Anabolic-androgenic steroids abuse

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Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Anabolic steroids were ranked 19th in dependence, 9th in physical harm, and 15th in social harm. Rational harm assessment of drugs radar plot.svg
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Anabolic steroids were ranked 19th in dependence, 9th in physical harm, and 15th in social harm.

Research data indicates that steroids affect the serotonin and dopamine neurotransmitter systems of the brain. [2] In an animal study, male rats developed a conditioned place preference to testosterone injections into the nucleus accumbens, an effect blocked by dopamine antagonists, which suggests that androgen reinforcement is mediated by the brain. Moreover, testosterone appears to act through the mesolimbic dopamine system, a common substrate for addictive substances. Nonetheless, androgen reinforcement is not comparable to that of cocaine, nicotine, or heroin. Instead, testosterone resembles other mild reinforcers, such as caffeine, or benzodiazepines. The potential for androgen addiction remains to be determined. [3]

Contents

Anabolic steroids are not psychoactive[ citation needed ] and cannot be detected by stimuli devices like a pupilometer which makes them hard to spot as a source of neuropsychological imbalances in some AAS users.


Prevalence

Early studies of illicit use of anabolic-androgenic steroids conducted in the 1970s-2000's, using questionnaires and police reports, were likely subject to underestimate bias. [4] Nevertheless, some studies in 2000’s reported, that 5-10 % of male students in USA and Australia took anabolic steroids for athletic and cosmetic reasons. [5]

More studies of anabolic steroid use were reported after 2010. Several meta-reviews published in 2014 and 2015 concluded, that overall use (unspecified frequency) of anabolic steroids was ca. 6.4% for men and 1.6% for women. [6] The highest rate was reported for men in the Middle East (21.7 %) followed by South America (4.8%), Europe (3.8%), North America (3.0%), Oceania (2.6%), Africa (2.4%) and Asia (0.2%). The three largest categories of men by motivation were recreational sportsmen (18 %), competitive athletes (13 %) and prisoners (12 %).

The prevalence of steroid use among prison inmates according to questionnaires was 3.7% in Finland in 1998, [7] 25 % in Sweden in 2010, [8] 7.5% for Norway for current use and 33% for former use in 2021. [9] In contrast, a 2021 Belgian study reported, that anabolic steroids comprise “a marginal share in the consumption of all drugs” in country’s prisons. [10]

Several analyses of news reporting anabolic steroid busts, sales and use in Valencia, Spain published in 2014-2019 concluded, that the use of these substances goes beyond bodybuilders and elite athletes, but also encompasses members of armed forces, security guards, affiliates of extreme right parties and porn actors. [11] More recent questionnaire studies report 2-5 % prevalence rate of occasional steroid use among men in Europe, Australia and Americas. [12] These numbers, however, are lower than those of cannabis ( ca 65%), cocaine (ca. 24%), LSD (14%) and heroin (4%). Notably, securing an athletic scholarship in college was among motivations for teenage steroid users in the USA. [13]

With advancements in analytic chemistry methods (see Liquid chromatography–mass spectrometry) by mid-2000’s it became possible to directly measure traces of various drugs and of their metabolites and conjugates in sewage. [14] In order to reduce the contributions from naturally present products (e.g. from testosterone), most reliable data are those for synthetic steroids with unique metabolites, such as nandrolone. Also, the effects from steroid use in animal farming were reduced by focusing on urban wastewater samples. Nevertheless, the number of such studies remains small as of 2023, and there is still no comprehensive spatio-temporal data in the open literature. [15] Most published studies are limited to single localities and to samples collected for a period of one month or less. Despite these shortcomings, it has been demonstrated, that certain sporting events result in a temporal increase in performance-enhancing and recreational drugs as well as of their metabolites in sewage.

Examples are:

2010 German study of sewage samples from fitness centers in Aachen found an order of magnitude diurnal variability of boldenone and a smaller variation in methyltestosterone. [16]

A 2018 Dutch-Spanish study [17] of small town sewage during two bodybuilding competitions without anti-doping control found substantial rise in 2,4-dinitrophenol (weight loss medication) concentration as well as an occasional appearance of methandienone and nandrolone.

2018 study by the University of Mississippi found a substantial increase in amphetamine, benzoylecgonine (the main metabolite of cocaine) and oxazepam in the campus sewage on weekends, when the Ole Miss Rebel football team held home games. [18] Steroids were not investigated in this study.

Several waste-water epidemiologic studies have been reported by the University of Queensland (Australia) since 2017. [19] In their earlier work the researchers did not find an increase in steroid metabolites or in testosterone/epitestosterone ratio in sewage during a bodybuilding competition in town. [20] It is likely, that these results were flawed, because they did not account for bioconjugation of the metabolites. [21] [22] Interestingly, since 2011 the Australian group has observed increasing levels of selective androgen receptor modulators- a class of investigational non-steroidal anabolics, which has not been approved for medical use. [23]

A 2023 study from Guangzhou University (PR China) [24] found a 9±1-fold spike in boldenone in the university campus sewage during a 2-week athletic event and smaller increases in methandienone, testosterone and androstenedione.

