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CORK Bibliography: Steroids

68 citations. January 2009 to present

Prepared: September 2012

Aguilera R; Chapman TE; Pereira H; Oliveira GC; Illanes RP; Fernandes TF et al. Drug testing data from the 2007 Pan American Games: Delta C-13 values of urinary androsterone, etiocholanolone and androstanediols determined by GC/C/IRMS. Journal of Steroid Biochemistry and Molecular Biology 115(3-5): 107-114, 2009. (45 refs.)

The main purpose of this article is to show the application of the CG/C/IRMS in real time during competition in the steroid confirmation analysis. For this reason, this paper summarizes the results obtained from the doping control analysis during the period of the 2007 Pan American Games held in Rio de Janeiro, Brazil. Approximately 5600 athletes from 42 different countries competed in the games. Testing was performed in accordance to World Anti-Doping Agency (WADA) technical note for prohibited substances. This paper reports data where abnormal urinary steroid profiles, have been found with the screening procedures. One 8 mL urine sample was used for the analysis of five steroid metabolites with two separate analyses by gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS). Urine samples were submitted to GC/C/IRMS for confirmation analysis to determine the C-13/C-12 ratio of selected steroids. Fifty-seven urine samples were analyzed by GC/C/IRMS and the delta C-13 values (parts per thousand) of androsterone, etiocholanclone, 5 beta-androstane-3 alpha, 17 beta-diol (5 beta-diol), 5 alpha-androstane-3 alpha, 1 beta p-diol (5 alpha-diol) and 5 beta-pregnane-3 alpha, 20 alpha-diol (5 beta-pdiol), the endogenous reference compound are presented. One urine sample with a testosterone/epitestosterone (T/E) ratio of 4.7 was confirmed to be positive of doping by GC/C/IRMS analysis. The delta values of 5 beta-diol and 5 alpha-diol were 3.8 and 10.8, respectively, compared to the endogenous reference compound 5 beta-pdiol, which exceeded the WADA limit of 3 parts per thousand. The results obtained by CG/C/IRMS confirmation analyses, in suspicious samples, were conclusive in deciding whether or not a doping steroid violation had occurred.

Allahverdipour H; Jalilian F; Shaghaghi A. Vulnerability and the intention to anabolic steroids use among Iranian gym users: An application of the theory of planned behavior. Substance Use & Misuse 47(3): 309-317, 2012. (46 refs.)

This correlational study explored the psychological antecedents of 253 Iranian gym users' intentions to use the anabolic-androgenic steroids (AAS), based on the Theory of Planned Behavior (TPB). The three predictor variables of (1) attitude, (2) subjective norms, and (3) perceived behavioral control accounted for 63% of the variation in the outcome measure of the intention to use the AAS. There is some support to use the TPB to design and implement interventions to modify and/or improve individuals' beliefs that athletic goals are achievable without the use of the AAS.

Anton AJM; Rodriguez GS; Martinez CAC; Quintana MS. Anabolic drugs consumption by adolescent students of physical education degree in Spain, Portugal and Italy: A survey. African Journal of Pharmacy and Pharmacology 5(5): 654-657, 2011. (28 refs.)

This paper aims to analyse the use of anabolic drugs among Spanish, Portuguese and Italian students in the Physical Education and Sport Faculties. In order to do it, a survey was conducted in February and March 2011 in six different faculties in these three countries. The sample was 144 students in their first or second year at the university. The results showed that although 25.2% of them had consumed some kind of drugs, only 3.4% (all of them males) informed that they had used anabolic steroids sometime in the past, whereas 5.2% reported that they would intend to use them in the future. This confirms that anabolic steroids are still an important problem among adolescents and students at the sport faculties, but the governments should not focus only in this direction but also in the prevention of other type of drugs, which consumption rate is much higher. Educational programs should increase students' knowledge about drugs, and they should come not only from the state, but also from coaches, teachers, trainers and parents.

Baggish AL; Weiner RB; Kanayama G; Hudson JI; Picard MH; Hutter AM et al. Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction. Circulation. Heart Failure 3(4): 472-U15, 2010. (42 refs.)

Background-Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure. Methods and Results-We performed 2D tissue-Doppler and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n=12) and otherwise similar AAS nonusers (n=7). AAS users (median [quartile 1, quartile 3] cumulative lifetime AAS exposure, 468 [169, 520] weeks) closely resembled nonusers in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups; however, AAS users had significantly lower LV ejection fraction (50.6% [48.4, 53.6] versus 59.1% [58.0%, 61.7%]; P=0.003 by two-tailed Wilcoxon rank sum test), longitudinal strain (16.9% [14.0%, 19.0%] versus 21.0% [20.2%, 22.9%]; P=0.004), and radial strain (38.3% [28.5%, 43.7%] versus 50.1% [44.3%, 61.8%]; P=0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (>= 55%). AAS users also demonstrated decreased diastolic function compared to nonusers as evidenced by a markedly lower early peak tissue velocity (7.4 [6.8, 7.9] cm/s versus 9.9 [8.3, 10.5] cm/s; P=0.005) and early-to-late diastolic filling ratio (0.93 [0.88, 1.39] versus 1.80 [1.48, 2.00]; P=0.003). Conclusions-Cardiac dysfunction in long-term AAS users appears to be more severe than previously reported and may be sufficient to increase the risk of heart failure.

Berneman SB. One strike and you're out: Alcohol in the major league baseball clubhouse. Vanderbilt Journal of Entertainment and Technology Law 11(Winter): 399-424, 2009. (187 refs.)

Summary: In the past decade, much has been written about Major League Baseball's (MLB) mistaken policies regarding performance-enhancing substance abuse by players. MLB executives are shortsighted, however, if they believe that steroids are the only substances being abused by players. Along with performance-enhancing drugs, professional baseball has a long-standing history of alcohol abuse. Steroids may provide better headlines-Congress has never held an investigation into alcohol abuse by professional athletes-but professional baseball faces a real danger from the unchecked liability of allowing players to overindulge at the ballpark and drive home shortly thereafter. By serving beer in the clubhouse after games, clubs are subjecting themselves, their players, and the public to undue danger. This Note asks whether an MLB club would be vicariously liable for injuries to third parties resulting from the drunk driving of players who drank club-provided alcohol following a game. To address this question, the Note first will show that baseball and alcohol have a long and often negative history. Subsequently, it discusses the legalframework for third-party liability, describing three formulations of vicarious liability that may create liability for the clubs. Next, this Note argues that MLB clubs could be held liable under both standard theories of third-party liability as well as respondeat superior employer liability. Finally, this Note proposes potential and easy solutions to MLB's problem.

Boccard J; Badoud F; Grata E; Ouertani S; Hanafi M; Mazerolles G et al. A steroidomic approach for biomarkers discovery in doping control. Forensic Science International 213(1-3): 85-94, 2011. (43 refs.)

Anti-doping authorities have high expectations of the athlete steroidal passport (ASP) for anabolic-androgenic steroids misuse detection. However, it is still limited to the monitoring of known well-established compounds and might greatly benefit from the discovery of new relevant biomarkers candidates. In this context, steroidomics opens the way to the untargeted simultaneous evaluation of a high number of compounds. Analytical platforms associating the performance of ultra-high pressure liquid chromatography (UHPLC) and the high mass-resolving power of quadrupole time-of-flight (QTOF) mass spectrometers are particularly adapted for such purpose. An untargeted steroidomic approach was proposed to analyse urine samples from a clinical trial for the discovery of relevant biomarkers of testosterone undecanoate oral intake. Automatic peak detection was performed and a filter of reference steroid metabolites mass-to-charge ratio (m/z) values was applied to the raw data to ensure the selection of a subset of steroid-related features. Chemometric tools were applied for the filtering and the analysis of UHPLC-QTOF-MSE data. Time kinetics could be assessed with N-way projections to latent structures discriminant analysis (N-PLS-DA) and a detection window was confirmed. Orthogonal projections to latent structures discriminant analysis (O-PLS-DA) classification models were evaluated in a second step to assess the predictive power of both known metabolites and unknown compounds. A shared and unique structure plot (SUS-plot) analysis was performed to select the most promising unknown candidates and receiver operating characteristic (ROC) curves were computed to assess specificity criteria applied in routine doping control. This approach underlined the pertinence to monitor both glucuronide and sulphate steroid conjugates and include them in the athletes passport, while promising biomarkers were also highlighted.

Boregowda K; Joels L; Stephens JW; Price DE. Persistent primary hypogonadism associated with anabolic steroid abuse. Fertility and Sterility 96(1): E7-E8, 2011. (9 refs.)

Objective: To report a case of primary gonadal failure due to the chronic abuse of anabolic steroids used for bodybuilding. Design: Case report. Setting: Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, Wales, United Kingdom. Patient(s): A 40-year-old man. Intervention(s): None. Main Outcome Measure(s): Clinical symptoms, levels of serum T, FSH, and LH. Result(s): Primary gonadal failure resulting from anabolic steroid use. Conclusion(s): We describe a case of initially secondary gonadal failure resulting from anabolic steroid use with subsequent primary gonadal failure and infertility. This case adds to the current literature and illustrates that the side effects of anabolic steroids can be prolonged and irreversible.

Brant WO; Myers JB; Carrell DT; Smith JF. Male athletic activities and their effects on semen and hormonal parameters. Physician and Sportsmedicine 38(3): 114- 120, 2010. (54 refs.)

Infertility is generally defined as the inability to conceive a pregnancy or the failure to do so within a reasonable period (typically 12 months). Approximately 85% of couples conceive a first pregnancy within 12 months. The prevalence of infertility has increased over the past 10 years, with approximately 10 million affected couples in the United States. Roughly 40% to 50% of infertility is either due to, or is contributed by, a male factor. Given how common the condition is, men and their partners are understandably concerned and interested in identifying and eliminating risk factors for male infertility. This article reviews the available literature on various aspects of male infertility related to athletic pursuits. These include the effects of exercise on semen parameters, hormonal axes, and testicular health. Due to the prevalence and particular relevance of anabolic steroid use by athletes and the impact of steroid use on fertility, this topic is also reviewed.

Brennan BP; Kanayama G; Hudson JI; Pope HG. Human growth hormone abuse in male weightlifters. American Journal on Addictions 20(1): 9-13, 2011. (40 refs.)

In a study of performance-enhancing substance use among 231 experienced young male weightlifters, we found that 27 (12%) reported illicit use of human growth hormone (HGH) or its bioactive derivative, insulin-like growth factor-1. All of these 27 men also reported use of anabolic-androgenic steroids (AAS) and 22 (81%) met criteria for current or past AAS dependence. Fifteen (56%) also reported current or past dependence on opioids, cocaine, and/or ecstasy. These findings suggest that among young male weightlifters, illicit HGH use has become a common form of substance abuse, frequently associated with both AAS dependence and classical substance dependence.

Cordaro FG; Lombardo S; Cosentino M. Selling androgenic anabolic steroids by the pound: Identification and analysis of popular websites on the Internet. Scandinavian Journal of Medicine & Science in Sports 21(6): E247-E259, 2011. (34 refs.)

