Recruitment to Doping & Help-Seeking Behavior of Eight Female Anabolic Androgenic Steroid (AAS) Users

BACKGROUND:

Doping with anabolic androgenic steroids in sports has now developed to a widespread use of these agents among young people outside the sport. This is of major concern to the society. The purpose of the use is mainly for aesthetic reasons and is seen as a male phenomenon. But use also occurs in women where the knowledge is scarce. Our aim was to identify the pattern of doping agents in eight female cases and compare them with similar data from men.

METHODS:

Eight female users were recruited through Anti-Doping Hot-Line, a national telephone counseling service on doping issues during the years 1998-2004. The use was confirmed with urine doping analysis at the Doping Laboratory. The characteristic of use, co-use of narcotics/other doping agents, exercise pattern, adverse-side effects, family history and reason to begin was evaluated.

RESULTS:

The women used on average 1.9 different anabolic androgenic steroids and clenbuterol preparations. Ephedrine and growth hormone were co-used in five and one of the women, respectively. Three women reported co-use of narcotics (cannabis and cocaine). The average duration of anabolic agent use before contacting health care was 58 weeks (range 7-104). Side effects for anabolic androgenic steroids (n = 5) included voice changes, clitoral enlargement, body hair growth, whereas women using clenbuterol (n = 2) reported tachycardia and depression. All women except one had a man in close relationship encouraging them to begin with the doping agents.

CONCLUSIONS:

The use of doping agents in our eight women was different from that in male users. The women used less doping agents and were more prone to contact the health care, at an earlier stage, probably due to the adverse effects. The co-use with ephedrine, growth hormone and cannabis appeared to be in the same range as in men. This is the first study showing that a man in close relationship may motivate a woman to use anabolic agents.

Adverse effects, reported and observed, in women using AAS or clenbuterol

Subject	Self-reported adverse effect	Cholesterol mmol/L	HDL/LDL mmol/L	HB g/L
K1	Clitoral enlargement, voice change, body hair growth, menstrual disorders	4.2	0.7/3.3	135
K2	Tachycardia, depression	3.2	1.2/1.6	125
K3	Tachycardia, depression, mood changes, edema	5.9	1.4/4	NA
K4	Clitoral enlargement, voice change, menstrual disorders, acne, body hair growth	3.8	0.6/3	154
K5	Enlarged clitoris, voice change, body hair growth, acne, menstrual disorder	3.6	1.5/1.9	134
K6	Clitoral enlargement, voice change, menstrual disorders, body hair growth, aggressiveness, acne, memory disturbance, stretch marks, tremor, tachycardia, depression	3.9	1.2/2.1	134
K7	Clitoral enlargement, voice change, menstrual disorders, acne, mood changes, depression, lost hair head	4.3	1.9/2.0	134
K8	Clitoral enlargement, voice change, mood swings, stretch marks, reduced breast	3.2	0.7/2.2	128

Full article at:   http://goo.gl/d6tb1V

By:  Börjesson A1,2, Gårevik N3,4, Dahl ML5,6, Rane A7,8, Ekström L9,10.

• 1Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. annica.borjesson@ki.se.
• 2Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. annica.borjesson@ki.se.
• 3Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Nina.Garevik@ki.se.
• 4Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Nina.Garevik@ki.se.
• 5Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Marja-Liisa.Dahl@ki.se.
• 6Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Marja-Liisa.Dahl@ki.se.
• 7Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Anders.Rane@ki.se.
• 8Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Anders.Rane@ki.se.
• 9Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Lena.Ekstrom@ki.se.
• 10Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. Lena.Ekstrom@ki.se. 
• Subst Abuse Treat Prev Policy. 2016 Mar 5;11(1):11. doi: 10.1186/s13011-016-0056-3.

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Characteristics and Behaviors of Older Male Anabolic Steroid Users

OBJECTIVE:

To compare and contrast the characteristics of 2 groups of men ≥40 years old: reported anabolic-androgenic steroid (AAS) users and nonusers...

...MAIN OUTCOMES MEASURED:

Demographics, utilization of AAS and other performance-enhancing agents (PEAs), exercise patterns, history of illicit drugs and alcohol use, and psychiatric traits/diagnoses.