Dependence potential

The Diagnostic Statistical Manual IV (DSM IV) and the International Classification of Diseases, Volume 10 (ICD-10) differ in the way they regard Anabolic-Androgenic Steroids' (AAS) potential for producing dependence.

DSM IV regards AAS as potentially dependence producing. ICD-10, however, regards them as non-dependence producing. [25] Anabolic steroids are not physically addictive but users can develop a psychological dependence on the physical result. [26]

Diagnostic Statistical Manual

For DSM-IV, anabolic-androgenic steroid dependency is found in the "other substance-related disorder" (which includes inhalants, anabolic steroids, medications) section and can be coded, depending on which diagnostic criteria are met. [27]

International Classification of Diseases

ICD–10 criteria for dependence include experience of at least three of the following during the past year: [28]

However, the following ICD-10-CM Index entries contain back-references to ICD-10-CM F55.3: [29]

ICD-10 goes on to state that "although it is usually clear that the patient has a strong motivation to take the substance, there is no development of dependence or withdrawal symptoms as in the case of the psychoactive substances." [27]

National Institute on Drug Abuse

The National Institute on Drug Abuse (NIDA) says that "even though anabolic steroids do not cause the same high as other drugs, steroids are reinforcing and can lead to addiction. Studies have shown that animals will self-administer steroids when given the opportunity, just as they do with other addictive drugs. People may persist in abusing steroids despite physical problems and negative effects on social relationships, reflecting these drugs' addictive potential. Also, people who use anabolic steroids typically spend large amounts of time and money obtaining the drug; another indication of addiction. Individuals who use anabolic steroids can experience withdrawal symptoms when they stop taking them, including mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued use. One of the most dangerous withdrawal symptoms is depression. When depression is persistent, it can sometimes lead to suicidal thoughts. Research has found that some people who use anabolic steroids turn to other substances such as opioids to counteract the negative effects of steroids." [30]

Causes and treatment

Males who use anabolic androgenic steroids often have a troubled social background. [31]

Childhood trauma

25% of male weightlifters reported memories of childhood physical or sexual abuse in an interview.[ citation needed ] Anabolic steroids are sometimes used by people with muscle dysmorphia (a specific type of body dysmorphic disorder (BDD)) as a defense mechanism. [32] Yohimbine (a common pre-workout ingredient), although it fails to increase testosterone levels as had at first been suspected, has at higher doses been discovered to be useful in facilitating recall of traumatic memories during post traumatic stress disorder (PTSD) treatment that can be used in conjunction with exposure therapy. [33] [34] [35]

Illicit use by groups

Criminals

Anabolic steroid use has been associated with an antisocial lifestyle involving various types of criminality. [36]

Governments

Law enforcement

Steroid abuse among law enforcement is considered a problem by some. "It's a big problem, and from the number of cases, it's something we shouldn't ignore. It's not that we set out to target cops, but when we're in the middle of an active investigation into steroids, there have been quite a few cases that have led back to police officers," says Lawrence Payne, a spokesman for the United States Drug Enforcement Administration. [37] The FBI Law Enforcement Bulletin stated that "Anabolic steroid abuse by police officers is a serious problem that merits greater awareness by departments across the country". [38] It is also believed that police officers across the United Kingdom "are using criminals to buy steroids and abuse their power for sexual gratification" which he claims to be a top risk factor for police corruption.

Sports

Professional wrestling

Following the resurgence of Bill Graham, the Oversight and Government Reform Committee investigated steroid usage in the wrestling industry. [39] The Committee investigated WWE and Total Nonstop Action Wrestling (TNA), asking for documentation of their companies' drug policies. WWE CEO and Chairman, Linda and Vince McMahon respectively, both testified. The documents stated that 75 wrestlers—roughly 40 percent—had tested positive for drug use since 2006, most commonly for steroids. [40] [41]

Students

Middle school

According to a 1998 study, 2.7% of middle school students (between 9 and 13 years of age) from four public middle schools in Massachusetts admitted to taking steroids, with similar numbers for boys and girls. 2% of non-users indicated they would use steroids in the future. [42] This study was critisized on the grounds, that the students probably did not understand the questions, and thought that they were asked about over-the-counter supplements. [43]

A similar study conducted in 2005-2006 (with the majority of students coming from New Jersey) found a low AAS's use among middle schoolers, although the numbers over 6% were reported for middle school male football players. [44] In a questionaire study conducted in 2013-2015 1 % of Massachusetts high school male students reported using anabolic steroids without a prescription at least once. The numbers were somewhat higher for black (2.9%) and gay (8%) students. [45]

Recreational users

A high-profile 2007 study [46] by the University of South Florida based on an anonymous internet survey concluded, that median anabolic steroid user in the USA is a 29-years old single white male, who started "juicing" after the age of 25. Most users have a bachelor degree or higher, are employed white collar professionals with an above average income, and not active in competitive sports. This user profile is quite different from those of typical substance abusers.