Internet websites offering androgenic anabolic steroids (AAS) were identified and available products were examined. Keywords for the website search were: "anabolic steroids," "anabolic steroids buy," "anabolic steroid purchase." The first 10 websites offering AAS in the first 10 pages of results were considered. At least two AAS-containing products per website were selected. Thirty AAS-selling websites were identified, mainly located in the United States (46.7%) and Europe (30%). Most websites sold other anabolic/ergogenic products (clenbuterol, 76.7%; GH/IGF, 60.0%; thyroid hormones, 46.7%; erythropoietin, 30.0%; insulin, 20.0%) or products for AAS-related adverse effects (mainly: estrogen antagonists, 63.3%; products for erectile dysfunction, 56.7%; 5 alpha-reductase inhibitors, 33.3%; anti-acne products, 33.3%). AAS were sold as medicines (69.6%) or as dietary supplements (30.4%). AAS in medicines were mainly: nandronole (20.4%), methandrostenolone (18.4%), and testosterone (12.2%). Dietary supplements contained mainly DHEA and included several fake compounds. Manufacturers were declared for 97.9% of medicines and 66.7% of dietary supplements; however, several manufacturers were not found on the Internet. Described benefits were usually few adverse effects and no estrogenicity. Toxicity was seldom reported and presented as mild. Recommended doses were two-fourfold higher than current medical recommendations. In conclusion, misleading information and deceiving practices were common findings on AAS-selling websites, indicating their deleterious potential for public health.

Denham BE. Adolescent self-perceptions and attitudes toward school as determinants of anabolic-androgenic steroid risk estimates and normative judgments. Youth & Society 43(3): 1041-1065, 2011. (55 refs.)

Grounded in symbolic interactionism and drawing on data gathered in the 2007 Monitoring the Future Study (n = 2,201), this research examines how self-esteem and perceived intelligence, as well as attitudes and behaviors related to school environments, associate with perceptions of anabolic-androgenic steroids. With perceived risk and approval/disapproval of steroid use as dependent measures, logistic regression models identified explanatory effects for sex, race, newspaper exposure, and peer use of steroids, with males, Whites, those who seldom read the newspaper, and those with friends who had used steroids estimating lower levels of risk and indicating less disapproval. Those who viewed themselves as being more intelligent than their peers as well as those with higher levels of self-esteem estimated higher levels of risk and expressed greater disapproval, whereas those who indicated "hating" school and those who had skipped school the most estimated lower risk and less disapproval. Logit log-linear models identified the most parsimonious representations of variable relationships, demonstrating how the presence of a self-esteem index stands to reduce the centrality of sex and race as explanatory measures.

Denham BE. Association between narcotic use and anabolic-androgenic steroid use among American adolescents. Substance Use & Misuse 44(14): 2043-2061, 2009. (52 refs.)

Drawing on the data gathered in the 2006 Monitoring the Future study of American youth, the present research examines associations between use of narcotics and use of anabolic-androgenic steroids (AASs) among high-school seniors (n = 2,489). With independent measures and controls including sex, race, media exposure, socializing with friends, participation in recreational and school-sponsored sports, perceptions of drug use among professional athletes, and perceptions of steroid use among close friends, binary logistic regression analyses revealed significant associations between AAS use and the use of alcohol, crack cocaine, Vicodin, gamma-hydroxybutyrate (GHB), Ketamine, and Rohypnol. While use of both AASs and the narcotic drugs generally did not eclipse 5% of the sample, the numbers extend to many thousands in larger populations. Implications for health practitioners and recommendations for future research are offered. The study's limitations are noted.

Denham BE. When science, politics, and policy collide: On the regulation of anabolic-androgenic steroids, steroid precursors, and "dietary supplements" in the United States. Journal of Sport & Social Issues 35(1): 3-21, 2011. (47 refs.)

Twenty years after policy makers passed the Anabolic Steroid Control Act of 1990, adding steroids to the list of Schedule III Controlled Substances in the United States, illicit use of the drugs continues among both adolescents and adults in American society. Some of the men and women who use steroids seek enhanced athletic performance, whereas others simply want to appear more muscular. But what, exactly, is a "steroid"? The present article examines legislation surrounding actual anabolic-androgenic steroids, steroid precursors, and associated "dietary supplements," exploring how the political interests of policy actors and the economic interests of industry lobbies have compromised regulatory efforts. Among the issues addressed are the arbitrary assignment of substances to (and exemption from) the Omnibus Controlled Substances Act and the retailing of "dietary supplements" that contain widely varying amounts of active ingredients and, in some cases, synthetic steroids. Conceptually, the article draws on the "garbage can" model of policy processes as well as the broader public arenas model of social problems, focusing on subjective issue constructions and symbolic appeals.

Deshmukh N; Petroczi A; Barker J; Szekely AD; Hussain I; Naughton DP. Potentially harmful advantage to athletes: A putative connection between UGT2B17 gene deletion polymorphism and renal disorders with prolonged use of anabolic androgenic steroids. Substance Abuse Treatment, Prevention and Policy 5: e-article 7, 2010. (56 refs.)

Background and objective: With prolonged use of anabolic androgenic steroids (AAS), occasional incidents of renal disorders have been observed. Independently, it has also been established that there are considerable inter-individual and inter-ethnic differences, in particular with reference to the uridine diphosphate-glucuronosyltransferase 2B17 (UGT2B17) gene, in metabolising these compounds. This report postulates the association of deletion polymorphism in the UGT2B17 gene with the occurrence of renal disorders on chronic exposure to AAS. Presentation of the hypothesis: The major deactivation and elimination pathway of AASs is through glucuronide conjugation, chiefly catalyzed by the UGT2B17 enzyme, followed by excretion in urine. Excretion of steroids is affected in individuals with a deletion mutation in the UGT2B17 gene. We hypothesize that UGT2B17 deficient individuals are more vulnerable to developing renal disorders with prolonged use of AAS owing to increases in body mass index and possible direct toxic effects of steroids on the kidneys. Elevated serum levels of biologically active steroids due to inadequate elimination can lead to prolonged muscle build up. An increase in body mass index may cause renal injuries due to sustained elevated glomerular pressure and flow rate. Testing the hypothesis: In the absence of controlled clinical trials in humans, observational studies can be carried out. Real time PCR with allelic discrimination should be employed to examine the prevalence of different UGT2B17 genotypes in patients with impaired renal function and AAS abuse. In individuals with the UGT2B17 deletion polymorphism, blood tests, biofluid analyses, urinalysis, and hair analyses following the administration of an anabolic steroid can be used to determine the fate of the substance once in the body. Implications of the hypothesis: If the hypothesis is upheld, anabolic steroid users with a deletion mutation in the UGT2B17 gene may be exposed to an increased risk of developing renal disorders. In the current detecting sanctioning anti-doping system, athletes motivated by the potential to evade detection owing to their unique genetic make-up could subject themselves to a serious health consequence. More research on AAS metabolism in the presence of UGT2B17 gene deletion is required. Benefit - harm evaluations in therapeutic use of anabolic steroids should also consider this potential link between UGT2B17 gene deletion polymorphism and renal disorders.

Dodge T; Hoagland MF. The use of anabolic androgenic steroids and polypharmacy: A review of the literature. (review). Drug and Alcohol Dependence 114(2-3): 100- 109, 2011. (38 refs.)

Background: A review of the literature was conducted to examine the relationship between the use of anabolic androgenic steroid (AAS) use and the use of other drugs. Methods: Studies published between the years of 1995 and 2010 were included in the review. Results: The use of AAS is positively associated with use of alcohol, illicit drugs and legal performance enhancing substances. In contrast, the relationship between AAS and the use of tobacco and cannabis is mixed. Conclusion: Results of the review indicate that the relationship between AAS use and other substance use depends on the type of substance studied. Implications for treatment and prevention are discussed. Suggestions for future research are provided.

Dunn M; Mazanov J; Sitharthan G. Predicting future anabolic-androgenic steroid use intentions with current substance use: Findings from an Internet-based survey. Clinical Journal of Sport Medicine 19(3): 222-227, 2009

Objective: To explore how current substance use, including the use of sports supplements and illicit drugs, may impact upon a pet-son's future intentions to use anabolic-androgenic steroids (AAS). research is necessary to explore in depth whether Such substances may act as a "gateway" to future AAS use. Design: Web-based survey. Participants: Two hundred fourteen exercising males (mean age. 30 years; range, 17-61 years) recruited from 5 gymnasia in Sydney, Australia, completed a web-based survey. The survey contained questions relating to sport supplement use, illicit substance use, reasons for currently not using AAS, and reasons for intending to use AAS in the future. Interventions: Participants completed a structured interview schedule that included questions regarding licit and illicit substance use, reasons for non-AAS use, and, where appropriate, reasons for intended future AAS use. Main Outcome Measures: The planned main outcome measure was positive intention to use AAS. Results: Sixteen percent of the sample indicated that they would use AAS in the future. Reasons for future AAS use included increasing muscle size (80%), improving appearance (74%), and increasing strength (57/o). Four-fifths (80%) of the sample reported use of sports supplements, with vitamins and protein supplements commonly reported (83% and 67%. respectively), more than one-third (36%) reported use of creatine in the past 6 months. Half (52%) of the sample reported use of illicit substances in the preceding 6 months, with amphetamines and cannabis commonly reported (66%, and 62%, respectively). Significant predictors of intending to use AAS included past 6-month use of creatine and knowing AAS users. Conclusions: The use of sport supplements and/or illicit substances may remove barriers for the future use of such drugs as AAS. Future research is necessary to explore in depth whether Such substances may act as a "gateway" to future AAS use.

Dunn M; White V. The epidemiology of anabolic-androgenic steroid use among Australian secondary school students. Journal of Science and Medicine In Sport 14(1): 10-14, 2011. (25 refs.)

There is evidence to suggest that the prevalence of anabolic androgenic steroids (AAS) is higher among young people than the general population. The purpose of the current study was to examine the proportion of students who reported lifetime and past-year AAS use, explore other drug use among those who reported AAS use, and investigate demographic correlates of AAS use. Data was taken from a cross-sectional survey of a representative sample of Australian secondary students. A stratified two-stage probability sampling methodology was employed and schools were randomly sampled from each Australian State and Territory. A total of 376 schools participated in the survey. Lifetime AAS use was reported by 2.4% of 12-17-year-old students: use was more common among 12-15-year olds then 16-17-year olds. Regardless of age, being male, speaking a language other than English at home, not be at school on the previous school day, and rating own scholastic ability as below average were all associated with a greater likelihood of using AAS in their lifetime and in the past year. Those who reported AAS use also reported the use of a range of other substances, suggesting that AAS use may be part of a broader experimentation with substances. Interventions towards these groups regarding AAS may best be placed within a larger substance use intervention rather than being AAS-specific. In light of the low levels of AAS use among this group, more detailed research into AAS use among adolescent sporting groups may be warranted.

Elfverson M; Johansson T; Zhou Q; Le Greves P; Nyberg F. Chronic administration of the anabolic androgenic steroid nandrolone alters neurosteroid action at the sigma-1 receptor but not at the sigma-2 or NMDA receptors. Neuropharmacology 61(7, special issue): 1172-1181, 2011. (85 refs.)

