Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T14:09:38.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse

Published online by Cambridge University Press:  16 April 2020

Thomas A. Pagonis ,
Nikiforos V. Angelopoulos ,
George N. Koukoulis  and
Christos S. Hadjichristodoulou
Thomas A. Pagonis*
Affiliation:
Department of Psychiatry, University Hospital, Thessaly University Medical School, Larissa, Greece
Nikiforos V. Angelopoulos
Affiliation:
Department of Psychiatry, University Hospital, Thessaly University Medical School, Larissa, Greece
George N. Koukoulis
Affiliation:
Department of Endocrinology, University Hospital, Thessaly University Medical School, Larissa, Greece
Christos S. Hadjichristodoulou
Affiliation:
Department of Hygiene and Epidemiology, Thessaly University Medical School, Larissa, Greece
*
*Corresponding author. Present address: Korai 14, 43100, Karditsa, Greece. Tel.: +30 69 7688 8205. E-mail address: tpsportmed@the.forthnet.gr (T.A. Pagonis).
Get access

Abstract

Objective

The objective of our study was to evaluate the psychological consequences of real-world AAS use in athletes abusing such agents, in comparison with a placebo and control group of comparable athletes, while correlating the severity of abuse with the side effects observed. The hypothesis tested by the study was that the use of AAS induces a wide range of psychological side effects whose impact and emergence is dependent upon the severity of the abuse.

Design

The study includes a substantial group of AAS abusing athletes and two more groups demographically similar to the first, one composed of athletes not using any substance and a placebo group. All athletes were stratified according to the severity of AAS abuse. Psychometric instruments were applied to all athletes in specific time intervals, dependent to the AAS abusers' regimens, providing us with a final psychological profile that was to be compared to the pre-study profile. All results were comparable (within and between groups) for statistically significant differences and correlated to the severity of the abuse. Homogeneity of all groups was safeguarded by random doping controls, monitoring of drug levels and analysis of all self obtained drugs by method of liquid chromatography/mass spectrometry. All athletes were provided with a common exercise and dietary regime, so common training and nutritional conditions were achieved.

Methods

We studied a cohort of 320 body-building, amateur and recreational athletes, of whom 160 were active users of AAS (group C), 80 users administering placebo drugs (group B) and 80 not abusing any substance (Group A). Group C athletes were stratified according to AAS abuse parameters, thus providing us with three subgroups of “light, medium and heavy abuse”. Athletes of groups A and B were included in a “no abuse” subgroup. The psychometric instruments used were the Symptoms Check List-90 (SCL-90) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The psychometric evaluations took place within a time interval of 13 months. Statistical analysis was performed by using the Mann–Whitney/Wilcoxon two-sample non-parametric test (Kruskal–Wallis test for two groups) for data that were not normally distributed and Linear regression analysis was used to ascertain the correlation between severity of use and escalation of side effects.

Results

The study showed a statistically significant increase in all psychometric subscales recorded in group C, and no statistically significant difference in group C and A. There was a significant increase in the scorings of group C for all subscales of SCL-90 and HDHQ. Correlation of abuse severity and side effects showed that there was a statistical significant increase in Δ values of all SCL-90 and HDHQ subscales that escalated from light abuse to medium and heavy abuse/consumption patterns.

Conclusions

The results of the study suggest that the wide range of psychiatric side effects induced by the use of AAS is correlated to the severity of abuse and the force of these side effects intensifies as the abuse escalates.

