national institute on drug abuse (nida) steroids and other...
TRANSCRIPT
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NationalInstituteonDrugAbuse(NIDA)
SteroidsandOtherAppearanceandPerformanceEnhancingDrugs(APEDs)
LastUpdatedFebruary2018https://www.drugabuse.gov
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TableofContents
SteroidsandOtherAppearanceandPerformanceEnhancingDrugs(APEDs)
Introduction
WhatarethedifferenttypesofAPEDs?
Whatisthehistoryofanabolicsteroiduse?
Whousesanabolicsteroids?
Whyareanabolicsteroidsmisused?
Howareanabolicsteroidsused?
Whatarethesideeffectsofanabolicsteroidmisuse?
Howdoesanabolicsteroidmisuseaffectbehavior?
Whataretherisksofanabolicsteroiduseinteens?
Howdoanabolicsteroidsworkinthebrain?
Areanabolicsteroidsaddictive?
Howareanabolicsteroidstestedinathletes?
Whatcanbedonetopreventsteroidmisuse?
Whattreatmentsareeffectiveforanabolicsteroidmisuse?
WherecanIgetfurtherinformationaboutsteroids?
References
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Introduction
Appearanceandperformanceenhancingdrugs(APEDs)aremostoftenusedbymalestoimproveappearancebybuildingmusclemassortoenhanceathleticperformance.Althoughtheymaydirectlyandindirectlyhaveeffectsonauser’smood,theydonotproduceaeuphorichigh,whichmakesAPEDsdistinctfromotherdrugssuchascocaine,heroin,andmarijuana.However,usersmaydevelopasubstanceusedisorder,definedascontinuedusedespiteadverseconsequences.
Anabolic-androgenicsteroids,thebest-studiedclassofAPEDs(andthemainsubjectofthisreport)canboostauser’sconfidenceandstrength,leadinguserstooverlookthesevere,long-lasting,andinsomecases,irreversibledamagetheycancause.Theycanleadtoearlyheartattacks,strokes,livertumors,kidneyfailure,andpsychiatricproblems.Inaddition,stoppingusecancausedepression,oftenleadingtoresumptionofuse.
Becausesteroidsareofteninjected,userswhoshareneedlesorusenonsterileinjectingtechniquesarealsoatriskforcontractingdangerousinfectionssuchasviralhepatitisandHIV.
Steroidsarepopularlyassociatedwithdopingbyeliteathletes,butsincethe1980s,theirusebymalenon-athleteweightliftershasexceededtheirusebycompetitiveathletes. Theiruseiscloselyassociatedwithdisorderedmalebodyimage—mostspecifically,muscledysmorphia.
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WhatarethedifferenttypesofAPEDs?
Anabolic-androgenicsteroids,oftenshortenedto"anabolicsteroids,""steroids,"or"androgens," arethemostwidelymisusedAPED.Thesearesyntheticsubstancessimilartothemalesexhormonetestosterone.Theypromotethegrowthofskeletalmuscle(anaboliceffects)andthedevelopmentofmalesexualcharacteristics(androgeniceffects)inbothmalesandfemales.
Thesecompoundsaresometimesusedmedicallytotreatdelayedpubertyandmusclelossduetodisease andtotreatlowlevelsoftestosteroneinmenwithanassociatedmedicalcondition. Anabolicandrogenicsteroidscanalsoimprovefeelingsofwell-beingandincreasebonestrength,butarenotapprovedforthesepurposes.However,testosterone-supplementationtherapyisanincreasinglycommontreatmentformoodandsexualperformanceproblemsassociatedwithmaleaging,anditiscontroversiallybeingprescribedevenforyoungermen.
Notethatinthecontextofthisreport,anabolicsteroidsreferonlytothenon-prescribeduse(misuse)oftestosteroneandtestosterone-likesubstancesbyathletesandnon-athletebodybuilders.Thisresearchreportwillnotcoverimageenhancers,suchasdermalfillers,Botox,ortheskintanner,melanotan.
Non-steroidalanabolics,includeinsulin,insulin-likegrowthhormone(IGF),andhumangrowthhormone(HGH)—substancesthatareproducedbythehumanbodyandareprescribedforlegitimatemedicalusesbutalsosometimesmisusedforperformanceenhancement.
Ergo/thermogenicsarecompoundsusedtodecreasebodyfatortopromoteleannessversusmusclemassinenduranceathletes. Thethreemaincategoriesofergo/thermogenicsare:
Xanthines:compoundsthatincreaseattentionandwakefulnessand
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suppressappetite.Examplesarecaffeine,theasthmadrugtheophylline,andtheobromine—asubstancefoundinchocolate,coffee,andtea.
Sympathomimetics:drugsthataresimilarinstructureandactiontoepinephrineandnorepinephrine—naturalchemicalsinthebodythatincreaseheartrate,constrictbloodvessels,andraisebloodpressure.Anexampleisephedrine,whichisderivedfromtheephedraplant.Ephedrine/ephedrausedtobeincludedindietarysupplementsthatpromotedweightloss,increasedenergy,andenhancedathleticperformance. In2004,theFDAbannedtheU.S.saleofdietarysupplementscontainingephedrine/ephedraduetovariouspossiblehealthrisksincludingcardiovascularandnervoussystemeffects.