RESULTS:

The majority of AAS users ≥40 years old were caucasian (92.5%), heterosexual (97.0%), and classified themselves as recreational exercisers (79.1%). AAS users took more PEAs (11.5 ± 5.6 vs 4.6 ± 2.7; P < .001), were more likely to binge drink (47.8% vs 29.0%; P = .025), report heavy alcohol use (21.0% vs 7.9%; P = .031), meet criteria for substance dependence disorder (27.4% vs 4.0%; P < .001), and report an anxiety disorder diagnosis (12.0% vs 2.6%; P = .046) than nonusers.

CONCLUSIONS:

AAS misuse is prevalent among older men and is associated with polypharmacy, more aggressive alcohol use, and a higher incidence of substance dependence and anxiety disorders compared to nonusers. This information may help clinicians and researchers identify and develop appropriate intervention strategies for AAS abuse among older men.

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By:  Ip EJ1, Trinh K2, Tenerowicz MJ2, Pal J2, Lindfelt TA2, Perry PJ2.

• 1Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA eric.ip@tu.edu.
• 2Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA.
• J Pharm Pract. 2015 Oct;28(5):450-6. doi: 10.1177/0897190014527319. Epub 2014 Mar 18.

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Mad Men, Women & Steroid Cocktails: A Review of the Impact of Sex & Other Factors on Anabolic Androgenic Steroids Effects on Affective Behaviors

RATIONALE:

For several decades, elite athletes and a growing number of recreational consumers have used anabolic androgenic steroids (AAS) as performance enhancing drugs. Despite mounting evidence that illicit use of these synthetic steroids has detrimental effects on affective states, information available on sex-specific actions of these drugs is lacking.

OBJECTIVES:

The focus of this review is to assess information to date on the importance of sex and its interaction with other environmental factors on affective behaviors, with an emphasis on data derived from non-human studies.

METHODS:

The PubMed database was searched for relevant studies in both sexes.

RESULTS:

Studies examining AAS use in females are limited, reflecting the lower prevalence of use in this sex. Data, however, indicate significant sex-specific differences in AAS effects on anxiety-like and aggressive behaviors, interactions with other drugs of abuse, and the interplay of AAS with other environmental factors such as diet and exercise.

CONCLUSIONS:

Current methods for assessing AAS use have limitations that suggest biases of both under- and over-reporting, which may be amplified for females who are poorly represented in self-report studies of human subjects and are rarely used in animal studies. Data from animal literature suggest that there are significant sex-specific differences in the impact of AAS on aggression, anxiety, and concomitant use of other abused substances. These results have relevance for human females who take these drugs as performance-enhancing substances and for transgender XX individuals who may illicitly self-administer AAS as they transition to a male gender identity.

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By:  Onakomaiya MM1, Henderson LP2.

• 1Cherokee Nation Technology Solutions Contractor to: The National Intrepid Center of Excellence (NICoE) Network Research Program, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda, MD, 20889, USA. marie.m.onakomaiya.gr@dartmouth.edu.
• 2Department of Physiology and Neurobiology, Geisel School of Medicine at Dartmouth, HB 7701, Hanover, NH, 03755, USA. 
• Psychopharmacology (Berl). 2016 Feb;233(4):549-69. doi: 10.1007/s00213-015-4193-6. Epub 2016 Jan 12.

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The Misuse of Anabolic-Androgenic Steroids among Iranian Recreational Male Body-Builders and Their Related Psycho-Socio-Demographic Factors

Background:

The high prevalence and potential side effects of anabolic-androgenic steroids (AAS) misuse by athletes has made it a major public health concern. Epidemiological studies on the abuse of such drugs are mandatory for developing effective preventive drug control programs in sports community. This study aimed to investigate the prevalence of AAS abuse and their association with some psycho-socio-demographic factors in Iranian male recreational body-builders.