Studies have shown that anabolic androgenic steroids (AASs) can induce profound changes to mental health. Commonly reported psychiatric side effects among AAS users include aggression, anxiety, depression, drug abuse and cognitive disabilities. In experimental animals, many of these effects have been associated with alterations in a number of neurotransmitter systems. We have observed that chronic administration of the AAS nandrolone (nandrolone decanoate) can affect excitatory amino acids as well as monoaminergic and peptidergic pathways in a way that is compatible with nandrolone-induced behavioural changes. The aim of the present work was to further explore the mechanisms underlying nandrolone-induced effects, with a particular focus on components known to be involved in aggression and cognitive function. Male rats were given daily injections of nandrolone decanoate for 14 days and the effects on neurosteroid interactions with sites on the N-methyl-D-aspartyl (NMDA) and sigma receptors were examined. These receptors were chosen because of their involvement in aggressive and cognitive behaviors and the hypothesis that nandrolone might affect the brain via interaction with neurosteroids. Radiolabelled [(3)H]ifenprodil was used in the binding studies because of its significant affinity for the NMDA and sigma receptors. The results indicated that [(3)H]ifenprodil binds to both sigma-1 and sigma-2 sites and can be displaced to a certain extent from both sites by the neurosteroids pregnenolone sulphate (PS), pregnanolone sulphate (3 alpha 5 beta S) and dehydroepiandrosterone sulphate (DHEAS). The remainder of the [(3)H]ifenprodil was displaced from the sigma-1 site by the sigma-1 receptor-selective ligand (+)-SKF 10,047. Chronic nandrolone treatment changed the sigma-1 receptor target for the neurosteroids but not for ifenprodil. The sigma-2 receptor site was unaltered by treatment with nandrolone decanoate. The results also indicated that the neurosteroid-induced allosteric modulation of the NMDA receptor subunit NR2B was not affected by nandrolone treatment. We conclude that chronic treatment with nandrolone changes the affinity of the neurosteroids PS, 3 alpha 5 beta S and DHEAS at the sigma-1 site but not at the sites on the sigma-2 receptor or the NMDA receptor subunit NR2B.

Eliakim A; Cale-Benzoor M; Klinger-Cantor B; Freud E; Nemet D; Feigin E et al. A case study of virilizing adrenal tumor in an adolescent female elite tennis player: Insight into the use of anabolic steroids in young athletes. Journal of Strength and Conditioning Research 25(1): 46-50, 2011. (15 refs.)

A 14-year-old Caucasian girl was referred to the endocrine clinic for evaluation of voice deepening, facial hirsutism, and acne starting 2 years previously. She had been a competitive tennis player since age 7 years, practicing for 4-6 hours daily. On physical examination she was noticed to have a masculine appearance with mild facial acne and moderate hirsutism. Tanner stage was 1 for breast tissue and 5 for pubic hair. Her androgen levels (testosterone, androstenedione, dehydroepiandrosterone sulfate) were extremely elevated. Adrenal ultrasonography revealed a round left 4.6 X 5.3-cm adrenal mass. Laparoscopic left adrenalectomy was performed. The histologic findings were compatible with a benign adrenocortical tumor. Postoperatively, androgen levels dropped to within the normal range. Breast development proceeded normally, menarche occurred 2 months after tumor resection, and menses has been regular since then. Muscle strength of the dominant and nondominant upper and lower extremities was measured 1 month before surgery and 1 year later, using an isokinetic dynamometer (Biodex Systems II, Biodex, Shirley, NY, USA). There was no significant decrease in overall muscle strength after removal of the virilizing tumor and the marked drop in circulating androgens. In addition, the patient maintained her age category, number 1, national tennis ranking. The results suggest that even extremely high levels of tumor-related circulating androgens had no evident effect on muscle strength and competitive performance in a female adolescent tennis player. The lack of beneficial effect on performance in adolescents, combined with the potentially hazardous side effects of anabolic steroids, suggests that teenage athletes should avoid their use.

Evans-Brown M; McVeigh J. Injecting human growth hormone as a performance-enhancing drug-perspectives from the United Kingdom. (review). Journal of Substance Use 14(5): 267-288, 2009. (121 refs.)

Injectable human growth hormone has been used as a performance-enhancing drug in the United Kingdom since at least the mid-1980s. However, because of its prohibitive cost and limited supply it was initially restricted to a relatively small number of people. More recently data suggest that there has been a large increase in the use of the hormone within some sections of the general population. Here the hormone is usually taken as part of a high-dose polydrug regimen (which includes multiple types of anabolic steroids) predominately to enhance physique and/or bodily aesthetics. However, detailed systematic studies of the cultural diffusion of this drug (including the motivations for use, prevalence, patterns of use, and supply network) are lacking. Moreover, questions about growth hormone's efficacy, effectiveness, and safety (including risks from injecting and the use of adulterated products) when used as a performance-enhancing drug remain largely unanswered. This article reviews the data that are available on the self-directed use of growth hormone in the United Kingdom and the associated risks to individual and public health.

Garevik N; Rane A. Dual use of anabolic-androgenic steroids and narcotics in Sweden. Drug and Alcohol Dependence 109(1/3): 144-146, 2010. (24 refs.)

Background: Anabolic-androgenic steroids (AAS) have long been used by body-builders seeking to increase muscle size, strength and beauty. AAS are sometimes used together with narcotic agents and are thought to serve as a gateway to narcotic substance use, but this theory has not yet been substantiated clinically or sociologically. Methods: Mandatory interviews were carried out with individuals (n = 56) suspected of infringement of the narcotic laws in Sweden with confiscated and/or confirmed use of AAS. Data were collected over 12 months. Results: Seventy-three percent of subjects with confirmed use of AAS were also using narcotic substances. The use of AAS was preceded by the use of narcotic agents in 55% of subjects. Only one-fifth of the subjects in the study had used AAS before using narcotic agents. Conclusion: Co-use of AAS and narcotics agents is frequent among young people taken into custody for criminal activity and investigated by the police in Sweden. The study does not lend support to the hypothesis that AAS are commonly a gateway drug to narcotic use.

Goldman RD. Drug-induced gynecomastia in children and adolescents. Canadian Family Physician 56(4): 344-345, 2010. (11 refs.)

QUESTION I frequently see adolescent boys in my practice with transient gynecomastia. My management includes reassuring the boys and their families; however, I also understand that specific medication, alcohol, and drugs can cause gynecomastia. How common is this phenomenon, and what medications can induce gynecomastia? ANSWER While gynecomastia is a physiologic phenomenon in most newborns and adolescents, it is important to consider pathologic conditions and medications that can cause breast enlargement. Antibiotics, antiulcer drugs, growth hormones, and chemotherapy have been reported to induce gynecomastia. Adolescents who use anabolic steroids, or who abuse alcohol, marijuana, heroin, or amphetamines, should be alerted to the fact that gynecomastia might develop. Treatment of drug-induced gynecomastia includes discontinuation of the offending drug. Very rarely is surgical intervention required.

Goltsos K; Soulas D; Martinez CAC; Zakynthinaki M; Anton AJM; Rodriguez GS. Anabolic drugs consumption of high school students participating in school championships of physical education. African Journal of Pharmacy and Pharmacology 6(1): 66-70, 2012. (27 refs.)

This paper aims to analyse the use of anabolic drugs among Greek students participating in school championships of physical education (PE). In order to do it, a survey was conducted during the 2008 to 2009 academic year in suburban, urban and metropolitan areas in Greece. The sample was 2,535 high school students from the 10 to 12th grade, participating in the school physical education championships. The results showed that 9.6% of boys and 3.7% of girls reported that they had used anabolic drugs sometime in the past whereas 11.2% boys and 4.8% girls reported that they would intend to use them in the future. This confirms that anabolic steroids are an important problem among adolescents, and educational programs should increase their knowledge about these drugs. Information should come not only from the state, but also from coaches, teachers, trainers and parents.

Grata E; Perrenoud L; Saugy M; Baume N. SARM-S4 and metabolites detection in sports drug testing: A case report. Forensic Science International 213(1-3): 104-108, 2011. (21 refs.)

Recently, pharmaceutical industry developed a new class of therapeutics called Selective Androgen Receptor Modulator (SARM) to substitute the synthetic anabolic drugs used in medical treatments. Since the beginning of the anti-doping testing in sports in the 1970s, steroids have been the most frequently detected drugs mainly used for their anabolic properties. The major advantage of SARMs is the reduced androgenic activities which are the main source of side effects following anabolic agents' administration. In 2010, the Swiss laboratory for doping analyses reported the first case of SARMs abuse during in-competition testing. The analytical steps leading to this finding are described in this paper. Screening and confirmation results were obtained based on liquid chromatography tandem mass spectrometry (LCMS/MS) analyses. Additional information regarding the SARM S-4 metabolism was investigated by ultra high-pressure liquid chromatography coupled to quadrupole time-of-flight mass spectrometer (UHPLC-QTOF-MS).

Hakansson A; Mickelsson K; Wallin C; Berglund M. Anabolic androgenic steroids in the general population: User characteristics and associations with substance use. European Addiction Research 18(2): 83-90, 2012. (38 refs.)

Aims: To analyse correlates of anabolic androgenic steroids (AAS) use in the general male population. Design: A national household survey. Participants: Individuals aged 15-64 years in Sweden. Measurements: AAS use and potential correlates of AAS use, including demographic data, financial situation, physical training, and substance use. In hierarchical logistic regression analyses, lifetime users of AAS (n = 240) were compared to all nonusers (n = 13,920) and to nonusers who reported that they had been offered AAS (n = 487). Results: AAS use was most strongly associated with a lifetime history of illicit drug use and the misuse of prescription drugs. When controlling for substance use, AAS was associated with physical training and lower education. Illicit drug use and misuse of prescription drugs separated AAS users from nonusers who had been offered AAS. No associations were seen with AUDIT scores for risk alcohol drinking. Conclusions: In this general population survey in men, lifetime use of AAS appears to share common characteristics with illicit substance use. Both substance use variables and physical training remained associated with AAS use when controlling for one another.

Hildebrandt T; Lai JK; Langenbucher JW; Schneider M; Yehuda R; Pfaff DW. The diagnostic dilemma of pathological appearance and performance enhancing drug use. (review). Drug and Alcohol Dependence 114(1): 1-11, 2011. (146 refs.)

Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement: (2) significant body image disturbance: (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

Hildebrandt T; Langenbucher JW; Lai JK; Loeb KL; Hollander E. Development and validation of the appearance and performance enhancing drug use schedule. Addictive Behaviors 36(10): 949-958, 2011. (89 refs.)

Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic-androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes the development and psychometric evaluation of the Appearance and Performance Enhancing Drug Use Schedule (APEDUS) which is a semi-structured interview designed to assess the spectrum of drug use and related features of APED use. Eighty-five current APED using men and women (having used an illicit APED in the past year and planning to use an illicit APED in the future) completed the APEDUS and measures of convergent and divergent validity. Inter-rater agreement, scale reliability, one-week test-retest reliability, convergent and divergent validity, and construct validity were evaluated for each of the APEDUS scales. The APEDUS is a modular interview with 10 sections designed to assess the core drug and non-drug phenomena associated with APED use. All scales and individual items demonstrated high inter-rater agreement and reliability. Individual scales significantly correlated with convergent measures (DSM-IV diagnoses, aggression, impulsivity, eating disorder pathology) and were uncorrelated with a measure of social desirability. APEDUS subscale scores were also accurate measures of AAS dependence. The APEDUS is a reliable and valid measure of APED phenomena and an accurate measure of the core pathology associated with APED use. Issues with assessing APED use are considered and future research is considered.