Thyroidhormones:substancesthatregulatemetabolismbyalteringthefunctionofthethyroid. Cytomelisanexample.
Nutritional/dietarysupplementsaresubstancespurchasedlegallyfromnutritionalstoresorviatheinternetthatareoftentakenincombinationwithotherAPEDS.Creatine,whichboostsexercisecapacity,isonecommonexample.
IntheUnitedStates,dietarysupplementscontainingsteroidprecursorssuchastetrahydrogestrinone(THG)andandrostenedione(streetname"Andro")previouslycouldbepurchasedlegallywithoutaprescription.Athletestooksteroidprecursorsinanefforttoboosttestosteronelevels.Lessisknownaboutthesideeffectsofsteroidprecursors,butiflargequantitiesofthesecompoundssubstantiallyincreasetestosteronelevelsinthebody,thentheyalsoarelikelytoproducethesamesideeffectsasanabolicsteroidsthemselves. Thepurchaseofthesesupplements,withthenotableexceptionofdehydroepiandrosterone(DHEA),becameillegalafterthepassageoftheAnabolicSteroidControlActof2004,whichamendedtheControlledSubstancesAct.
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Whatisthehistoryofanabolicsteroiduse?
TestosteronewasfirstsynthesizedinGermanyin1935 andwasusedmedicallytotreatdepression. Professionalathletesbeganmisusinganabolicsteroidsduringthe1954Olympics,whenRussianweightliftersweregiventestosterone. Inthe1980s,anabolicsteroidusebegantoextendintothegeneralpopulation,andyoungmenbeganusingthesesubstances,sometimestoenhanceathleticperformancebutinmostcasestoimprovepersonalappearance.
Mostanabolicsteroidusersaremalenon-athletesaimingtoimprovetheirappearancebybuildingmuscle,anduseofsteroidsisstronglytiedtoamalebodyimagedisordercalledmuscledysmorphia(see“Whousesanabolicsteroids?"). Justasfemalebodyimagedisordershavebeenlinkedtounrealisticportrayalsofthefemaleforminfashionmagazinesandpopularculture,muscledysmorphiainmalesislinkedtoexaggeratedphysiquesinactionmoviesandothermediaoverthepastthreedecades.
CongresspassedtheAnabolicSteroidActof1990torespondtotheincreasinglevelsofillicittrafficinsteroids.ThisActidentifiedanabolicsteroidsasaseparatedrugclassandcategorizedovertwodozendrugsascontrolledsubstances.TheActalsogaveafour-partdefinitionofthisdrugclass,whichallowedforflexibilityincontrollingnewanabolicsteroidsastheyweresynthesized.In2004,CongressenactedtheAnabolicSteroidControlActof2004,whichbannedover-the-countersteroidprecursors;increasedpenaltiesformaking,selling,orpossessingillegalsteroidprecursors;andprovidedfundsforpreventativeeducationalefforts.
Othercountries,suchasMexicoandsomeEuropeannations,wheresteroidsareavailablewithoutprescription,arethemainsourcesofillegalsteroidssmuggledintotheUnitedStates.Lesscommonillicitsourcesincludediversionfromlegitimatesources(e.g.,theftsorinappropriateprescribing)orproductionwithinclandestinelaboratories.
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Ahistoricaltimelineofanabolicsteroids.Source:Pope,Wood,Rogol,Nyberg,Bowers,Bhasin.EndocrineReviews.2014.
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Whousesanabolicsteroids?
Thevastmajorityofpeoplewhomisusesteroidsaremalenon-athleteweightliftersintheir20sor30s. Contrarytopopularbelief,onlyabout22percentofanabolicsteroidusersstartedasteenagers. Anabolicsteroiduseislesscommonamongfemales,sincefewerwomendesireextrememuscularityandthemasculinizingeffectsofsteroids.
Maleswhoaremorelikelytousesteroidstendtohavepoorself-esteem,higherratesofdepression,moresuicideattempts,poorknowledgeandattitudesabouthealth,greaterparticipationinsportsemphasizingweightandshape,greaterparentalconcernaboutweight,andhigherratesofeatingdisordersandsubstanceuse. Steroidmisuseisassociatedwithmuscledysmorphia,abehavioraldisorderinwhichmenthinkthattheylooksmallandweak,eveniftheyarelargeandmuscular(see“Whyareanabolicsteroidsmisused?”).
Somepeoplewhomisusesteroidshaveexperiencedphysicalorsexualabuse.Inastudyof506maleusersand771malenonusersofanabolicsteroids,usersweresignificantlymorelikelythannonuserstoreportbeingsexuallyabusedinthepast. Similarly,femaleweightlifterswhohadbeenrapedwerefoundtobetwiceaslikelytoreportuseofanabolicsteroidsoranotherpurportedmuscle-buildingdrug,comparedwiththosewhohadnotbeenraped.Moreover,almostallfemaleswhohadbeenrapedreportedthattheymarkedlyincreasedtheirbodybuildingactivitiesaftertheattack.Theybelievedthatbeingbiggerandstrongerwoulddiscouragefurtherattacksbecausemenwouldfindthemeitherintimidatingorunattractive.
