Charles E. Yesalis

Anabolic-androgenic steroids: current issues

SummaryThe use of drugs to enhance physical performance has been observed for thousands of years. Today, individuals continue to use a variety of substances, including anabolic-androgenic steroids, in the hope of enhancing their performance and appearance. Rumours persist regarding the incidence of the nonmedical use of anabolic steroids by athletes and nonathletes: however, true estimates are now available based on the results of systematic surveys.Although the vast majority of the athletic community accepts that anabolic steroids enhance performance and appearance, the extent to which this occurs and the factors influencing such effects remain incompletely understood and documented. Refinement of our knowledge of the ergogenic effects of anabolic steroids is not without merit; however, the existing scientific evidence coupled with an overwhelming number of anecdotal accounts argues against devoting significant resources to this area of investigation at present. The short term health effects of anabolic steroids have been increasingly studied and reviewed, and while anabolic steroid use has been associated with several adverse and even fatal effects, the incidence of serious effects thus far reported has been extremely low.The long term effects of anabolic steroid use are generally unknown. Unfortunately, the lack of scientific information on long term health effects has impeded, if not precluded, the formation of effective health education and drug abuse prevention strategies. Consequently, efforts should be expanded in the areas of prevention and education.

Risk Factors Associated With Anabolic-Androgenic Steroid Use Among Adolescents

AbstractTo identify risk factors associated with anabolic-androgenic steroid (AAS) use among adolescents, computerised and manual literature searches were performed and the resultant local, state, national and international reports of illicit AAS use by adolescents that referenced risk factors were reviewed. Results indicate that adolescent AAS users are significantly more likely to be males and to use other illicit drugs, alcohol and tobacco. Student athletes are also more likely than non-athletes to use AAS, and football players, wrestlers, weightlifters and bodybuilders have significantly higher prevalence rates than students not engaged in these activities. Currently, only a partial profile can be created to characterise the adolescent AAS user. Further research will be needed before associations can be made with a reasonable degree of confidence regarding risk factors such as athletic participation, ethnicity, socioeconomic status and educational level. More importantly, to improve prevention and intervention strategies, a better understanding of the process involved in initiating AAS use is needed, including vulnerability factors, age of initiation and the use of other illicit drugs.

Psychological and Behavioural Effects of Endogenous Testosterone Levels and Anabolic-Androgenic Steroids Among Males

SummaryThe psychological and behavioural effects of endogenous testosterone levels and anabolic-androgenic steroids in males have been investigated for over 50 years in both clinical and nonmedical uses, including the influence of anabolic-androgenic steroids on the nervous system and neuromuscular expression as a mechanism for behavioural and ergogenic effects. The relationship between moods, behaviour and endogenous plasma testosterone levels, as well as anabolic steroids and corticosteroid administration has been studied, including psychological dependence, withdrawal effects, and major methodological issues. While a relationship between endogenous testosterone levels and aggressive behaviour has been observed in various animal species, it is less consistent in humans. It can be concluded that, although the use of exogenous anabolic-androgenic steroids may have psychological and behavioural effects in some patients and athletes, the effects are variable, transient upon discontinuation of the drugs, and appear to be related to type (17α-alkalated rather than 17β-esterified), but not dose, of anabolic-androgenic steroids administered. The roles of genetic factors, medical history, environmental and peer influences, and individual expectations are likewise unclear. In general, the evidence at present is limited and much additional research will be necessary for a complete understanding of this relationship.

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

SummaryEndogenous testosterone levels have been linked to aggressive behaviour in both animals and humans. Studies administering moderate doses of exogenous testosterone for contraceptive and clinical purposes reveal essentially no adverse effects on male sexual and aggressive behaviour. However, investigations and case reports of athletes, usually involving higher doses, demonstrate an association between anabolic-androgenic steroid use and affective and psychotic syndromes and psychological dependence. Efforts to study the psychological and behavioural effects of anabolic-androgenic steroids are complicated by a variety of methodological limitations. Only 3 prospective, blinded studies demonstrating aggression or adverse overt behaviour resulting from anabolic-androgenic steroid use have been reported. With estimates of over 1 million past or current users in the US, an extremely small percentage of individuals using anabolic-androgenic steroids appear to experience mental disturbances severe enough to result in clinical treatment and medical case reports. Even among those so affected, the roles of previous psychiatric history, genetic susceptibility to addictions or mental disorders, environmental and peer influences, and individual expectations remain unclear.

Self-Reported Use of Anabolic-Androgenic Steroids by Elite Power Lifters.

In brief: Sixty-one athletes competed in the 1987 National Championship of the US Powerlifting Federation; all were surveyed to obtain information on anabolic-androgenic steroids regarding attitudes, patterns of use, and health effects. Of the 45 who responded to the survey, 15 admitted having used steroids. In a follow-up telephone interview of 20 of the competitors, 11 reported previous steroid use. The reason given most often for using steroids was improved athletic performance; the most common side effects reported were heightened libido, acne, and increased body hair. The small number of admitted users suggests that underreporting took place; this level of use probably represents the lower bound of steroid use among power lifters.