Methods:

Between March and October 2011; 906 recreational male body-builders from 103 randomly selected bodybuilding clubs in Tehran, Iran were participated in this study. Some psycho-socio- demographic factors including age, job, average family income, family size, sport experience (months), weekly duration of the sporting activity (h), purpose of participation in sporting activity, mental health as well as body image (via General Health Questionnaire and Multidimensional Body-Self Relations Questionnaire, respectively), and history of AAS use were obtained by interviews using questionnaires.

Results:

Participants were all recreational male body-builders [mean age (SD): 25.7 (7.1), ranging 14–56 yr]. Self-report of AAS abuse was registered in 150 body-builders (16.6%). Among different psycho-socio-demographic factors, only family income and sport experience were inversely associated with AAS abuse.

Conclusion:

Lifetime prevalence of AAS abuse is relatively high among recreational body-builders based on their self-report. Some psycho-socio-demographic factors including family income and sport experience may influence the prevalence of AAS abuse.

Below:  Comparison of Body image General Health Questionnaire (GHQ28) subscales between AAS users and non-users

Below:  Comparison of Multidimensional Body-Self Relations Questionnaire-Appearance (MBSRQ-AS) subscales between AAS users and non-users

Full article at:   http://goo.gl/sIvwpz

By:  Hooman Angoorani¹ and Farzin Halabchi^2,3,*

^1.Dept. of Sports and Exercise Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

^2.Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran

^3.Dept. of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

^*Corresponding Author: Email: ri.ca.smut@ihcbalahf

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Heavy Testosterone Use among Bodybuilders: An Uncommon Cohort of Illicit Substance Users

OBJECTIVE:

To identify and characterize patterns of use among a contemporary cohort of current anabolic-androgenic steroid (AAS) users.

PATIENTS AND METHODS:

An anonymous, self-administered, 49-item questionnaire was posted on message boards of Internet websites popular among AAS users and administered via SurveyMonkey from February 1, 2015, to June 1, 2015. Thirty-seven questions were analyzed for this study.

RESULTS:

A total of 231 male respondents met the inclusion criteria. 

• Most were white, were older than 25 years, were employed with above average income, and had received a formal education beyond high school. 
• 93% began using AAS after the age of 18 years, and 
• 81% reported using 400 mg or more of testosterone per week. 

Factors associated with longer duration of use (>5 years) included 

• higher incomes (≥$75,000, P=.003), 
• increased testosterone dosages (>600 mg per week, P=.007), 
• older age (≥35 years, P<.001), 
• being married (P<.001), 
• and being self-employed (P<.001). 

The Internet was the most common source of testosterone (53%). 

• 93% used at least one additional performance-enhancing drug. 
• 77% had routine laboratory tests performed, and 
• 38% reported laboratory abnormalities at some point. 

Nearly all experienced subjective adverse effects while using and not using testosterone. 

• 53% reported use of other illegal substances, 
• most commonly (90%) beginning before AAS initiation. 
• 10% had a criminal conviction, 
• 91% of which preceded AAS use. 
• 50% were felonies.

CONCLUSION:

The population of AAS users is disparate from that of other drugs of abuse. Laboratory test abnormalities and adverse effects are common and should be taken into account when counseling patients who may be using AASs.

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By:  Westerman ME1, Charchenko CM1, Ziegelmann MJ1, Bailey GC1, Nippoldt TB2, Trost L3.

• 1Department of Urology, Mayo Clinic, Rochester, MN.
• 2Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN.
• 3Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: Trost.Landon@mayo.edu (http://www.mayoclinic.org/biographies/trost-landon-w-m-d/bio-20055549)
• Mayo Clin Proc. 2016 Jan 5. pii: S0025-6196(15)00890-3. doi: 10.1016/j.mayocp.2015.10.027. 

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Do Performance & Image Enhancing Drug Users in Regional Queensland Experience Difficulty Accessing Health Services?

INTRODUCTION AND AIM:

To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland.

DESIGN AND METHODS:

Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides.

RESULTS:

Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances.

DISCUSSION AND CONCLUSION:

Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. 

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By:   Dunn M1,2, Henshaw R3, McKay FH1.

• 1School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia.
• 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
• 3Queensland Health, Brisbane, Australia. 