Hildebrandt T; Yehuda R; Alfano L. What can allostasis tell us about anabolic-androgenic steroid addiction? Development and Psychopathology 23(3, special issue): 907-919, 2011. (109 refs.)

Anabolic-androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction follow the traditional framework of drug abuse and dependence, which suggest that harmful use occurs as a result of the drug's ability to hijack the motivation-reward system. However, AASs, unlike typical drugs of abuse, are not used for acute intoxication effects or euphoria. Rather, AASs are used to affect the body through changes to the musculoskeletal system and the hypothalamic-pituitary-gonadal axis as opposed to stimulating the reward system. We offer an allostatic model of AAS addiction to resolve this inconsistency between traditional drug addiction and AAS addiction. This allostatic framework provides a way to (a) incorporate exercise into AAS misuse, (b) identify where AAS use transitions from recreational use into a drug problem, and (c) describe individual differences in vulnerability or resilience to AASs. Implications for this model of AAS addiction are discussed.

Hoffman JR; Kraemer WJ; Bhasin S; Storer T; Ratamess NA; Haff GG et al. Position stand on androgen and human growth hormone use. (review). Journal of Strength and Conditioning Research 23(Supplement 5): s1-s59, 2009. (550 refs.)

Perceived yet often misunderstood demands of a sport, overt benefits of anabolic drugs, and the inability to be offered any effective alternatives has fueled anabolic drug abuse despite any consequences. Motivational interactions with many situational demands including the desire for improved body image, sport performance, physical function, and body size influence and fuel such negative decisions. Positive countermeasures to deter the abuse of anabolic drugs are complex and yet unclear. Furthermore, anabolic drugs work and the optimized training and nutritional programs needed to cut into the magnitude of improvement mediated by drug abuse require more work, dedication, and preparation on the part of both athletes and coaches alike. Few shortcuts are available to the athlete who desires to train naturally. Historically, the NSCA has placed an emphasis on education to help athletes, coaches, and strength and conditioning professionals become more knowledgeable, highly skilled, and technically trained in their approach to exercise program design and implementation. Optimizing nutritional strategies are a vital interface to help cope with exercise and sport demands (516-518). In addition, research-based supplements will also have to be acknowledged as a strategic set of tools (e.g., protein supplements before and after resistance exercise workout) that can be used in conjunction with optimized nutrition to allow more effective adaptation and recovery from exercise. Researchistance exercise is the most effective anabolic form of exercise, and over the past 20 years, the research base for resistance exercise has just started to develop to a significant volume of work to help in the decision-making process in program design (187,248,305). The interface with nutritional strategies has been less studied, yet may yield even greater benefits to the individual athlete in their attempt to train naturally. Nevertheless, these are the 2 domains that require the most attention when trying to optimize the physical adaptations to exercise training without drug use. Recent surveys indicate that the prevalence of androgen use among adolescents has decreased over the past 10-15 years (154,159,246,253,370,441,493). The decrease in androgen use among these students may be attributed to several factors related to education and viable alternatives (i.e., sport supplements) to substitute for illegal drug use. Although success has been achieved in using peer pressure to educate high school athletes on behaviors designed to reduce the intent to use androgens (206), it has not had the far-reaching effect desired. It would appear that using the people who have the greatest influence on adolescents (coaches and teachers) be the primary focus of the educational program. It becomes imperative that coaches provide realistic training goals for their athletes and understand the difference between normal physiological adaptation to training or that is pharmaceutically enhanced. Only through a stringent coaching certification program will academic institutions be ensured that coaches that they hire will have the minimal knowledge to provide support to their athletes in helping them make the correct choices regarding sport supplements and performance-enhancing drugs. The NSCA rejects the use of androgens and hGH or any performance-enhancing drugs on the basis of ethics, the ideals of fair play in competition, and concerns for the athlete's health. The NSCA has based this position stand on a critical analysis of the scientific literature evaluating the effects of androgens and human growth hormone on human physiology and performance. The use of anabolic drugs to enhance athletic performance has become a major concern for professional sport organizations, sport governing bodies, and the federal government. It is the belief of the NSCA that through education and research we can mitigate the abuse of androgens and hGH by athletes. Due to the diversity of testosterone-related drugs and molecules, the term androgens is believed to be a more appropriate term for anabolic steroids. 1. Androgen administration in a concentration-dependent manner increases lean body mass, muscle mass, and maximal voluntary strength in men. However, the upper concentration for maximum effects remains unknown. 2. Combined administration of androgens and resistance exercise training is associated with greater gains in lean body mass, muscle size, and maximal voluntary strength in men than either intervention alone. 3. Testosterone therapy is approved only for the treatment of hypogonadism in adolescent and adult men. However, the anabolic applications of androgens and selective AR modulators are being explored for the functional limitations associated with aging and some types of chronic illness. 4. The magnitude and frequency of adverse effects among androgen users have not been systematically studied. Potential adverse effects of androgen use in men include suppression of the hypothalamic-pituitary-gonadal axis, mood and behavior disorders, increased risk of cardiovascular disease, hepatic dysfunction with oral androgens, insulin resistance, glucose intolerance, acne, gynecomastia, and withdrawal after discontinuation. In addition, the polypharmacy of many androgen users (psychoactive and accessory drugs) may have serious adverse effects of their own. 5. The adverse effects of androgen administration in women are similar to those noted in men. In addition, women using androgens may also experience virilizing side effects such as enlargement of the clitoris, deepening of the voice, hirsutism, and changes in body habitus. These changes may not be reversible on cessation of androgen use. 6. In pre- and peripubertal children, androgen use may lead to virilization, premature epiphyseal closure, and resultant adult short stature. 7. Since 1990, the use of androgens for a nonmedical purpose is illegal. Androgens are labeled as a schedule III drug. Possession of any schedule III substance including androgens is punishable by fine, prison time, or both. Prescribing androgens for bodybuilding or enhanced athletic performance is also punishable as noted above. 8. Human growth hormone increases lean body mass within weeks of administration; however, the majority of the change is within the water compartment and not in body cell mass. 9. Human growth hormone is unlikely to be administered as a single agent but often in combination with androgens. 10. Combined administration of hGH and resistance exercise training is associated with minimal gains in lean body mass, muscle size, and maximal voluntary strength in men compared with resistance exercise alone. 11. Human growth hormone is approved for the therapy of children and adolescents with growth hormone deficiency, Turner syndrome, small for gestational age with failure to catch-up to the normal growth curves, chronic kidney disease, Prader-Willi syndrome, idiopathic short stature, Noonan syndrome, and SHOX gene deletion. For adults, hGH is approved for the treatment of GH deficiency, AIDS/HIV with muscle wasting, and short bowel syndrome. 12. The magnitude and frequency of adverse events associated with hGH use are clearly dose related. Potential adverse events include suppression of the hypothalamic-pituitary GH/IGF-1 axis, water retention, edema, increased intracranial pressure, joint and muscle aches, and those of needle injection (hepatitis and HIV/AIDS). These should be the same in women as well as in men. 13. Continued effort should be made to educate athletes, coaches, parents, physicians, and athletic trainers along with the general public on androgen and hGH use and abuse. Educational programs should focus on potential medical risks of these illegal performance-enhancing drugs use, optimizing training programs and concurrent nutritional strategies to enhance physiological adaptation and performance. In addition, educating coaches on setting realistic training goals and expectations for their athletes will help reduce the pressures to use illegal PED and assist in potentially identifying potential users of illegal PED. 14. The NSCA supports and promotes additional research funding to be directed toward effective educational programs, documentation of both acute and long-term adverse effects of androgen and hGH abuse, strategies for optimizing athletic performance through training and nutritional interventions, strategies to help athletes discontinue androgen and hGH use, and strategies for the detection of abuse of androgens and hGH.

Invernizzi G; Ruprecht A; De Marco C; Mazza R; Nicolini G; Boffi R. Inhaled steroid/tobacco smoke particle interactions: A new light on steroid resistance. Respiratory Research 10(article 48), 2009. (42 refs.)

Background: Inhaled steroid resistance is an obstacle to asthma control in asthmatic smokers. The reasons of this phenomenon are not yet entirely understood. Interaction of drug particles with environmental tobacco smoke (ETS) could change the aerodynamic profile of the drug through the particle coagulation phenomenon. Aim of the present study was to examine whether steroid particles interact with smoke when delivered in the presence of ETS. Methods: Beclomethasone-hydrofluoralkane (BDP-HFA) pMDI particle profile was studied after a single actuation delivered in ambient air or in the presence of ETS in an experimental chamber using a light scattering Optical Particle Counter capable of measuring the concentrations of particle sized 0.3-1.0, 1.1-2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, and > 5.1 mu m in diameter with a sampling time of one second. The number of drug particles delivered after a single actuation was measured as the difference between total particle number after drug delivery and background particle number. Two groups of experiments were carried out at different ambient background particle concentrations. Two-tail Student's t-test was used for statistical analysis. Results: When delivered in ambient air, over 90% of BDP-HFA particles were found in the 0.3-1.0 mu m size class, while particles sized 1.1-2.0 mu m and 2.1-3.0 represented less than 6.6% and 2.8% of total particles, respectively. However, when delivered in the presence of ETS, drug particle profile was modified, with an impressive decrease of 0.3-1.0 mu m particles, the most represented particles resulting those sized 1.1-2.0 mu m (over 66.6% of total particles), and 2.1-3.0 mu m particles accounting up to 31% of total particles. Conclusion: Our data suggest that particle interaction between inhaled BDP-HFA pMDI and ETS takes place in the first few seconds after drug delivery, with a decrease in smaller particles and a concurrent increase of larger particles. The resulting changes in aerosol particle profile might modify regional drug deposition with potential detriment to drug efficacy, and represent a new element of steroid resistance in smokers. Although the present study does not provide any functional or clinical assessment, it might be useful to advise smokers and non smokers with obstructive lung disease such as asthma or COPD, to avoid to act inhaled drugs in the presence of ETS in order to obtain the best therapeutic effect.

Ip EJ; Barnett MJ; Tenerowicz MJ; Perry PJ. The Anabolic 500 Survey: Characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy 31(8): 757-766, 2011. (34 refs.)

Study Objective. To contrast the characteristics of two groups of men who participated in strength-training exercise those who reported anabolic-androgenic steroid (AAS) use versus those who reported no AAS use. Design. Analysis of data from the Anabolic 500, a cross-sectional survey. Participants. Five hundred six male self-reported AAS users (mean age 29.3 yrs) and 771 male self-reported nonusers of AAS (mean age 25.2 yrs) who completed an online survey between February 19 and June 30, 2009. Measurements and Main Results. Respondents were recruited from Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Data were collected on demographics, use of AAS and other performance-enhancing agents, alcohol and illicit drug use, substance dependence disorder, other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses, and history of sexual and/or physical abuse. Most (70.4%) of the AAS users were recreational exercisers who reported using an average of 11.1 performance-enhancing agents in their routine. Compared with nonusers, the AAS users were more likely to meet criteria for substance dependence disorder (23.4% vs 11.2%, p<0.001), report a diagnosis of an anxiety disorder (10.1% vs 6.1%, p=0.010), use cocaine within the past 12 months (11.3% vs 4.7%, p<0.001), and report a history of sexual abuse (6.1% vs 2.7%, p=0.005). Conclusion. Most of the AAS users in this study were recreational exercisers who practiced polypharmacy. The AAS users were more likely than nonusers to meet criteria for substance dependence disorder, report a diagnosis of an anxiety disorder, report recent cocaine use, and have a history of sexual abuse. The information uncovered in this study may help clinicians and researchers develop appropriate intervention strategies for AAS abuse.