Keywords

Anabolic steroidsAbuse correlationPsychopathologyPsychiatric side effects
Type
Original article
Information
European Psychiatry , Volume 21 , Issue 8 , December 2006 , pp. 551 - 562
Copyright
Copyright © Elsevier Masson SAS 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aagaard, P.Making muscles “stronger”: exercise, nutrition, drugs J. Musculoskelet Neuronal Interact. 4(2)2004 165–174.Google Scholar
Angelopoulos, N.V., Drosos, A.A., Moutsopoulos, H.M.Psychiatric symptoms associated with scleroderma Psychother. Psychosom. 70(3)2001 145–150. (Switzerland)CrossRefGoogle ScholarPubMed
Angelopoulos, N.V., Tzivaridou, D., Nikolaou, N., Pavlidis, N.Mental Symptoms, hostility features and stressful life events in people with cancer Acta Psychiatr. Scand. 1995; 92:44–50.CrossRefGoogle ScholarPubMed
Bahrke, M.S., Wright, J.E., Strauss, R.H., Catlin, D.H.Psychological moods and subjectively perceived behavioural and somatic changes accompanying anabolic–androgenic steroid use Am. J. Sports Med. 1992; 20:717–724.CrossRefGoogle ScholarPubMed
Bahrke, M.S., Yesalis, C.E., Wright, J.E.Psychological and behavioural effects of endogenous testosterone levels and anabolic–androgenic steroids among males Sports Med. 10(5)1990 303–337.CrossRefGoogle ScholarPubMed
Berning, J.M., Adams, K.J., Stamford, B.A.Anabolic steroid usage in athletics: facts, fiction, and public relations J. Strength Cond. Res. 18(4)2004 908–917.Google ScholarPubMed
Bhasin, S., Storer, T.W., Berman, N., Callegari, C., Clevenger, B., Phillips, J.et al.The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men N. Engl. J. Med. 335(1)1996 1–7.CrossRefGoogle ScholarPubMed
Bhasin, S., Woodhouse, L., Casaburi, R., Singh, A.B., Bhasin, D., Berman, N.et al.Testosterone dose–response relationships in healthy young men Am. J. Physiol. Endocrinol. Metab. 281(6)2001 E1172–E1181.CrossRefGoogle ScholarPubMed
Bhasin, S., Woodhouse, L., Storer, T.W.Androgen effects on body composition Growth Horm. IGF Res. 13(Suppl A)2003 S63–S71.CrossRefGoogle ScholarPubMed
Bjorkqvist, K., Nygren, T., Bjorklund, A.C., Bjorkqvist, S.E.Testosterone intake and aggressiveness: real effect or anticipation Aggressive Behaviour 1994; 20:17–26.3.0.CO;2-U>CrossRefGoogle Scholar
Blazevich, A.J., Giorgi, A.Effect of testosterone administration and weight training on muscle architecture Med. Sci. Sports Exerc. 33(10)2001 1688–1693.CrossRefGoogle ScholarPubMed
Caine, T.M., Foulds, G.A., Hope, K.Manual of the hostility and direction of hostility questionnaire University of London Press; 1967.Google Scholar
Clark, A.S., Henderson, L.P.Behavioural and physiological responses to anabolic–androgenic steroids Neurosci. Biobehav. Rev. 27(5)2003 413–436.CrossRefGoogle ScholarPubMed
Conacher, G.N., Workman, D.G.Violent crime possibly associated with anabolic steroid use Am. J. Psychiatry 1989; 146:679.Google ScholarPubMed
Cooper, C.J., Noakes, T.D., Dunne, T.et al.A high prevalence of abnormal personality traits in chronic users of anabolic–androgenic steroids Br. J. Sports Med. 1996; 30:46–250.CrossRefGoogle ScholarPubMed
Derogatis, L.R., Lipman, R.S., Covi, L.The SCL-90: an out-patients psychiatric rating scale Psychopharmacol. Bull. 1973; 9:13–28.Google Scholar
Drosos, A.A., Angelopoulos, N.V., Liakos, A.et al.Personality structure disturbances and psychiatric manifestations in primary Sjogren’s syndrome J. Autoimmun. 2(4)1989 489–493. (England)CrossRefGoogle ScholarPubMed
Economou, M., Angelopoulos, N.V.Dysthymic symptoms, hostility and scholastic achievement in a group of high school students Educ. Psychol. 9(4)1989 331–337.CrossRefGoogle Scholar
Evans, N.A.Current concepts in anabolic–androgenic steroids Am. J. Sports Med. 32(2)2004 534–542.CrossRefGoogle ScholarPubMed