ItisdifficulttoestimatethetrueprevalenceofsteroidmisuseintheUnitedStatesbecausemanysurveysthataskaboutillicitdrugusedonotincludequestionsaboutsteroids.However,theannualMonitoringtheFuturestudy,aNIDA-fundedsurveyofdruguseandattitudesinmiddleandhighschoolstudentsacrosstheUnitedStates,showsthatpast-yearuseofsteroidshasgenerallydeclinedamong8thand10thgraders,afterpeakingin2000.Past-yearsteroiduseamong12thgradersincreasedfrom2011to2015,althoughusesignificantlydeclinedfrom2015to2016.The2017rateofuseamong12th
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gradersholdsrelativelysteady.
PastYearAnabolicSteroidUseAmongMiddleandHighSchoolStudents,2007-2017
Dataarefromthe2017MonitoringtheFuturesurvey,fundedbytheNationalInstituteonDrugAbuseandconductedannuallybytheUniversityofMichigan'sInstituteforSocialResearch.
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Whyareanabolicsteroidsmisused?
Anabolicsteroidsincreaseleanmusclemasswhenusedinconjunctionwithweighttraining.Theaim,fornon-athleteweightlifters,istypicallyimprovementofappearance.Asmentionedin“Whousesanabolicsteroids?”steroiduseisoftenassociatedwithaformofmalebodydysmorphicdisordercalledmuscledysmorphia,apreoccupationwiththeperceivedinadequatesizeoftheirmuscles.
Asaresult,someusersreporttakinganabolicsteroidstoincreaseconfidenceandbecausetheyfeelthattheyareatapointwheretheycannolongergetbiggerthroughweighttrainingalone.Mostusersreportthatanabolicsteroidshelpthemachievetheiridealbody.
Increasingmusclemassmayalsopromotestrength,whichcanimproveperformanceincertaintypesofsports.Morebenefitisseenforstrength-dependentsports(weightlifting,shot-putthrowing,football)thanforsportsthatrequirespeed,agility,flexibility,and/orendurance.
Anabolicsteroidusersalsoreportthattheirmusclesrecoverfasterfromintensestrainandmuscleinjury. Researchinanimalshasnotconclusivelysupportedthisbelief,withsomeshowingthatanabolicsteroidscanenhancerecoveryfromcertaintypesofmuscledamage, butothersfindingnobenefitintakinganabolicsteroidstoenhancemusclerecovery.
Anabolicsteroidusersreportusinganaverageofabout11APEDsperyear.Theyarealsomorelikelythannon-steroiduserstotakesupplementssuchasproteinpowdersandcreatine;estrogenblockers;ergo/thermogenics,suchascaffeineorephedrine;medicationsforerectiledysfunction;andotherhormonessuchasinsulin,thyroidhormones,andhumangrowthhormone.
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Howareanabolicsteroidsused?
Someanabolicsteroidsaretakenorally,othersareinjectedintramuscularly,andstillothersareprovidedingelsorcreamsthatareappliedtotheskin.Manyusersstartwiththeoralformandthenprogresstoinjectableforms,sincethelattercauseslessliverdamage.However,oralsteroidsclearmorerapidlyfromthebody,oftenmakingthisthepreferredrouteforusersconcernedwithdrugtesting. Dosestakenbypeoplemisusingthesesubstancescanbe10to100timeshigherthanthedosesusedtotreatmedicalconditions.
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CommonlyMisusedSteroids
OralSteroids
Anadrol(oxymetholone)
Anavar(oxandrolone)
Dianabol(methandienone)
Winstrol(stanozolol)
Restandol(testosteroneundecanoate)
InjectableSteroids
Deca-Durabolin(nandrolonedecanoate)
Durabolin(nandrolonephenpropionate)
Depo-Testosterone(testosteronecypionate)
Agovirin(testosteronepropionate)
Retandrol(testosteronephenylpropionate)
Equipoise(boldenoneundecylenate)
Cycling,stacking,pyramiding,andplateauing
Steroidsareoftenusedinpatternscalled"cycling."Thisinvolvestakingmultipledosesofsteroidsoveraspecificperiodoftime,stoppingforaperiod,andstartingagain.Peoplewhomisusesteroidsalsotypically"stack"thedrugs,meaningthattheytaketwoormoredifferentanabolicsteroids,mixoraland/orinjectabletypes,andsometimeseventakecompoundsthataredesignedforveterinaryuse. Thebeliefisthatdifferentsteroidsinteracttoproduceaneffectonmusclesizethatisgreaterthantheeffectsofeachdrugindividually,
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atheorythathasnotbeentestedscientifically.