Ip EJ; Barnett MJ; Tenerowicz MJ; Perry PJ. Weightlifting's risky new trend: A case series of 41 insulin users. (review). Current Sports Medicine Reports 11(4): 176-179, 2012. (21 refs.)

Use of performance-enhancing drugs (PEDs) is common among strength-trained individuals, and a growing concern is the misuse of insulin. A 99-item Internet-based survey was posted on discussion boards of various fitness, bodybuilding, weightlifting, and anabolic steroid Web sites between February and June 2009. A case series of 41 nondiabetic insulin users is described. The typical insulin user was 30.7 +/- 9.2 years old, male (97.6%), and Caucasian/white (86.8%) who classified himself as a "recreational exerciser'' (47.5%). The average insulin user also used anabolic steroids (95.1%) and practiced polypharmacy by incorporating 16.2 +/- 5.6 PEDs in his or her yearly routine. Hypoglycemia was reported by most of the subjects (56.8%), and one individual reported unconsciousness. Insulin was obtained most commonly from local sources (e.g., friends, training partners, gym member/dealer; 40.5%) and community pharmacies (37.8%), with most (80.6%) finding it "easy'' to acquire their insulin. Strategies aimed to prevent insulin misuse are needed.

Ip EJ; Barnett MJ; Tenerowicz MJ; Kim JA; Wei H; Perry PJ. Women and anabolic steroids: An analysis of a dozen users. Clinical Journal of Sport Medicine 20(6): 475-481, 2010. (38 refs.)

Objective: To provide an in-depth analysis of 12 female self-reported anabolic-androgenic steroid (AAS) users. Design: Web-based survey. Setting: A Web-based survey was posted on 38 discussion boards of various fitness, bodybuilding, weightlifting, and steroid Web sites between February and June 2009. Interventions: Participants completed a survey regarding demographics and use of AAS and other performance-enhancing agents (PEAs). Participants: A cohort of 1519 strength-trained subjects fully completed and submitted a valid survey. Five hundred eighteen subjects were self-reported AAS users consisting of 12 women and 506 men. One thousand one subjects were non-AAS users consisting of 230 women and 771 men. Main Outcome Measures: Demographic data and use of AAS and other PEAs. Results: The female AAS users reported using an average of 8.8 PEAs in their routine. Compared with male AAS users and female non-AAS users, respectively, female AAS users were more likely to have met criteria for substance-dependence disorder (58.3% vs 23.4%; P = 0.01; 58.3% vs 9.1%; P < 0.001), have been diagnosed with a psychiatric illness (50.0% vs 17.4%; P = 0.01; 50.0% vs 22.2%; P = 0.04), and have reported a history of sexual abuse (41.7% vs 6.1%; P < 0.001; 41.7% vs 15.3%; P = 0.03). Conclusions: Female AAS users practice polypharmacy. Female AAS users are more likely to have qualified for substance-dependence disorder, have been diagnosed with a psychiatric illness, and have a history of sexual abuse than both male AAS users and female non-AAS users.

Kanayama G; Brower KJ; Wood RI; Hudson JI; Pope HG. Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications. (review). Drug and Alcohol Dependence 109(1-3): 6-13, 2010. (152 refs.)

Currently, few users of anabolic-androgenic steroids (AAS) seek substance abuse treatment. But this picture may soon change substantially, because illicit AAS use did not become widespread until the 1980s, and consequently the older members of this AAS-using population - those who initiated AAS as youths in the 1980s - are only now reaching middle age. Members of this group, especially those who have developed AAS dependence, may therefore be entering the age of risk for cardiac and psychoneuroendocrine complications sufficient to motivate them for substance abuse treatment. We suggest that this treatment should address at least three etiologic mechanisms by which AAS dependence might develop. First, individuals with body image disorders such as "muscle dysmorphia" may become dependent on AAS for their anabolic effects: these body image disorders may respond to psychological therapies or pharmacological treatments. Second, AAS suppress the male hypothalamic-pituitary-gonadal axis via their androgenic effects, potentially causing hypogonadism during AAS withdrawal. Men experiencing prolonged dysphoric effects or frank major depression from hypogonadism may desire to resume AAS, thus contributing to AAS dependence. AAS-induced hypogonadism may require treatment with human chorionic gonadotropin or clomiphene to reactivate neuroendocrine function, and may necessitate antidepressant treatments in cases of depression inadequately responsive to endocrine therapies alone. Third, human and animal evidence indicates that AAS also possess hedonic effects, which likely promote dependence via mechanisms shared with classical addictive drugs, especially opioids. Indeed, the opioid antagonist naltrexone blocks AAS dependence in animals. By inference, pharmacological and psychosocial treatments for human opioid dependence might also benefit AAS-dependent individuals.

Kanayama G; Hudson JI; Pope HG. Culture, psychosomatics and substance abuse: The example of body image drugs. Psychotherapy and Psychosomatics 81(2): 73-78, 2012. (76 refs.)

Patterns of illicit drug use vary widely around the world. For example, one recent survey found lifetime cannabis use among 41.9% of respondents in New Zealand, but only 6.6% of respondents in Italy and 1.5% in Japan. Cocaine was reported by 16.2% of respondents in the USA, versus 4.1% in Spain and 0.0% in the People�s Republic of China. Favored drugs of abuse may also rank differently within different countries. Japan, for instance, has experienced three major epidemics of methamphetamine abuse over the last 50 years , but shows a low prevalence of many other forms of drug abuse that are widespread elsewhere. Clearly, factors such as drug availability, government enforcement policies and national healthcare systems contribute to these figures, but one must also acknowledge the critical role of culture. Culture influences not only attitudes towards illicit drug use in general, but also which particular drugs people choose to use; a drug effect sought by one population might have little appeal for another. As one example of this little-studied issue, we explore here a form of drug abuse that is strikingly asymmetric across cultures: the use of �body image drugs� such as anabolic-androgenic steroids (AAS). AAS abuse is a particularly common problem in Scandinavia, followed perhaps next by the USA, then the British Commonwealth countries, Brazil and the rest of Western Europe. By contrast, AAS abuse is rare in the Far East. The authors explore the possibility that forces in Western culture, dating from ancient times, as illustrated by Samson in the Bible, or by the supernaturally muscular gods of ancient Greece and Rome, as well as the mythic traditions of Scandinavia.

Kanayama G; Hudson JI; Pope HG. Features of men with anabolic-androgenic steroid dependence: A comparison with nondependent AAS users and with AAS nonusers. Drug and Alcohol Dependence 102(1/3): 130-137, 2009. (96 refs.)

Background: Anabolic-androgenic steroid (AAS) dependence has been a recognized syndrome for some 20 years, but remains Poorly understood. Methods: We evaluated three groups of experienced male weightlifters: (I) men reporting no history of AAS use (N=72): (2) nondependent AAS users reporting no history of AAS dependence (N=42); and (3) men meeting adapted DSM-IV criteria for Current or past AAS dependence (N=20). We assessed demographic indices, lifetime history of psychiatric disorders by the Structured Clinical Interview for DSM-IV, variables related to AAS use, and results from drug tests of urine and hair. Results: Nondependent AAS users showed no significant differences from AAS nonusers On any variable assessed. Dependent AAS users, however, differed Substantially from both other groups on many measures. Notably, they reported a more frequent history of conduct disorder than nondependent AAS users (odds ratio [95% CI]: 8.0 [1.7, 38.0]) or AAS nonusers (13.1 [2.8, 60.4]) and a much higher lifetime prevalence of opioid abuse and dependence than either comparison group (odds ratios 6.3 [1.2, 34.5] and 18.6 [3,0,116.8], respectively). Conclusions: Men with AAS dependence, unlike nondependent AAS users or AAS nonusers, showed a distinctive pattern Of comorbid psychopathology, overlapping with that of individuals with other forms of substance dependence. AAS dependence showed a particularly strong association with opioid dependence - an observation that recalls recent animal data suggesting similarities in AAS and opioid brain reward mechanisms. Individuals with AAS dependence and individuals with "classical" substance dependence may possibly harbor similar underlying biological and neuropsychological vulnerabilities.

Kanayama G; Pope HG. Gods, men, and muscle dysmorphia. Harvard Review of Psychiatry 19(2): 95- 98, 2011. (28 refs.)

Some psychiatric disorders are profoundly modulated by culture; syndromes common in one society, or in one period of history may be rare or nonexistent in another. Body dysmorphic disorder (BDD) is a prime example. It refers to preoccupation about a perceived defect in one's personal appearance, that is essentially trivial or un recognized by others. First recognized in the nineteenth century, it has recently become relatively common. In current society, this is often manifest by 'muscle dysmorphia, a preoccupation that one is not sufficiently muscular. In some this is associated with weight lifting. This condition is seen as predisposing people, almost exclusively males, to anabolic-androgenic steroids. This is associated with myocardial toxicity, atherosclerotic disease, hypogonadism, and mood disorders. It is also notable that areas with the highest rate of body dismorphic disorder also have the highest rate of steroid use/misuse.

Kao TC; Deuster PA; Burnett D; Stephens M. Health behaviors associated with use of body building, weight loss, and performance enhancing supplements. Annals of Epidemiology 22(5): 331-339, 2012. (40 refs.)

Purpose: To identify health-related behaviors associated with potentially harmful dietary supplements (DS) - body building (BB), weight loss (WL) and performance enhancing (PE), explore common reasons and sources of information for DS use. Methods: Based on the 2005 Survey of 16,146 U.S. military personnel, BB users were dichotomized as yes (regular use - taking any supplement of BB at least once a week in past 12 months) or no; similarly defined for WL and PE. Weighted logistic regression models are used. Results: BB, WL and PE were used by 19.4%, 17.0%, and 8.0% of participants, respectively. Significantly more users were overweight or obese: BMI >= 25 (vs. BMI <25); heavy drinkers (vs. abstainers); and users of taking steroids in their lifetime (vs. not). Most common reasons of BB, WL, and PE users wanted to increase muscle mass, lose weight, and improve physical performance (BB: 45.8%, WL: 54.8%, PE: 38.5%). Fewer than 30% discussed dietary supplements use with their healthcare providers. The leading source of dietary supplements information (BB: 27.8%, WL: 23.6%, PE: 30.0%) was magazines. Conclusions: The dietary supplements: BB, WL and PE were used by significant proportions of service members, and associated with risk-taking behaviors that may affect overall military readiness and public health.

Kerwin J. The asterisk chronicles: A short history of steroid use and analysis. Drug Testing and Analysis 2(9-10): 456-459, 2010. (41 refs.)