Side effects

There are heavy physiological side effects that affect the human body upon using anabolic steroids. Both men and women can use androgenic (testosterone) hormones and experience the repercussions. There are "Male Specific", [47] "Female Specific", [47] Universal, [47] Physical, [47] Injection related, [47] and Psychological [47] side effects that occur from anabolic steroid use.

Male specific side effects

These side effects pertain to males which include: [47]

Female specific side effects

These side effects pertain to females which include: [47]

Universal side effects

These side effects can happen to any people of any sex. They are broken down into three categories which are the Physical, [48] Injection related, [47] and Psychological [47] side effects.

Physical side effects

Side effects that men and women experience physically include: [47]

Injection side effects

Common side effects of anabolic steroid use via injection include: [47]

Psychological side effects

Anabolic steroid abuse can affect one's psyche, regardless of gender. Psychological damages from abuse include: [47]

Note that all of these side effects of anabolic steroid use may or may not occur. Side effects occur because of hormonal imbalances. Non-direct reasonings for steroid use for sports can also stem from the low positive dope tests that occur before an event. [49] When competition is at an all-time high, the incentive to use steroids becomes that much easier as sports events do not have a just way to provide fool-proof drug tests. [48]

Related Research Articles

<span class="mw-page-title-main">Methyltestosterone</span> Chemical compound

Methyltestosterone, sold under the brand names Android, Metandren, and Testred among others, is an androgen and anabolic steroid (AAS) medication which is used in the treatment of low testosterone levels in men, delayed puberty in boys, at low doses as a component of menopausal hormone therapy for menopausal symptoms like hot flashes, osteoporosis, and low sexual desire in women, and to treat breast cancer in women. It is taken by mouth or held in the cheek or under the tongue.

<span class="mw-page-title-main">Nandrolone decanoate</span> Anabolic steroid

Nandrolone decanoate, sold under the brand name ROLON among others, is an androgen and anabolic steroid (AAS) medication which is used primarily in the treatment of anemias and wasting syndromes, as well as osteoporosis in menopausal women. It is given by injection into muscle or fat once every one to four weeks.

<span class="mw-page-title-main">Oxymetholone</span> Androgen and anabolic steroid

Oxymetholone, sold under the brand names Anadrol and Anapolon among others, is an androgen and anabolic steroid (AAS) medication which is used primarily in the treatment of anemia. It is also used to treat osteoporosis, HIV/AIDS wasting syndrome, and to promote weight gain and muscle growth in certain situations. It is taken by mouth.

<span class="mw-page-title-main">Metandienone</span> Androgen and anabolic steroid

Metandienone, also known as methandienone or methandrostenolone and sold under the brand name Dianabol (D-Bol) among others, is an androgen and anabolic steroid (AAS) medication which is still quite often used because of its affordability and effectiveness for bulking cycles. It is also used non-medically for physique- and performance-enhancing purposes. It is often taken by mouth.

<span class="mw-page-title-main">Quinbolone</span> Chemical compound

Quinbolone, sold under the brand names Anabolicum and Anabolvis, is an androgen and anabolic steroid (AAS) which was previously marketed in Italy. It was developed by Parke-Davis as a viable orally administered AAS with little or no liver toxicity.

<span class="mw-page-title-main">Testosterone enanthate</span> Chemical compound

Testosterone enanthate is an androgen and anabolic steroid (AAS) medication which is used mainly in the treatment of low testosterone levels in men. It is also used in hormone therapy for transgender men. It is given by injection into muscle or subcutaneously usually once every one to four weeks.

<span class="mw-page-title-main">Metenolone enanthate</span> Chemical compound

Metenolone enanthate, or methenolone enanthate, sold under the brand names Primobolan Depot and Nibal Injection, is an androgen and anabolic steroid (AAS) medication which is used mainly in the treatment of anemia due to bone marrow failure. It is given by injection into muscle. Although it was widely used in the past, the drug has mostly been discontinued and hence is now mostly only available on the black market. A related drug, metenolone acetate, is taken by mouth.

<span class="mw-page-title-main">Norethandrolone</span> Chemical compound

Norethandrolone, sold under the brand names Nilevar and Pronabol among others, is an androgen and anabolic steroid (AAS) medication which has been used to promote muscle growth and to treat severe burns, physical trauma, and aplastic anemia but has mostly been discontinued. It is still available for use in France however. It is taken by mouth.