Anothercommonmodeofsteroidmisuseisreferredtoas"pyramiding,"whichtypicallyinvolvestakingtheminacycleofsixto12weeks,taperinggraduallyratherthanstartingandfinishingacycleabruptly.Atthebeginningofacycle,thepersonstartswithlowdosesofthedrugsbeingstackedandthenslowlyincreasesthedoses.Inthesecondhalfofthecycle,thedosesareslowlydecreasedtozero.Thisissometimesfollowedbyasecondcycleinwhichthepersoncontinuestotrainbutwithoutdrugs.Steroidusersbelievethatpyramidingallowsthebodytimetoadjusttothehighdoses,andthedrug-freecycleallowsthebody'shormonalsystemtimetorecuperate.
Atechniquecalled"plateauing"mayalsobeused,wherebysteroidsarestaggered,overlapped,orsubstitutedwithanothertypeofsteroidtoavoiddevelopingtolerance. Aswithstacking,theeffectsofpyramiding,cycling,andplateauinghavenotbeensubstantiatedscientifically.
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Whatarethesideeffectsofanabolicsteroidmisuse?
Avarietyofsideeffectscanoccurwhenanabolicsteroidsaremisused,rangingfrommildeffectstoonesthatareharmfulorevenlife-threatening.Mostarereversibleiftheuserstopstakingthedrugs.However,othersmaybepermanentorsemi-permanent.
Mostdataonthelong-termeffectsofanabolicsteroidsinhumanscomefromcasereportsratherthanformalepidemiologicalstudies.Seriousandlife-threateningadverseeffectsmaybeunderreported,especiallysincetheymayoccurmanyyearslater.Onereviewfound19deathsinpublishedcasereportsrelatedtoanabolicsteroidusebetween1990and2012;however,manysteroidusersalsousedotherdrugs,makingitdifficulttoshowthattheanabolicsteroidusecausedthesedeaths. Oneanimalstudyfoundthatexposingmalemiceforonefifthoftheirlifespantosteroiddosescomparabletothosetakenbyhumanathletescausedahighfrequencyofearlydeaths.
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PossibleHealthConsequencesofAnabolicSteroidMisuse
Cardiovascularsystem
highbloodpressure
bloodclots
heartattacks
stroke
arterydamage
Hormonalsystem
Men
decreasedspermproduction
enlargedbreasts
shrinkingofthetesticles
male-patternbaldness
testicularcancer
Women
voicedeepening
decreasedbreastsize
coarseskin
excessivebodyhairgrowth
male-patternbaldness
Infection
HIV/AIDS
hepatitis
Liver
peliosishepatis
tumors
Musculoskeletalsystem
shortstature(iftakenbyadolescents)
tendoninjury
Psychiatriceffects
aggression
mania
delusions
Skin
severeacneandcysts
oilyscalpandskin
abscessatinjectionsite
jaundice
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CardiovascularSystem
Steroidusehasbeenassociatedwithhighbloodpressure; decreasedfunctionoftheheart’sventricles; andcardiovasculardiseasessuchasheartattacks, arterydamage, andstrokes, eveninathletesyoungerthan30.Steroidscontributetothedevelopmentofcardiovasculardiseasepartlybyincreasingtheleveloflow-densitylipoprotein(LDL) anddecreasingthelevelofhigh-densitylipoprotein(HDL). HighLDLandlowHDLlevelsincreasetheriskofatherosclerosis,aconditioninwhichfattysubstancesaredepositedinsidearteriesanddisruptbloodflow.Ifbloodispreventedfromreachingtheheartorbrain,theresultcanbeaheartattackorstroke,respectively.Steroidsalsoincreasetheriskthatbloodclotswillforminbloodvessels,potentiallydisruptingbloodflowanddamagingtheheartmuscle,sothatitdoesnotpumpbloodeffectively.
HormonalSystem
Steroidusedisruptsthenormalproductionofhormonesinthebody.Changesthatcanbereversedincludedecreasedspermproduction, decreasedfunctionofthetestes(hypogonadism)thatleadstolowtestosteronelevels, andshrinkingofthetesticles(testicularatrophy). Irreversiblechangesincludemale-patternbaldnessandbreastdevelopment(gynecomastia)inmen. Anabolicsteroidsmayalsoactuponthehormonesystemtoincreasetheriskoftesticularcancer,especiallywhensteroidsareusedincombinationwithinsulin-likegrowthfactor.
Infemales,anabolicsteroidscausemasculinization.Specifically,breastsizeandbodyfatdecrease,theskinbecomescoarse,andthevoicedeepens. Womenmayexperienceexcessivegrowthofbodyhairbutlosescalphair. Withcontinuedadministrationofsteroids,someoftheseeffectsbecomeirreversible.Itiscommonlybelievedthatanabolicsteroidswillproduceirreversibleenlargementoftheclitorisinfemales,althoughtherearenostudiesonthis.
Infections
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Manypeoplewhoinjectanabolicsteroidsmayusenonsterileinjectiontechniquesorsharecontaminatedneedleswithotherusers.Thisputsthesesteroidusersatriskforacquiringlifethreateningviralinfections,suchasHIVandhepatitisBandC. Inaddition,animalmodelsindicatethatanabolicsteroidssuppresstheimmunesystem, whichcouldworseninfections.