Self-injection of extracts from dog and guinea pig testicles by C.-E. Brown-Sequard in 1889 initiated widespread use of organotherapy following (apparently unsubstantiated) claims of increased physical strength and mental acuity. While there were previous experiments on humans and animals using similar extracts, this report launched worldwide use of these potent "Elixirs of Life." In 1927, a crude but potent form of testosterone was isolated; however, it wasn't until 1935 that testosterone was crystallized, and a facile synthesis of testosterone developed using cholesterol as a starting material. There is some question about the provenance of the discovery, but the pertinent issue is that subsequent rapid progress in research on this compound and structurally related anabolic androgenic steroids (AAS) led to their widespread use in diagnosis and treatment of human and other animal maladies�among other things. The quest for magic elixirs dates at least back to the ancient Greeks, calling into question the protestations of Pierre de Coubertin and others, who exploited the myth of athletic purity while promoting the development of modern Olympic competitions. Paul de Kruif (circa 1945) experimented with testosterone injections, leading him to extol the ability of steroids to not only add weight and muscle mass, but to prolong sexual prowess and increase productivity. A pivotal period in the explosion of steroid use can be traced to the 1952 Olympics in Helsinki, specifically the performance of weight lifters from the former Soviet Union, and the Vienna1954 World Weightlifting Championships. Following exceptional performances by the Soviet team, Dr John Ziegler and Bob Hoffman, team physician and coach, respectively, of the United States weightlifting team, suspected the Soviet team of using "the hormone stuff", a conjecture subsequently confirmed by a Soviet team physician after an extended evening at a Vienna tavern. Upon returning to the USA, Ziegler experimented with testosterone injections on himself, Hoffman, and selected members of the weightlifting team, with impressive results. Claiming the results were due to a revolutionary training technique, the steroid supplements were not mentioned. Ziegler is recognized as one of, if not the most, pivotal figures in promoting early steroid use for athletic performance enhancement.The impact of "Pumping Iron "on the bodybuilding community (and other athletes) worldwide was immense and immediate, putting Venice Beach�and steroid use�on the map. Dan Duchaine further rattled both the habitu�s of Gold's Gym and the Venice Beach law enforcement community with the 1981 publication of The Underground Steroid Handbook for Men and Women (USH)." the use of laboratory tests to identify steroid use, emerged in the 1970s and early 1980s. The growth of testing and current status are described.

Koushesh HR; Afshari R. A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids. Drug and Chemical Toxicology 32(2): 114-119, 2009. (23 refs.)

Opioid abuse is common in Iran. In 2005, a new version of locally produced illicit opioid vials, so called Norgesic, appeared in the illicit market, which gained popularity rapidly and led to an improvement of stigmatizing the general appearance of dependent cases. Later, some cases suffered Cushing's-like problems. A prospective case series was designed to evaluate 18 Norgesic-dependent subjects who volunteered for abstinence therapy in a rehabilitation clinic from November 1, 2005, to December 30, 2005. In this study, we aimed to describe the clinical and paraclinical findings in detail and define the potential determinants of this Cushing's syndrome outbreak. History, physical examination, plasma cortisol level, and urine screen tests were used to describe the patients. All subjects were male with a mean (SEM) age of 29.8 +/- 1.6 years. The opioid-dependence period was 8.4 +/- 0.9 years. In an average of 4.7 +/- 0.3 months, subjects increased their usage to 5.5 +/- 0.5 vials a day. Patients claimed to gain weight. Striae were seen in 38.9%, previously documented psychological problems in 33.3%, weakness in 27.8%, high systolic blood pressure in 22.2%, moon face in 16.7%, hirsutism in 11.1%, extensive dermal infection in 11.1%, gynecomastia in 5.6%, back pain in 5.6%, insomnia in 5.6%, and lack of potency in 5.6%. Their cortisol level, on average, was 4.8 +/- 1.1 mu g/dL. Hepatitis C virus was positive in 22.2%. Urine-screening tests were positive for morphine and negative for buprenorphine. In conclusion, these new vials contain steroids as well as opioids. This combination could be more dangerous than opioids themselves.

Leifman H; Rehnman C; Sjoblom E; Holgersson S. Anabolic androgenic steroids: Use and correlates among gym users-an assessment study using questionnaires and observations at gyms in the Stockholm region. International Journal of Environmental Research and Public Health 8(7): 2656-2674, 2011. (21 refs.)

The purpose of this study was to estimate the prevalence of anabolic androgenic steroid (AAS) use and offers to use among gym users in Stockholm County (Sweden), and to conduct a comparison of concordance in estimates of AAS and supplements at gyms between two data collection methods. A questionnaire was distributed to members at 36 training facilities and 1,752 gym users participated in the study. An observation study was conducted as covert participant observations at 64 gyms. According to the questionnaire, 3.9% of men reported life time use of AAS, 1.4% use during the past 12 months and 0.4% AAS use during past 30 days. Not only were there similar patterns found in the two methods, i.e., similar age and gender distributions for AAS use, but analyses of concordance showed that gyms with a higher prevalence of self-reported AAS-use and supplement use (questionnaire) showed a significantly higher proportion of observer-assessed AAS users. Analyses of individual predictors showed that AAS users were almost always young men, regular weight trainers and more often users of drugs and nutritional supplements. The higher prevalence of AAS use among gym users than in the general population makes the former an appropriate target group for AAS prevention. The connection between supplements, drugs and AAS use suggests that effective AAS prevention need to focus on several risk factors for AAS use. The clear resemblance in estimates between the observation and questionnaire data strengthen the credibility of the two methods.

Lood Y; Eklund A; Garle M; Ahlner J. Anabolic androgenic steroids in police cases in Sweden 1999-2009. Forensic Science International 219(1-3): 199-204, 2012. (31 refs.)

Anabolic Androgenic Steroids (AAS) are considered drugs of abuse and are controlled substances in Sweden since 1999. Traditionally AAS have been used by elite athletes to enhance performance, but in recent years it has become an increasing problem outside elite sport among athletes, bodybuilders and criminals. Use of AAS is associated with psychiatric side effects such as aggression, depression and violent behavior. Supraphysiological doses and long term use can cause serious physical harm such as cardiovascular toxicity and even premature death. We investigated and evaluated the drug analytical findings in forensic cases from suspected perpetrators in cases from the police where a screening for AAS was requested to get information about the prevalence of AAS use and the occurrence of poly-drug abuse. The study was based on samples submitted from the police authorities to the Department of Forensic Toxicology in Sweden during the period 1999-2009. Urines were analyzed by methods based on GC-MS and LC-MS-MS. We also analyzed the prevalence of AAS use at the prison and probation services. A total number of 12,141 urine samples (6362 police cases and 5779 inmates) were analyzed and 33.5% of the cases from the police and 11.5% of the inmates were tested positive for AAS. The users of AAS were mainly in 99.2% men with a mean age of 26.2 +/- 6.2 years whereas the women were 29.5 +/- 6.5 years old. The most frequently used AAS was nandrolone followed by testosterone and methandienone. Other illicit and licit drugs were detected in 60% of the cases from the police, strongly indicating a frequent poly-drug abuse among users of AAS.

Lundholm L; Kall K; Wallin S; Thiblin I. Use of anabolic androgenic steroids in substance abusers arrested for crime. Drug and Alcohol Dependence 111(3): 222-226, 2010. (42 refs.)

Background: Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs . The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous With the Intent of further investigating this issue we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes. Methods: Data were collected from structured interviews with substance abusers (n = 3597) apprehended at two remand prisons in Sweden from 2002 through 2008 Analyses concerned type of criminal act primary drug used during the past year and experience of AAS use Results: Those stating AAS experience (n = 924 20 women and 904 men) were more often apprehended for violent crimes (OR = 1 65). This association remained significant after controlling for age and sex (OR = 1 28). AAS users and non-users claimed similar primary substances of use during the past year with the exception of benzodiazepine use which was more common in the AAS group (OR = 2 30) although this did not affect the frequency of violent crime. Among MS-experienced participants there was no difference in violent crime incidence between current users and former users. Conclusions: Study results suggest that AASs do not function as a proximal trigger for violence but still involve an Increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.

Mattila VM; Rimpela A; Jormanainen V; Sahi T; Pihlajamaki H. Anabolic-androgenic steroid use among young Finnish males. Scandinavian Journal of Medicine & Science in Sports 20(2): 330-335, 2010. (19 refs.)

The aim of the present study was to describe the lifetime occurrence and associated factors of anabolic-androgenic steroids (AAS) among young Finnish males. Of the 10 829 male conscripts (median age 19), 10 396 (96%) answered a questionnaire during the first days of their conscription in the years 2001-2007. The main outcome was lifetime AAS use. We also studied associations between 13 socioeconomic, health, and health behavioral background variables and AAS use by logistic regression. Eighty-nine (0.9%) respondents reported having used AAS. In addition, 26 (0.3%) respondents reported that they would use AAS if they could obtain them. In multivariate analysis, which included all significant variables and age, the strongest associated factors were weight training at fitness centers more than three times a week [odds ratio (OR) 11.8; 95% confidence interval (CI): 7.1-19.6], low educational status (OR 3.7; 95% CI: 2.0-7.0), and weekly drunkenness as drinking style (OR 2.4; 95% CI: 1.4-4.5). Sports other than weight training were not associated with AAS in our sample. The use of AAS is relatively uncommon among Finnish males. It is strongly associated with weight training at fitness centers but also with lower educational status and a drunkenness-oriented lifestyle. Prevention should be targeted at those males participating in weight training.

Melrose D; Ocker L; Bonnette R; Spaniol F. The internet and steroids: A less than honest relationship. Strength and Conditioning Journal 33(2): 95-99, 2011. (14 refs.)

The purpose of this article is to inform strength and conditioning professionals about potentially dishonest tactics used on the internet to sell and distribute anabolic steroids. Products purchased through this medium may have broad, diverse, and unforeseen consequences for users. By dissemination of this information, strength and conditioning professionals can use their influence to educate those individuals mostly at risk for obtaining steroids through this medium.

Montisci M; El Mazloum R; Cecchetto G; Terranova C; Ferrara SD; Thiene G et al. Anabolic androgenic steroids abuse and cardiac death in athletes: Morphological and toxicological findings in four fatal cases. Forensic Science International 217(1-3): E13-E18, 2012. (39 refs.)

Anabolic androgenic steroids (AAS) are the main class of doping agents and their consumption produces adverse effects involving several organs and systems. Three cases of sudden cardiac death (SCD) and one of death due to congestive heart failure of previously healthy athletes who were AAS users are herein reported. Concentric cardiac hypertrophy with focal fibrosis (one case), dilated cardiomyopathy with patchy myocyte death (two cases) and eosinophilic myocarditis (one case) were observed and most probably relate to the final event. Molecular investigation for viral genomes was positive in one case (Ebstein virus). Our data confirm previous findings, showing that the most typical cardiac abnormality in AAS abusers is left ventricular hypertrophy, associated with fibrosis and myocytolysis. An exceptional cardiovascular substrate was represented by the case with drug induced eosinophilic myocarditis. These features are at risk of ventricular arrhythmias as well as congestive heart failure. The cause-effect relationship between AAS abuse and cardiac death can be established only by a rigorous methodology with the use of standardized protocols, including precise morphological studies of all target organs to search for chronic toxic effects. Laboratory investigations should focus on AAS searching on a wide range of biological matrices to demonstrate type, magnitude and time of exposure.

Mosley PE. Bigorexia: Bodybuilding and muscle dysmorphia. European Eating Disorders Review 17(3): 191-198, 2009. (21 refs.)