Feller, A.A., Mylonakis, E., Rich, J.D.Medical complications of anabolic steroids Med. Health R. I. 85(11)2002 338–340.Google ScholarPubMed
Freinhar, J.P., Alvarez, W.Androgen-induced hypomania J. Clin. Psychiatry 1985; 46:354–355.Google ScholarPubMed
Fudala, P.J., Weinrieb, R.M., Calarco, J.S.et al.An evaluation of anabolic–androgenic steroid abusers over a period of 1 year: seven case studies Ann. Clin. Psychiatry 15(2)2003 121–130.CrossRefGoogle Scholar
Griggs, R.C., Kingston, W., Jozefowicz, R.F., Herr, B.F., Forbes, G., Halliday, D.Effects of testosterone on muscle mass and protein synthesis J. Appl. Physiol. 1989; 66:498–503.CrossRefGoogle ScholarPubMed
Gomez, J.E.Performance-enhancing substances in adolescent athletes Tex. Med. 98(2)2002 41–46.Google ScholarPubMed
Hall, R.C., Hall, R.C.Abuse of supraphysiologic doses of anabolic steroids South. Med. J. 98(5)2005 550–555.CrossRefGoogle ScholarPubMed
Hartgens, F., Kuipers, H.Effects of androgenic–anabolic steroids in athletes Sports Med. 34(8)2004 513–554.CrossRefGoogle ScholarPubMed
Hartgens, F., van Straaten, H., Fideldij, S.et al.Misuse of androgenic–anabolic steroids and human deltoid muscle fibers: differences between polydrug regimens and single drug administration Eur. J. Appl. Physiol. 86(3)2002 233–239.CrossRefGoogle ScholarPubMed
Herbst, K.L., Bhasin, S.Testosterone action on skeletal muscle Curr. Opin. Clin. Nutr. Metab. Care 7(3)2004 271–277.CrossRefGoogle ScholarPubMed
Hickson, R.C., Ball, K.L., Falduto, M.T.Adverse effects of anabolic steroids Med. Toxicol. Adverse Drug Exp. 1989; 4:254–271.CrossRefGoogle ScholarPubMed
Inigo, M.A., Arrimadas, E., Arroyo, D.43 cycles of anabolic steroid treatment studied in athletes: the uses and secondary effects Rev. Clin. Esp. 200(3)2000 133–138.Google ScholarPubMed
Irving, L.M., Wall, M., Neumark-Sztainer, D.et al.Steroid use among adolescents: findings from Project EAT J. Adolesc. Health 30(4)2002 243–252.CrossRefGoogle ScholarPubMed
Kadi, F.Adaptation of human skeletal muscle to training and anabolic steroids Acta Physiol. Scand. Suppl. 2000; 646:1–52.Google ScholarPubMed
Kanayama, G., Cohane, G.H., Weiss, R.D., Pope, H.G.Past anabolic–androgenic steroid use among men admitted for substance abuse treatment: an underrecognized problem? J. Clin. Psychiatry 64(2)2003 156–160.CrossRefGoogle Scholar
Kennedy, M.C., O’Sullivan, A.J.Do anabolic–androgenic steroids enhance sporting performance? Med. J. Aust. 166(2)1997 60–61.CrossRefGoogle ScholarPubMed
Kicman, A.T., Gower, D.B.Anabolic steroids in sport: biochemical, clinical and analytical perspectives Ann. Clin. Biochem. 40(Pt 4)2003 321–356.CrossRefGoogle ScholarPubMed
Kouri, E.M., Lukas, S.E., Poper, H.G.et al.Increased aggressive responding in male volunteers following the administration of gradually increasing doses of testosterone cypionate Drug Alcohol Depend. 1995; 40:73–79.CrossRefGoogle ScholarPubMed
Kuhn, C.M.Anabolic steroids Recent Prog. Horm. Res. 2002; 57:411–434.CrossRefGoogle ScholarPubMed
Kutscher, E.C., Lund, B.C., Perry, P.J.Anabolic steroids: a review for the clinician Sports Med. 32(5)2002 285–296.CrossRefGoogle ScholarPubMed
Laure, P.Doping: epidemiological studies Presse Med. 29(24)2000 1365–1372. (8–15)Google ScholarPubMed
Lyketsos, G.S., Blackburn, I.M., Tsiantis, J.The movement of hostility during recovery from depression Psychol. Med. 1988; 8:145–149.CrossRefGoogle Scholar
Marcos, J., Pascual, J.A., de la Torre, X.et al.Fast screening of anabolic steroids and other banned doping substances in human urine by gas chromatography/tandem mass spectrometry J. Mass Spectrom. 37(10)2002 1059–1073.CrossRefGoogle ScholarPubMed