Liver
Steroidmisusehasbeenassociatedwithliverdamage, tumors, andarareconditioncalledpeliosishepatis,inwhichblood-filledcystsformintheliver. Thecystscanrupture,causinginternalbleedingandevendeathinrarecases.
MusculoskeletalSystem
Risinglevelsoftestosteroneandothersexhormonesnormallytriggerthegrowthspurtthatoccursduringpubertyandadolescence.Theserisinglevelsoftestosteronealsoprovidethesignalstostopgrowth. Whenachildoradolescenttakesanabolicsteroids,theresultingartificiallyhighsexhormonelevelscanprematurelysignalthebonestostopgrowing.
Evidencesuggeststhatweightlifterswhomisuseanabolicsteroidshavestiffertendons,whichcouldleadtoanincreasedriskfortendoninjury.
Skin
Steroidmisusecancauseacne, hairlossonthehead,cysts,andoilyhairandskin. Userswhoinjectsteroidsmayalsodeveloppainandabscessformationatinjectionsites.
Anabolicsteroidscanalsoproducejaundice,oryellowingoftheskinoreyes,asaresultofdamagetotheliver.
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Howdoesanabolicsteroidmisuseaffectbehavior?
Aggression
Casereportsandsmallstudiesindicatethatanabolicsteroidsincreaseirritabilityandaggression, althoughfindingsmaybeconfoundedbypersonalitytraitsthatareoverrepresentedinsteroidusers(i.e.,antisocial,borderline,andhistrionicpersonalitydisorder) anduseofotherdrugs.Peoplewhomisuseanabolicsteroidsreportmoreangerthannonusers, aswellasmorefights,verbalaggression,andviolencetowardtheirsignificantothers, sometimescalled"roidrage."Onestudysuggeststhatthemoodandbehavioraleffectsseenduringanabolic-androgenicsteroidmisusemayresultfromsecondaryhormonalchanges.
Scientistshaveattemptedtotesttheassociationbetweenanabolicsteroidsandaggressionbyadministeringhighsteroiddosesorplacebofordaysorweekstohumanvolunteersandthenassessingbehavioralsymptoms.Inonesuchstudy,researchersfoundthattestosteroneoverasixweekperiodwasassociatedwithincreasedaggression,asassessedbyaquestionnaireandcomputer-basedmodelofaggressivebehavior. Inaddition,highsteroiddosesproducedgreaterfeelingsofirritabilityandaggressionthanplacebo, althoughtheeffectsappeartobehighlyvariableacrossindividuals, andotherstudieshavenotshownthateffect. Onepossibleexplanation,accordingtotheresearchers,isthatsomebutnotallanabolicsteroidsincreaseirritabilityandaggression.
PsychiatricDisorders
Anabolicsteroidusersaremorelikelythannonuserstoreportanxiety.Moderatetohighdosesofanabolicsteroidsarealsoassociatedwithmajormooddisorderssuchasmania,hypomania, andmajordepression. Inonestudy,manicsymptomswerenotuniformacrossindividuals,withmostshowinglittlepsychologicalchange,whereasafewdemonstratedprominenteffects.
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OtherDrugUse
Anabolicsteroidusersaremorelikelytousedrugssuchasmarijuana,prescriptionopioids,cocaine, orheroin. Inastudyofmenadmittedtotreatmentforopioidusedisorders,25percentreportedprioruseofanabolicsteroids.Somedescribedfirstlearningaboutopioidsfromfriendsatthegym,andthattheyfirstpurchasedopioidsfromthesamepersonwhohadsoldthemtheanabolicsteroids. Inastudyofanabolicsteroidusersdependentupontheinjectableopioidanalgesicnalbuphine,mostreportedthattheybeganusingnalbuphinetotreatpainfromweightliftinginjuries.Theyalsodescribedwidespreaduseofnalbuphineintheirgyms.
Researchalsoindicatesthatsomeusersmightturntootherdrugstoalleviatesomeofthenegativeeffectsofanabolicsteroids.Forexample,astudyof227menadmittedin1999toaprivatetreatmentcenterforaddictiontoheroinorotheropioidsfoundthat9.3percenthadpreviouslymisusedanabolicsteroids.Ofthese,mostreportedusingopioidstocounteractinsomnia,irritability,depression,andwithdrawalfromanabolicsteroids.
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Whataretherisksofanabolicsteroiduseinteens?
Unlikemostillicitdruguse,misuseofanabolicsteroidsmostcommonlybeginsinyoungadulthoodratherthanadolescence.Butsteroiduseinteensisofconcern,especiallysincethehormonalsystemstheyinteractwithplayacriticalroleinbraindevelopmentduringtheseyears. Inadolescentrodents,exposuretoanabolicsteroidsincreasedneuronalspinedensitiesinthehippocampusandamygdala—brainregionsinvolvedinlearningandemotions(e.g.,aggression),respectively.Fourweeksafterwithdrawal,theseincreasesinneuronalspinedensitiesreturnedtonormalintheamygdala,butnotinthehippocampus.Thissuggeststhatpubertalsteroidexposurecouldproducelong-lastingstructuralchangesincertainbrainregions.