Muscle dysmorphia is an emerging condition that primarily affects male bodybuilders. Such individuals obsess about being inadequately muscular. Compulsions include spending hours in the gym, squandering excessive amounts of money on ineffectual sports supplements, abnormal eating patterns or even substance abuse. In this essay, I illustrate the features of muscle dysmorphia by employing the first-person account of a male bodybuilder afflicted by this condition. I briefly outline the history of bodybuilding and examine whether the growth of this sport is linked to a growing concern with body image amongst males. I suggest that muscle dysmorphia may be a new expression of a common pathology shared with the eating disorders.

Myles TD. Steroids - plenty of benefits, but not without risk. (editorial). Obstetrics and Gynecology 117(2, Part 2 Supplement): 429-430, 2011. (13 refs.)

Nicolich RS; Padilha MC; Neto FRD. Study of the endogenous steroid profile of male athletes from the Brazilian National Soccer Championship 2009. Drug Testing and Analysis 2(11-12, special issue): 599-602, 2010. (19 refs.)

Changes in the endogenous profile of androgenic anabolic steroids (AAS) may be interpreted as markers of doping. The objective of this study was to evaluate the endogenous profile of AAS in male athletes of the 2009 Brazilian National Soccer Championship, in normal conditions, particularly in the light of the revision of World Anti-Doping Agency's (WADA) Technical Document on the Interpretation of Endogenous AAS in athletes for doping control drafted in that year, as well as comparing these results to profiles already published in the literature. The upper limit of the 95% central reference interval of the following parameters for the studied population were estimated to be significantly higher than WADA's criteria, with a confidence of 90%: DHEA (about 2.3 times higher), Adiol (1.2 times higher), Bdiol (2.7 times higher), and Adiol/E (6 times higher). These findings seem to imply that WADA's criteria proposed in 2009 for DHEA, Adiol, Bdiol, and Adiol/E may not have been applicable to the studied population. Moreover, their comparison to previously published studies pointed to the need to evaluate in detail the appropriateness of adopting these criteria as universal, since there seems to be variations among different populations of athletes.

Papacosta E; Nassis GP. Saliva as a tool for monitoring steroid, peptide and immune markers in sport and exercise science. (review). Journal of Science and Medicine In Sport 14(5): 424-434, 2011. (128 refs.)

Objectives: This paper discusses the use of saliva analysis as a tool for monitoring steroid, peptide, and immune markers of sports training. Design: Salivary gland physiology, regarding the regulation and stimulation of saliva secretion, as well as methodological issues including saliva collection, storage and analysis are addressed in this paper. The effects of exercise on saliva composition are then considered. Method: Exercise elicits changes in salivary levels of steroid hormones, immunoglobulins, antimicrobial proteins and enzymes. Cortisol, testosterone and dehydroepiandrosterone can be assessed in saliva, providing a non-invasive option to assess the catabolic and anabolic effects of exercise. Validation studies using blood and salivary measures of steroid hormones are addressed in this paper. Effects of acute exercise and training on salivary immunoglobulins (SIgA, SIgM, SIgG) and salivary antimicrobial proteins, including a-amylase, lysozyme and lactoferrin, are also discussed. Results: Analysis of cortisol and testosterone in saliva may help detect the onset of non-functional overreaching and subsequently may help to prevent the development of overtraining syndrome. Assessment of salivary immunoglobulins and antimicrobial proteins has been shown to successfully represent the effects of exercise on mucosal immunity. Increases in SIgA and antimicrobial proteins concentration and/or secretion rate are associated with acute exercise whereas conversely, decreases have been reported in athletes over a training season leaving the athlete susceptible for upper respiratory tract infections. Conclusions: The measurement of physiological biomarkers in whole saliva can provide a significant tool for assessing the immunological and endocrinological status associated with exercise and training.

Petersson A; Bengtsson J; Voltaire-Carlsson A; Thiblin I. Substance abusers' motives for using anabolic androgenic steroids. Drug and Alcohol Dependence 111(1-2): 170-172, 2010. (6 refs.)

Background: The use of anabolic androgenic steroids (AAS) has been associated with the use of illegal drugs. Earlier observations suggested that users of illegal drugs may use AAS for reasons other than increasing muscle strength or size. The aim of the present study was to investigate the motives for AAS use among outpatients at a substance abuse center in Stockholm, Sweden. Methods: All male patients under the age of 50 were asked whether they had used AAS during a 2-month period. An AAS survey was administered to those who reported AAS experiences in the admittance interview. Results: Twenty of the 175 respondents (11%) reported using AAS. The most frequently reported motives were related to anabolic effects (i.e., for a good-looking body, to become stronger, or to perform better in sports). However, some users reported other motives; for example, to conceal concomitant drug use, to alleviate insecurity or low self-esteem, to become brave, or in preparation of committing a crime. Furthermore, many respondents reported side effects that were associated with AAS; most notably, irritability and depression/suicidal ideation. Conclusion: Some users of illicit drugs also use AAS for reasons other than the anabolic properties of these compounds. Therefore, considering that AAS may cause or contribute to diverse morbidity, it is important to ask users of illicit drugs about AAS use, even when obvious external signs of AAS use are lacking.

Petraglia AL; Huang JH; Amenta PS; Jallo JI. Anabolic steroids and head injury. Comments. Neurosurgery 70(1): 209-210, 2012. (0 refs.)

Petroianu A; dos Reis DCF; Cunha BDS; de Souza DM. Prevalence of alcohol, tobacco and psychotropic drug consumption by medical students of the "Universidade Federal de Minas gerais". Revista da Associacao Medica Brasileira 56(5): 568-571, 2010. (34 refs.)

OBJECTIVE. The purpose of this study was to assess the prevalence of alcohol, tobacco and psychotropic drug consumption by students of the Medical School of the Federal University of Minas Gerais, Brazil, and to verify aspects related to those addictions. METHODS. This study was carried out with students of all years of the medical course invited to participate anonymously, by answering a self-applied questionnaire which was previously evaluated and adapted to Brazilian reality. It was based upon the World Health Organization's Guidelines for Student Substance Use Survey and included 25 questions about drug addiction. Student's t test and chi-square test were applied to assess differences between the mean and proportions of data. RESULTS. Alcohol and tobacco were the more frequently used by the students, 85.2% and 16.3% respectively. Among psychotropic drugs, marijuana was reported by 16.5% of students, LSD by 6.9%, sedatives by 12%, amphetamines by 7.5% and inhalant substances by 16.8%. Cocaine, crack, opiates, anti-cholinergics and anabolics consumption were rarely mentioned. CONCLUSION. Alcohol was the drug most used and was related to other drug addictions. Drugs were most frequently used by single, male students, who live alone and do not support themselves.

Picu RM; Lamor M; Radu GL. Evaluation of urinary steroid profile after administration of pharmaceutical preparations. Romanian Biotechnological Letters 16(2): 6008- 6016, 2011. (19 refs.)

On World Anti-Doping Agency (WADA) initiative, in the near future, a passport will be developed for the athletes, comprising the main parameters of the steroid profile. The most characteristic endogenous steroids that define the steroid profile, one of the most versatile and informative screening tools for the detection of steroid abuse in sports drug testing, are testosterone, epitestosterone. androsterone. etiocholanolone. dehydroepiandrosterone. 5 alpha-androstane-3 alpha, 17 beta-diol and 5 beta-androstane-3 alpha.17 beta-diol. Knowledge of factors that influence the steroid profile pattern is of central importance. In addition to parameters such as specific gravity, pH-value, gender, sport discipline and time of sampling, other factors such as pharmaceutical, technical and biological issues need consideration when interpreting steroid profile. The purpose of this study was to monitor the values of steroid profile for two male volunteers after the administration of pharmaceutical preparations that contained human chorionic gonadotropin hormone. The analysis was performed by a selective, specific and sensitive gas chromatography/mass spectrometry method in selective ion monitoring (SIM) mode. The study showed that the concentrations of the main parameters of steroid profile increased, but the testosterone/epitestosterone ratio has not exceeded the WADA action limit for human doping control (ratio 4) after the intramuscular administration of one single dose (5000UI) of Pregnyl injection.

Piper T; Geyer H; Schanzer W. Degradation of urine samples and its influence on the C-13/C-12 ratios of excreted steroids. Drug Testing and Analysis 2(11-12, special issue): 620-629, 2010. (29 refs.)

The degradation processes in deficiently stored urine samples are well investigated regarding steroid concentrations and diagnostic ratios, such as the quotient of testosterone divided by epitestosterone. In contrast, nothing is known about the influence on carbon isotope ratios (CIR) by inappropriate storage conditions. In general, it is assumed that degradation, i.e. deconjugation or dehydrogenation, does not change CIR and thus CIR can be used in cases where the steroid profile turns out to be invalid. Therefore, the CIR of urinary steroids was investigated in different urine samples during the course of degradation over a time period of six months. Several steroids excreted as glucuronides (androsterone (A), etiocholanolone (E), testosterone, pregnanediol (PD) and 5 alpha- and 5 beta-androstane-3 alpha,17 beta-diol) or sulfo-conjugated (A, E and androst-5-ene-3 beta,17 beta-diol (5EN17b)) were investigated together with their unconjugated correspondents (A, E, PD and 5EN17b) and the main dehydrogenation products (5a- and 5 beta-androstane-3,17-diol and androst-4-ene-3,17-diol). For this purpose, the exiting methods for CIR determination were extended and validated. In addition, the urinary concentrations of all investigated steroids were monitored. Particular attention was paid to dehydroepiandrosterone conjugated and unconjugated together with its degradation product 3 alpha,5-cyclo-5 alpha-androstan-6 beta-ol-17-one as here the strongest influence on CIR was expected.

Pope HG; Kanayama G; Hudson JI. Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: A cross-sectional cohort study. Biological Psychiatry 71(3): 254-261, 2012. (57 refs.)

Background: Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood. Methods: We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively, using structured clinical interviews and computerized questionnaires. This cross-sectional cohort approach -- a design that we have formally presented in the recent methodological literature -- utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters. Results: Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder versus those without, the hazard ratio (95% confidence interval) for subsequent AAS use was 2.2 (1.5, 3.4). For individuals in the middle versus lowest tertile of scores on a retrospective adolescent muscle-dysmorphia scale, the hazard ratio was 1.5 (. 84, 2.6); for the highest versus lowest tertile, the hazard ratio was 3.3 (2.0, 5.3); and for the linear trend of hazard ratios, p < .001. Conclusions: Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.

Ritter JM. Sex, steroids and anabolic androgens in athletics. (editorial). British Journal of Clinical Pharmacology 74(1): 1-2, 2012. (2 refs.)

Rogol AD. How does an anabolic/androgenic steroid get banned from sport competition? (editorial). Endocrinology 152(12): 4473-4474, 2011. (7 refs.)

Rossi SS; Botre F. Prevalence of illicit drug use among the Italian athlete population with special attention on drugs of abuse: A 10-year review. Journal of Sports Sciences 29(5): 471-476, 2011. (21 refs.)