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Black Market Products Confiscated in Norway 2011-2014 Compared to Analytical Findings in Urine Samples

Doping agents are widely and illicitly distributed through the Internet. Analysis of these preparations is useful in order to monitor the availability of prohibited substances on the market, and more importantly to predict which substances are expected to be found in urine samples collected from athletes and to aid clinical and forensic investigations. 

Based on a close collaboration with the Norwegian police and the Norwegian custom authorities, the Norwegian Doping Control Laboratory has performed analyses of confiscated material suspected of containing doping agents. The analyses were performed using gas chromatography (GC) and liquid chromatography (LC) combined with mass spectrometry (MS). 

The majority (67%) of the analyzed black market products contained anabolic- androgenic steroids (AAS) as expected, whereas peptide- and protein-based doping substances were identified in 28% of the preparations. 

The Norwegian Doping Control Laboratory receives samples collected from recreational and elite athletes in addition to samples collected in clinical and forensic investigations. 

The findings in the seized material reflected the findings in the urine samples analyzed regarding the anabolic steroids. Thus, analyzing material seized in Norway may give a good indication of doping agents available on the local market. 

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By:  Hullstein IR1, Malerod-Fjeld H1, Dehnes Y1, Hemmersbach P1,2.

• 1Norwegian Doping Control Laboratory, Oslo University Hospital, Aker Hospital, P.O. Box 4959 Nydalen, 0424, Oslo, Norway.
• 2School of Pharmacy, University of Oslo, P.O. Box 1068 Blindern, 0316, Oslo, Norway. 

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Self-Perceived Weight and Anabolic Steroid Misuse among US Adolescent Boys

Purpose

Anabolic steroid misuse is a growing concern among adolescent boys, and chronic misuse is associated with multisystemic health consequences. However, little is known about weight related predictors of anabolic steroid misuse. We examined the prediction of lifetime anabolic steroid misuse as a function of self-perceived weight status among US adolescent boys.

Methods

Analysis was undertaken using the 2013 Youth Risk Behavior Survey, a nationally representative data set sampling public and private high school students throughout the United States. Data from a total of 6,000 US adolescent boys were used in the present study.

Results

The prevalence of ever misusing anabolic androgenic steroids was 12.6% among boys who viewed themselves as very underweight, 11.9% for boys who viewed themselves as very overweight, compared with 3.8% for boys who viewed themselves as about the right weight. Compared to boys who viewed themselves as about the right weight, boys who self-perceived themselves as very underweight (adjusted odds ratio = 6.9, 95% confidence interval: 2.7–17.7, p < .001) and very overweight (adjusted odds ratio = 3.8, 95% confidence interval: 1.8–7.7, p < .001) were significantly associated with increased risk of anabolic androgenic steroid misuse.

Conclusions

Large effect size estimates were revealed, suggesting that anabolic androgenic steroid misuse is not solely a function of boys desiring increased mass; boys who desire leanness are also likely to misuse anabolic androgenic steroids. Future prevention efforts should target not only boys who view themselves as underweight but also those who perceive themselves as overweight.

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By:  Jonathan D. Jampel,  Stuart B. Murray, Ph.D., Scott Griffiths, Aaron J. Blashill, Ph.D.

Affiliations

Department of Psychology, San Diego State University, San Diego, California

Department of Psychology, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California

Correspondence

Address correspondence to: Aaron J. Blashill, Ph.D., Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA 92120.

 

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Infectious Disease, Injection Practices & Risky Sexual Behavior among Anabolic Steroid Users

Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. 

This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984-17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. 

In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases.

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By: Ip EJ1, Yadao MA1, Shah BM2, Lau B3,4.

• 1a Department of Clinical Sciences , Touro University California College of Pharmacy , Vallejo , CA , USA.
• 2b Department of Social , Behavioral, and Administrative Sciences, Touro University California College of Pharmacy , Vallejo , CA , USA.
• 3c Department of Emergency Medicine , Kaiser Permanente Santa Clara Medical Center , Santa Clara , CA , USA.
• 4d Division of Emergency Medicine , Stanford University School of Medicine , Palo Alto , CA , USA. 

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