<span class="mw-page-title-main">Mesterolone</span> Chemical compound

Mesterolone, sold under the brand name Proviron among others, is an androgen and anabolic steroid (AAS) medication which is used mainly in the treatment of low testosterone levels. It has also been used to treat male infertility, although this use is controversial. It is taken by mouth.

<span class="mw-page-title-main">Fluoxymesterone</span> Chemical compound

Fluoxymesterone, sold under the brand names Halotestin and Ultandren among others, is an androgen and anabolic steroid (AAS) medication which is used in the treatment of low testosterone levels in men, delayed puberty in boys, breast cancer in women, and anemia. It is taken by mouth.

<span class="mw-page-title-main">Trenbolone acetate</span> Chemical compound

Trenbolone acetate, sold under brand names such as Finajet and Finaplix among others, is an androgen and anabolic steroid (AAS) medication which is used in veterinary medicine, specifically to increase the profitability of livestock by promoting muscle growth in cattle. It is given by injection into muscle.

<span class="mw-page-title-main">Trestolone</span> Chemical compound

Trestolone, also known as 7α-methyl-19-nortestosterone (MENT), is an experimental androgen/anabolic steroid (AAS) and progestogen medication which has been under development for potential use as a form of hormonal birth control for men and in androgen replacement therapy for low testosterone levels in men but has never been marketed for medical use. It is given as an implant that is placed into fat. As trestolone acetate, an androgen ester and prodrug of trestolone, the medication can also be given by injection into muscle.

<span class="mw-page-title-main">Selective androgen receptor modulator</span> Class of pharmaceutical drugs

Selective androgen receptor modulators (SARMs) are a class of androgen receptor ligands that were developed with the intention of maintaining some of the desirable effects of androgens, such as improving bone density and increasing lean body mass, with a much lower risk of androgenic side effects than alternative therapies such as testosterone.

<span class="mw-page-title-main">Anabolic steroid</span> Steroidal androgen that is structurally related and has similar effects to testosterone

Anabolic steroids, also known as anabolic-androgenic steroids (AAS), are synthetic substances that mimic the effects of testosterone, the male sex hormone. They are used to increase muscle size, strength, and performance and are commonly associated with athletic performance enhancement and bodybuilding. Anabolic steroids are classified as Schedule III controlled substances in many countries due to their potential for abuse and adverse health effects.

See also *Anabolic-androgenic steroids abuse

<span class="mw-page-title-main">Nandrolone phenylpropionate</span> Anabolic steroid

Nandrolone phenylpropionate (NPP), or nandrolone phenpropionate, sold under the brand name Durabolin among others, is an androgen and anabolic steroid (AAS) medication which has been used primarily in the treatment of breast cancer and osteoporosis in women. It is given by injection into muscle once every week. Although it was widely used in the past, the drug has mostly been discontinued and hence is now mostly no longer available.

<span class="mw-page-title-main">Dimethandrolone undecanoate</span> Chemical compound

Dimethandrolone undecanoate (DMAU), also known by its developmental code name CDB-4521, is an experimental androgen/anabolic steroid (AAS) and progestogen medication which is under development as a potential birth control pill for men. It is taken by mouth, but can also be given by injection into muscle.

<span class="mw-page-title-main">11β-Methyl-19-nortestosterone dodecylcarbonate</span> Chemical compound

11β-Methyl-19-nortestosterone 17β-dodecylcarbonate (11β-MNTDC) is a synthetic and orally active anabolic–androgenic steroid (AAS) and a derivative of nandrolone (19-nortestosterone) which was developed by the Contraceptive Development Branch (CDB) of the National Institute of Child Health and Human Development (NICHD) and has not been marketed for medical use at this time. It is an androgen ester – specifically, the C17β dodecylcarbonate ester of 11β-methyl-19-nortestosterone (11β-MNT) – and acts as a prodrug of 11β-MNT in the body.

<span class="mw-page-title-main">11β-Methyl-19-nortestosterone</span> Chemical compound

11β-Methyl-19-nortestosterone (11β-MNT) is a synthetic and orally active anabolic–androgenic steroid (AAS) and a derivative of nandrolone (19-nortestosterone) which was developed by the Contraceptive Development Branch (CDB) of the National Institute of Child Health and Human Development (NICHD) and has not been marketed at this time.

References

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  21. ↑ In-Sample Stability of 52 Performance- and Image-Enhancing Drug Biomarkers in Wastewater. 2023. ACS ES&T Wat. 3/3, 669-78. K.M. Shimko, J.W. O'brien, X.L. Lin, B.J. Tscharke, K.V. Thomas. doi: 10.1021/acsestwater.2c00393.
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