Anabolic-androgenic steroid use among high school football players

Eight-hundred seventy-three Indiana high school football players were surveyed to investigate the use of anabolic-androgenic steroids (AAS). Subjects were varsity football players that were randomly selected from 27 high schools throughout Indiana. Out of a possible 1,325 subjects, 873 or 66% participated in the study. Subjects completed a 50 item questionnaire that measured demographic information, perceived use of AAS, reasons for use, and how AAS are taken. The results indicate that 6.3% of Indiana high school football players were current or former AAS users. The average age at time of first use of AAS was 14 years and 15% began taking before the age of ten. Almost half of respondents indicated they could obtain AAS if they so desired, and that other athletes, physicians, and coaches were listed as sources for AAS. Athletic trainers can play a vital role in disseminating accurate information about AAS abuse, including the long-term adverse health risks. These messages should begin with students and athletes as early as the fourth and fifth grades and delivered as often as possible throughout the school years.

Anabolic Steroid Use: Indications of Habituation among Adolescents.

The use of anabolic steroids (AS) by adolescent males is argued to be more widespread than currently acknowledged. Although the long-term physiological and psychological ramifications of use are not well established, current research and anecdotal information suggest that there is reason for concern. In addition, very little is known about the attitudes and behaviors of these adolescent AS users. While the debate concerning the physiological versus the psychological dependence liability of various drugs continues to evolve, there seems to be a consensus that drug dependence is not a per se phenomenon and that the characteristics of dependence differ in accordance with the drug being used. The following article attempts to identify characteristics of the adolescent male AS user and suggests that AS use does have a dependence potential. The AS user population was found to be significantly different from nonusers in several areas such as self-perceptions of health and strength, interest in controlling AS use, and perceptions of peer AS use. The AS user group was also found to contain several subgroups (heavy users [≥ 5 cycles] versus other users, and those who initiated use prior to age sixteen who reported significantly different attitudes and/or behaviors. These differences suggest that prevention efforts will have to focus on different motivations for AS use.

Anabolic-androgenic steroids and related substances.

Testosterone is the primary male sex hormone, and anabolic-androgenic steroids are synthetic derivatives of testosterone. Anabolic steroids are used to enhance athletic performance and appearance. Adverse effects include those on the liver, serum lipids, psyche/behavior, and the reproductive system. Androstenedione is an anabolic-androgenic steroid used to increase blood testosterone levels for the purposes of increasing strength, lean body mass, and sexual performance. However, there is no research indicating androstenedione or its related compounds, significantly increases strength and/or lean body mass by increasing testosterone levels. The long-term health effects of prolonged androstenedione supplementation are unknown. Dehydroepiandrosterone (DHEA) is a weak androgen also used to elevate testosterone levels. DHEA is also advertised as an antiobesity and antiaging supplement capable of improving libido, vitality, and immunity levels. However, research demonstrates that DHEA supplementation does not increase serum testosterone concentrations or increase strength in men, and it may have virilizing effects on women.

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

SummaryPsychological and behavioural changes are associated with anabolic-androgenic steroid (AAS) use. Changes in personality, moods and self-esteem following weight training have also been reported. The fact that nearly all AAS users are also dedicated weight trainers has often been overlooked in studies examining the relationship between AAS use and behavioural change. A triad may exist between AAS use, weight training and behavioural change (including dependence). It is also possible that changes frequently attributed to AAS use may also reflect changes resulting from the concurrent use of other substances such as alcohol, and from dietary manipulation including food supplements. Weight training and related practices should be considered potential confounding factors in future studies designed to examine the psychological and behavioural effects of AAS.

Health Status of the Rural Elderly According to Farm Work History: The Iowa 65+ Rural Health Study

In a geographically defined survey of 3,097 rural Iowans who were at least 65 yr of age, we examined the association between prior farm experience (greater than or equal to 25 yr) and various measures of current health status; we controlled for age, current working status, and, where appropriate, smoking and alcohol consumption. Health status was indexed by self-reported morbid conditions, symptoms, and physical function. After controlling for smoking behavior, it was found that both men and women with previous farm exposure currently experience a greater prevalence of all nine respiratory symptoms employed in the study relative to non-farmers. Farm men report a lower prevalence of Parkinsons disease and prostate conditions, but report a greater prevalence of stroke and a lower level of self-perceived health status. Women with a farm work history experience a greater level of physical function and fewer symptoms associated with mental illness. Overall significant benefits as well as risks associated with a history of farm work were identified. However, of those who survived to age 65, extended exposure to farm work did not have a major impact on the overall current health status of men and women.