The objective of this study was to assess the prevalence of illicit drugs use among young adults, in particular elite athletes. This study considers the data obtained from anti-doping analyses performed on nearly 100,000 urine samples from 2000 to 2009 by the World Anti-Doping Agency accredited Italian Anti-Doping Laboratory. The percentage of adverse analytical findings varies on a yearly basis, but it is in the range 1.0-1.8% (not considering atypical findings, such as an altered endogenous steroid profile). Among positive results, there is a high prevalence of stimulants and drugs of abuse. The drug of abuse found most frequently is the tetrahydrocannabinol (cannabis) metabolite, accounting for 0.2-0.4% of the total samples analysed (18% of the positive results). The second most frequently encountered drug is cocaine, as detected from cocaine metabolites, accounting for 0.1% of the total samples analysed (7% of positive results). Other stimulants found included amphetamines, ephedrines, carphedon, modafinil, and anorexic compounds. No amphetamine-like designer drugs were detected. These data are indicative of the widespread prevalence of cocaine and cannabis use among the young adult population. However, due to the particular population studied, it must be considered an underestimation of the phenomenon among elite athletes with respect to the general population.

Schafer CN; Guldager H; Jorgensen HL. Multi-organ dysfunction in bodybuilding possibly caused by prolonged hypercalcemia due to multi-substance abuse: Case report and review of literature. (review). International Journal of Sports Medicine 32(1): 60-65, 2011. (42 refs.)

A 26-year-old male bodybuilder was admitted to the surgical department of a Danish community hospital for hematemesis. During the clinical interview, he revealed that he had recently finished a course of anabolic steroids and erythropoietin. The patient also had a previous history of infections and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency, and was transferred to the ICU. After manometric monitoring on the patient's upper arms proved difficult, invasive blood pressure monitoring was used and revealed that the patient was in a state of hypertensive crisis. This case of multi-organ dysfunction was possibly caused by multi-substance-induced hypercalcemia.

Schwingel PA; Cotrim HP; Salles BR; Almeida CE; dos Santos CR; Nachef B et al. Anabolic-androgenic steroids: A possible new risk factor of toxicant-associated fatty liver disease. Liver International 31(3): 348-353, 2011. (33 refs.)

Background Industrial toxin and drugs have been associated with non-alcoholic fatty liver disease (NAFLD); in these cases, the disease has been termed toxicant-associated steatohepatitis (TASH). Aim This study hypothesizes that the use of anabolic-androgenic steroids (AAS) could also be a risk factor to TASH or better toxicant-associated fatty liver disease (TAFLD) development. Methodology Case-control study including 180 non-competitive recreational male bodybuilders from August/2007 to March/2009. Ninety-five had a history of intramuscular AAS use (cases; G1) and 85 were non-users (controls; G2). They underwent a clinical evaluation and abdominal ultrasound, and their blood levels of aminotransferases, creatine phosphokinase (CPK), lipids, glucose and insulin were measured. TAFLD criteria: history of AAS use > 2 years; presence of hepatic steatosis on ultrasound and/or aminotransferase alterations with normal CPK levels; exclusion of ethanol intake >= 20 g/day or use of other drugs; and exclusion of obesity, dyslipidaemia, diabetes and other liver diseases. Homeostasis model assessment for insulin resistance >= 3 was considered insulin resistant. Independent t-test, odds ratio (OR) and 95% confidence intervals (95% CI) were calculated. Results All cases were asymptomatic. Clinical and laboratorial data were similar in G1 and G2 (P > 0.05). TAFLD criteria were observed in 12.6% of the G1 cases and 2.4% of controls had criteria compliant with non-alcoholic fatty liver related to metabolic conditions. OR was 6.0 (95% CI: 1.3-27.6). Conclusions These results suggest that AAS could be a possible new risk factor for TAFLD. In this type of fatty liver disease, the individuals had a low body fat mass and they did not present insulin resistance.

Siokou C; Moore D; Lee H. 'Muzzas' and 'Old Skool Ravers': Ethnicity, drugs and the changing face of Melbourne's dance party/club scene. Health Sociology Review 19(2): 192-204, 2010. (47 refs.)

The relationship between ethnicity and the use of party drugs' (e.g., methamphetamine and ecstasy) has received little attention in Australia. This paper focuses on ethnicity and party drug use within the context of dance parties and clubs in Melbourne, Australia's second largest city. The young people who participated in our research, many of whom are long-time dance party attendees, or 'old skool ravers', frequently made claim's to the possession of subcultural capital by labelling as 'muzzas' those they perceived to be outsiders to the dance scene. Muzzas are defined as heavily muscled young men, commonly of Southern European or Middle Eastern background, who use cocaine and steroids, have 'no class' and dance in an overly aggressive way. Although the old skool ravers were often from similar ethnic backgrounds to muzzas, they rarely drew on ethnicity informing their own identities. They did, however, explicitly invoke ethnicity in the distinctions they created between themselves and muzzas. Their claims to subcultural capital are based on notions of nostalgia and an authentic involvement in the dance scene, and on their perceived distance from a mainstream culture consisting of 'normal people'.

Skarberg K; Nyberg F; Engstrom I. Is there an association between the use of anabolic-androgenic steroids and criminality? European Addiction Research 16(4): 213-219, 2010. (40 refs.)

Aims: The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality. Methods: The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use. Results: The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS. Conclusion: The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse.

Skarberg K; Nyberg F; Engstrom I. Multisubstance use as a feature of addiction to anabolic-androgenic steroids. European Addiction Research 15(2): 99-106, 2009. (43 refs.)

The aim of this study was to explore and describe total drug use among anabolic-androgenic steroid (AAS) users and the reasons given for the use of these drugs. The study was based on semi-structured interviews and questionnaires involving 32 patients who were attending an addiction centre in Orebro, Sweden, for AAS use. The results indicated that a history of polysubstance use among the patients was frequent. Over half were using drugs of abuse and also taking various other pharmaceuticals. Almost half of the patients took human growth hormones, and almost half of the interviewed persons were drinking alcohol to a hazardous or harmful extent. The most common reason given for taking AAS and other hormones was to increase muscle mass and strength, but some participants also used insulin as a means of losing fat. Cannabis was used to improve sleep, heroin to decrease pain and amphetamine to increase endurance and burn fat. Our data suggest that most of the current AAS users who have been admitted to a treatment programme are multiple drug users with polysubstance dependence. The study stresses the importance of carefully examining total drug use as part of the assessment regimen for this group.

Smith ACT; Stewart B. Body perceptions and health behaviors in an online bodybuilding community. Qualitative Health Research 22(7): 971-985, 2012. (81 refs.)

In this article we explore the social constructions, body perceptions, and health experiences of a serious recreational and competitive bodybuilder and powerlifter community. Data were obtained from a discussion forum appearing within an online community dedicated to muscular development. Forum postings for a period of 36 months were transposed to QSR NVivo, in which a narrative-based analytical method employing Gee's coding approach was employed. We used a priori codes based on Bourdieu's multipronged conceptual categories of social field, habitus, and capital accumulation as a theoretical frame. Our results expose an extreme social reality held by a devoted muscle-building community with a fanatical obsession with muscular hypertrophy and any accouterment helpful in its acquisition, from nutrition and supplements to training regimes and anabolic androgenic substances. Few health costs were considered too severe in this muscular meritocracy, where the strong commanded deference and the massive dominated the social field.

Solberg J; Ringer R. Performance-enhancing drug use in baseball: The impact of culture. Ethics & Behavior 21(2): 91-102, 2011. (21 refs.)

Few sports-related events have generated as much controversy as the steroid crisis in baseball. Both ardent fans and casual observers wonder why professional baseball players would choose to use such substances when their use was viewed as outside the bounds of fair play. This article attempts to answer that question by applying concepts from the area of organizational culture. Understanding the culture of baseball and the ways leaders embedded and strengthened that culture adds insight into the decisions by athletes to engage in steroid use. In general, such use was consistent with the already-existing culture. In addition, key decisions and events likely created the conditions in which steroid use was more likely.

Thorlindsson T; Halldorsson V. Sport, and use of anabolic androgenic steroids among Icelandic high school students: a critical test of three perspectives. Substance Abuse Treatment, Prevention and Policy 5: e-article 32, 2010. (37 refs.)

Background: This study investigates the use of anabolic androgenic steroids (AAS) among a national representative sample of high school students in Iceland. We test several hypotheses drawn from three perspectives. The first perspective focuses on the use of AAS as an individual phenomenon motivated by the desire to succeed in sport. The second perspective views the use of AAS as shaped by norms and values embedded in social relationships of formally organized sport. The third perspective suggests that factors outside sport, which have been shown to correlate with the use of other substances, predict the use of AAS. Method: We use logistic regression and predicted probabilities to analyze data from a national representative survey of 11031 Icelandic high school students. Results: Our results indicated that the use of AAS is not significantly related to participation in formally organized sports. However, it positively relates to fitness and physical training in informal contexts. We found a relatively strong relationship between the use of AAS and the use of illicit substances and a moderate relationship between AAS use and alcohol and tobacco consumption. We also found a significant negative relationship between AAS use and school integration and school achievement, and a significant positive relationship between AAS use and school anomie. The relation between AAS use and family-related variables was weaker. Finally, we found that the relationship between sport participation, physical exercise, and AAS use varies across levels of anomie and integration. Conclusion: Our findings suggest that the use of AAS and especially illegal substances should be considered more as a social and a health problem rather than a sport specific issue. We found that high school students participating in fitness and informal training outside of formally organized sport clubs are the main risk group and should be the target of prevention efforts. However, this should not be done at the expense of general risk factors that affect AAS and other substances used by the general population. Finally, we suggest that prevention efforts should target both groups and individuals.

Van Renterghem P; Van Eenoo P; Sottas PE; Saugy M; Delbeke F. Subject-based steroid profiling and the determination of novel biomarkers for DHT and DHEA misuse in sports. Drug Testing and Analysis 2(11-12, special issue): 582-588, 2010. (39 refs.)

Doping with natural steroids can be detected by evaluating the urinary concentrations and ratios of several endogenous steroids. Since these biomarkers of steroid doping are known to present large inter-individual variations, monitoring of individual steroid profiles over time allows switching from population-based towards subject-based reference ranges for improved detection. In an Athlete Biological Passport (ABP), biomarkers data are collated throughout the athlete's sporting career and individual thresholds defined adaptively. For now, this approach has been validated on a limited number of markers of steroid doping, such as the testosterone (T) over epitestosterone (E) ratio to detect T misuse in athletes. Additional markers are required for other endogenous steroids like dihydrotestosterone (DHT) and dehydroepiandrosterone (DHEA). By combining comprehensive steroid profiles composed of 24 steroid concentrations with Bayesian inference techniques for longitudinal profiling, a selection was made for the detection of DHT and DHEA misuse. The biomarkers found were rated according to relative response, parameter stability, discriminative power, and maximal detection time. This analysis revealed DHT/E, DHT/5 beta-androstane-3 alpha,17 beta-diol and 5 alpha-androstane-3 alpha,17 beta-diol/5 beta-androstane-3 alpha,17 beta-diol as best biomarkers for DHT administration and DHEA/E, 16 alpha-hydroxydehydroepiandrosterone/E, 7 beta-hydroxydehydroepiandrosterone/E and 5 beta-androstane-3 alpha,17 beta-diol/5 alpha-androstane-3 alpha,17 beta-diol for DHEA. The selected biomarkers were found suitable for individual referencing. A drastic overall increase in sensitivity was obtained. The use of multiple markers as formalized in an Athlete Steroidal Passport (ASP) can provide firm evidence of doping with endogenous steroids.