk assessment/anxiety-like behaviors in male and female rats

      2023, Physiology and Behavior
      Citation Excerpt :

      These brain regions, notably the prefrontal cortex areas, amygdala and hippocampus, also process aggressive responses ([25, 69]; Cupaioli et al., 2021). There is a consensus regarding emotional changes induced by exposure to ND [2, 38], and that the adenosine system operates in areas related to inhibitory control [15, 28, 40, 41, 50], however, there is a lack of studies investigating the concomitant administration of ND and caffeine. In the current study, we examined the impact of caffeine and ND (alone and in combination) on risk assessment/anxiety-like behaviors, habituation learning and locomotor activity in both female and male rats.

    • Androgenic steroid excess in women

      2023, Annales d'Endocrinologie
    • Commentary on Androgens and anabolic steroids by Marius Tausk

      2023, Standardizing Pharmacology: Assays and Hormones Discoveries in Pharmacology: Volume 2
    View all citing articles on Scopus
    View full text