Teenswhouseanabolicsteroidsmayalsobeatincreasedriskforsomecognitivesideeffectscomparedwithadults.Forexample,maleswhobeginusinganabolicsteroidsduringtheteenyearsshowincreasedimpulsivityanddecreasedattention,comparedtomenwhobeganusingsteroidsintheiradultyears. Inadolescentrats,anabolicsteroidexposureisassociatedwithelectrolyticimbalances,hyperactivity,anxiety,andincreasedsympatheticautonomicmodulation(e.g.,fightorflightresponse)duringadulthood,evenwhensteroidusewasdiscontinuedduringadolescence. Inaddition,adolescentmalehamstersgivenanabolicsteroidsshowincreasedaggression,evenaftersteroiduseisdiscontinued.Theseaggressiveeffectsareparalleledbychangesinlevelsofserotonin andandrogenreceptorsintherodentbrain.
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Howdoanabolicsteroidsworkinthebrain?
Anabolicsteroidsactatandrogenreceptorstoinfluencecellularfunctioningandgeneexpression.Inadditiontoregulatingpathwaysinvolvedinthedevelopmentofmalecharacteristics, activationofandrogenreceptorsalsoproducesrapidincreasesincalciumlevelswithinskeletalmuscle,heart,andbraincells. Calciumplaysimportantrolesinneuronalsignaling.
ResearchwithhumancellsdemonstratesthatanabolicsteroidsalsointeractwithcertaintypesofGABA receptors,whichcouldmediatetheincreasedanxietyreportedbysteroidusers. Inaddition,animalstudiesshowthatanabolicsteroidsincreaseserotoninlevelsinbrainregionsinvolvedinmoodanddopaminelevelsinreward-relatedbrainregions. Chronicuseofanabolicsteroidshasalsobeenshowntocausedysfunctionoftheserewardpathwaysinanimals.Specifically,ratsgiventwicedailynandroloneinjectionsforfourweeksshowedlossofsweetpreference(asignofrewarddysfunction)thatwasaccompaniedbyreductionsofdopamine,serotonin,andnoradrenalineinthenucleusaccumbens,areward-relatedbrainregion.
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Areanabolicsteroidsaddictive?
Anundeterminedpercentageofsteroidusersmaydevelopasteroidusedisorder.Substanceusedisordersaredefinedbycontinuedusedespiteadverseconsequences;forsteroidusers,thesemayincludephysicalorpsychologicalproblemssuchasbreastgrowth(inmen),sexualdysfunction,highbloodpressure,excessivefatsintheblood,heartdisease,moodswings,severeirritability,oraggressiveness.Anabolicsteroidusersalsomaygiveupotherimportantactivitiesforfearthattheywillmissworkouts,violatetheirdietaryrestrictions,orbepreventedfromusingsteroids.Steroidusersalsotypicallyspendlargeamountsoftimeandmoneyobtainingthedrugs,andtheymaytrytoreduceorstopanabolicsteroidusewithoutsuccess—possiblyduetodepression,anxietyaboutlosingmusclemass,orandotherunpleasanteffectsofwithdrawal.
Withdrawalfromsteroidsoccurswhenanindividualdevelopsdependence.Areviewoftheresearchsuggeststhatabout32percentofpeoplewhomisuseanabolicsteroidsbecomedependent. Symptomsofdependencecanincludetolerance,whichisneedingtotakemoresteroidstoachievethesameeffects.Anotherindicatorofdependenceiswithdrawalonceanabolicsteroidusestops. Withdrawalsymptomscanincludefatigue,restlessness,lossofappetite,insomnia,reducedsexdrive,andsteroidcravings. Themostdangerousofthewithdrawalsymptomsisdepression,becauseitsometimesleadstosuicideattempts.
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Howareanabolicsteroidstestedinathletes?
Althoughnon-athleteweightliftersaccountforthebulkofanabolicsteroidmisuse,occasionalsteroidusebyprofessionalandOlympicathletestoimproveperformanceorcheatincompetition("doping")hasdonethemosttoraiseawarenessofsteroidmisuse.TheWorldAnti-DopingAgency(WADA)wasfoundedin1999toconsistentlyapplyanti-dopingpoliciesacrosssportsorganizationsandgovernmentsaroundtheworld.Non-compliantorganizationscanfacesanctionssuchaseventcancellation,lossofWADAfunding,orineligibilitytohostevents.
Refinementsindrugtestinghaveimprovedtheabilitytodetectanti-dopingviolations,resultinginincreasednumbersofreportedviolationsoverrecentyears.Forexample,thediscoveryoflong-termsteroidmetaboliteshaslengthenedthedrugdetectionwindow,makingitmoredifficultforathletestopassdrugtestsbysimplydiscontinuingsteroidusejustpriortoanevent.Inaddition,moresensitivetechnologieshavealloweddetectionoflowermetabolitethresholds.
AlthoughtestingproceduresarenowinplacetodetersteroiduseamongprofessionalandOlympicathletes,newdesignerdrugsconstantlybecomeavailablethatcanescapedetectionandputathleteswillingtocheatonestepaheadoftestingefforts. Todetectearlyuseofdesignersteroidsand
Sportswiththegreatestnumbersofanti-dopingrulesviolationsin2015.Source:WADA.2015Anti-DopingRuleViolations(ADRVs)Report.2017.
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providemoreaccuratebaselinestandardsforeachathlete,testinglaboratoriesstoredatafromeachdrugtestingsample.Thesesamplesarethenusedasreferencepointsforfuturetesting,therebyeliminatingthepossibilitythatapersontestspositivesimplybecauseheorshehasnaturallyelevatedlevelsoftestosteronewhencomparedtothegeneralpopulation. Long-termuseofdesignersteroidssuppresseslevelsendogenoussteroidsinurinesamples,whichcouldbethefirstindicationthatanathleteistakingadesignersteroid.
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DrugTestingandNutritionalSupplements
Athletestakingover-the-counternutritionalsupplementsmaybelievethatsuchproductsaresafe.However,nutritionalsupplementsarenotsubjectedtothesamepre-approvalrequirementsandqualitytestsasFDA-approvedmedications. Forexample,somesupplementsadvertisedtopromoteweightlosshavebeenfoundtocontainbannedstimulantssuchasephedrine orclenbuterol. Otherresearchshowsthatsupplementssometimescontainprohormonesoranabolicsteroids. Inastudylookingat634nutritionalsupplementsfrom13differentcountries,15percentincludedsometypeofprohormonenotlistedonthelabel. Anotherstudyshowedthatsomenon-labeledprohibitedsubstancescouldbedetectedbydrugtestsupto144hourslater.
Nutritionalsupplementssometimescontainbannedsubstancesthatarenotindicatedintheirlabels. TheFDAnotesthatconsumersshouldbewaryifaproductmeetsanyofthesecriteria:
productsclaimingtobealternativestoFDA-approveddrugsortohaveeffectssimilartoprescriptiondrugs
productsclaimingtobealegalalternativetoanabolicsteroids
productsthataremarketedprimarilyinaforeignlanguageorthosethataremarketedthroughmasse-mails
sexualenhancementproductspromisingrapideffectssuchasworkinginminutestohours,orlong-lastingeffectssuchas24hoursto72hours
productsthatprovidewarningsabouttestingpositiveinperformanceenhancementdrugtests
AccordingtoWADA’scodes,athletesareresponsibleforanyprohibitedsubstancefoundintheirsamples,regardlessofwhetheringestionwasintentionalorunintentional.However,sanctionsmaybereducedoravoidediftheathletecandemonstratethatthesubstancewasingestedthroughno
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significantfaultornegligenceonhis/herpart,orinsomecircumstanceswheretheathletedidnotintendtoenhanceperformance.126
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Whatcanbedonetopreventsteroidmisuse?
Researchsuggeststhathighschoolathletesarelesslikelytousesteroidsiftheirpeersandparentsdisapprove,indicatingthatpeersandparentscanbestrongpartnersinpreventionefforts.
However,researchshowsthatsimplyteachingstudentsaboutsteroids'adverseeffectsdoesnotconvinceadolescentsthattheywillbeadverselyaffected,nordoessuchinstructiondiscourageyoungpeoplefromtakingsteroidsinthefuture.Presentingboththerisksandbenefitsofanabolicsteroiduseismoreeffectiveinconvincingadolescentsaboutsteroids'negativeeffects,apparentlybecausethestudentsfindabalancedapproachmorecredible.
Researchalsoindicatesthatsomeadolescentsmisusesteroidsaspartofapatternofhigh-riskbehaviorssuchasdrinkinganddriving,carryingagun,drivingamotorcyclewithoutahelmet,andusingotherillicitdrugs.Thissuggeststhatapreventionprogramshouldfocusoncomprehensivehigh-riskbehaviorscreeningandcounselingamongteenswhouseanabolicsteroids.
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NIDA-FundedPreventionResearchHelpsReduceSteroidMisuse
Amoresophisticatedapproachhasshownpromiseforpreventingsteroidmisuseamongplayersonhighschoolsportsteams.TheAdolescentsTrainingandLearningtoAvoidSteroids(ATLAS)programisshowinghighschoolfootballplayersthattheydonotneedsteroidstobuildpowerfulmusclesandimproveathleticperformance.Byeducatingstudentathletesabouttheharmfuleffectsofanabolicsteroidsandprovidingnutritionandweight-trainingalternativestosteroiduse,theATLASprogramhasincreasedfootballplayers'healthybehaviorsandreducedtheirintentionstomisusesteroids.Intheprogram,coachesandteamleadersteachtheharmfuleffectsofanabolicsteroidsandotherillicitdrugsonimmediatesportsperformanceanddiscusshowtorefuseoffersofdrugs.
Studiesshowthatoneyearaftercompletionoftheprogram,comparedwithacontrolgroup,ATLAS-trainedfootballstudentathletesin15highschoolshad:
lessuseofanabolicsteroidsandlessintentiontomisusetheminthefuture
lessmisuseofalcohol,amphetamines,andnarcotics
lessmisuseof"athleticenhancing"supplements
lesslikelihoodofengaginginhazardousbehaviorssuchasdrinkinganddriving
betterknowledgeaboutanabolicsteroid,alcohol,andmarijuanaeffects;betterknowledgeofalternativestosteroidmisuse;greaterconfidenceinathleticabilities;andimprovednutritionalbehaviors
TheAthletesTargetingHealthyExerciseandNutritionAlternatives(ATHENA)programwaspatternedaftertheATLASprogram,butdesignedforadolescentgirlsonsportsteams.EarlytestingofgirlsenrolledintheATHENAprogram
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showedsignificantdecreasescomparedtocontrolsinriskybehaviorssuchasridingwithanintoxicateddriverorengaginginsexualactivitywithnewpartners.ATHENAparticipantswerealsolesslikelytousedietpills,amphetamines,anabolicsteroids,andmuscle-buildingsupplementsduringthesportsseason.Althoughtheprogramhadnoimmediateeffectontobacco,alcohol,ormarijuanause, ATHENA-trainedathletesreportedlesslifetimeuseofthesesubstanceswhensurveyedonetothreeyearsfollowinghighschoolgraduation.Dietpillandsteroidusedeclinedbythisonetothreeyearfollow-upforbothATHENA-trainedandcontrol-groupathletes,sothatthesegroupsnolongerdifferedintheiruseofthesesubstances.
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Whattreatmentsareeffectiveforanabolicsteroidmisuse?
Peoplewhousesteroidsoftendonotseektreatmentfortheiruse,withonestudyreportingthat56percentofusershadnevertoldtheirphysicianabouttheiruse. Thiscouldbebecauseusersfeeltheirphysicianlacksknowledgeaboutanabolicsteroids. Inaddition,manyinternetsitesdevotedtoanabolicsteroidsandotherAPEDschallengetheprofessionalismofhealthcareprovidersandoffertheirownmedicallyquestionableadviceontheuseofAPEDs. Thismakesitimportantforhealthcareproviderstobeeducatedonthesignsandsymptomsofsteroiduseintheirpatients.
Currentviewsrecommendthattreatmentforsteroiduseaddresstheunderlyingcausesofthesteroiduse.Thiscaninclude:
psychologicaltherapies(andpossiblymedications)formuscledysmorphia
endocrinetherapiestorestorefunctioninthosesufferingfromhypogonadismandtoalleviatesymptomsofdepression
antidepressantsforthosewhosedepressiondoesnotrespondtoendocrinetherapies
pharmacologicalandpsychosocialtreatmentsforpatientswhoarealsodependentonopioids,whichappeartoalsobeeffectiveinalleviatingsignsofanabolicsteroiddependence
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WherecanIgetfurtherinformationaboutsteroids?
TolearnmoreaboutSteroids,otherAppearanceandPerformanceEnhancingDrugs(APEDs),andotherdrugsofuseandmisuse,visittheNIDAwebsiteatwww.drugabuse.govorcontactDrugPubsat877-NIDA-NIH(877-643-2644;TTY/TDD:240-645-0228).
NIDA'swebsiteincludes:
Informationondrugsofuseandmisuseandrelatedhealthconsequences
NIDApublications,news,andevents
Resourcesforhealthcareprofessionals,educators,andpatientsandfamilies
InformationonNIDAresearchstudiesandclinicaltrials
Fundinginformation(includingprogramannouncementsanddeadlines)
Internationalactivities
Linkstorelatedwebsites(accesstowebsitesofmanyotherorganizationsinthefield)
InformationinSpanish(enespañol)
NIDAwebsitesandwebpages
drugabuse.gov/publications/drugfacts/anabolic-steroids
drugabuse.gov/drugs-abuse/steroids-anabolic
drugabuse.gov
teens.drugabuse.gov
easyread.drugabuse.gov
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researchstudies.drugabuse.gov
irp.drugabuse.gov
Forphysicianinformation
NIDAMED:drugabuse.gov/nidamed
Otherwebsites
InformationontheabuseofSteroidsandotherAppearanceandPerformanceEnhancingDrugs(APEDs)isalsoavailablethroughthefollowingwebsites:
MonitoringtheFuture
ThePartnershipforDrug-FreeKids
WorldAnti-DopingAgency:
LabelinginformationfromtheFDA:Testosteronelabeling
LabelinginformationfromtheFDA:TaintedProductsMarketedasDietarySupplements
Steroidpreventionprogramsforhighschoolathletes:AthletesTraining&LearningtoAvoidSteroids(ATLAS)
Steroidpreventionprogramsforhighschoolathletes:AthletesTargetingHealthyExercise&NutritionAlternatives(ATHENA)
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