McPherson, F.M.A note on the female norms of the HDHQ Br. J. Clin. Psychol. 1988; 27:263–264.CrossRefGoogle ScholarPubMed
Millman, R.B., Ross, E.J.Steroid and nutritional supplement use in professional athletes Am. J. Addict. 12(Suppl 2)2003 548–554.CrossRefGoogle ScholarPubMed
Mottram, D.R., George, A.J.Anabolic steroids Baillieres. Best Pract. Res. Clin. Endocrinol. Metab. 14(1)2000 55–69.CrossRefGoogle ScholarPubMed
Paul, G.L.Dietary protein requirements of physically active individuals Sports Med. 8(3)1989 154–176.CrossRefGoogle ScholarPubMed
Perry, P.J., Andersen, K.H., Yates, W.R.Illicit anabolic steroid use in athletes: a case series analysis Am. J. Sports Med. 1990; 18:422–428.CrossRefGoogle ScholarPubMed
Perry, P.J., Kutscher, E.C., Lund, B.C., Yates, W.R., Holman, T.L., Demers, L.Measures of aggression and mood changes in male weightlifters with and without androgenic anabolic steroid use J. Forensic Sci. 48(3)2003 646–651.CrossRefGoogle ScholarPubMed
Peterson, M.D., Rhea, M.R., Alvar, B.A.Maximizing strength development in athletes: a meta-analysis to determine the dose–response relationship J. Strength Cond. Res. 18(2)2004 377–382.Google ScholarPubMed
Pope, H.G., Katz, D.L.Affective and psychotic symptoms associated with anabolic steroid use Am. J. Psychiatry 1988; 145:487–490.Google ScholarPubMed
Pope, H.G., Katz, D.L.Homicide and near-homicide by anabolic steroid users J. Clin. Psychiatry 1990; 51:28–31.Google ScholarPubMed
Pope, H.G., Kouri, E.M., Hudson, J.I.Effects of supraphysiologic doses of testosterone on mood and aggression in normal men Arch. Gen. Psychiatry 2000; 57:133–140.CrossRefGoogle ScholarPubMed
Riem, K.E., Hersey, K.G.Using anabolic–androgenic steroids to enhance physique and performance: Effects on mood and behaviour Clin. Psychol. Rev. 1995; 15:235–256.CrossRefGoogle Scholar
Rogol, A.D.Sex steroid and growth hormone supplementation to enhance performance in adolescent athletes Curr. Opin. Pediatr. 12(4)2000 382–387.CrossRefGoogle ScholarPubMed
Rolf, C., Nieschlag, E.Potential adverse effects of long-term testosterone therapy Baillieres Clin. Endocrinol. Metab. 12(3)1998 521–534.CrossRefGoogle ScholarPubMed
Rozenek, R., Rahe, C.H., Kohl, H.H., Marple, D.N., Wilson, G.D., Stone, M.H.Physiological responses to resistance-exercise in athletes self-administering anabolic steroids J. Sports Med. Phys. Fitness 30(4)1990 354–360.Google ScholarPubMed
Shahidi, N.T.A review of the chemistry, biological action, and clinical applications of anabolic–androgenic steroids Clin. Ther. 23(9)2001 1355–1390.CrossRefGoogle ScholarPubMed
Sheffield-Moore, M.Androgens and the control of skeletal muscle protein synthesis Ann. Med. 32(3)2000 181–186.CrossRefGoogle ScholarPubMed
Sinha-Hikim, I., Roth, S.M., Lee, M.I., Bhasin, S.Testosterone-induced muscle hypertrophy is associated with an increase in satellite cell number in healthy, young men Am. J. Physiol. Endocrinol. Metab. 285(1)2003 E197–E205.CrossRefGoogle ScholarPubMed
Su, T.P., Pagliaro, M., Schmidt, P.J.et al.Neuropsychiatric effects of anabolic steroids in male normal volunteers JAMA 1993; 269:2760–2764.CrossRefGoogle ScholarPubMed
Tamaki, T., Uchiyama, S., Uchiyama, Y.et al.Anabolic steroids increase exercise tolerance Am. J. Physiol. Endocrinol. Metab. 280(6)2001 E973–E981.CrossRefGoogle ScholarPubMed
Thiblin, I., Parlklo, T.Anabolic androgenic steroids and violence Acta Psychiatr. Scand Suppl 2002; 412:125–128.CrossRefGoogle Scholar
Thiblin, I., Petersson, A.Pharmacoepidemiology of anabolic androgenic steroids: a review Fundam. Clin. Pharmacol. 19(1)2005 27–44.CrossRefGoogle ScholarPubMed
Tilzey, A., Heptonstall, J., Hamblin, T.Toxic confusional state and choreiform movements after treatment with anabolic steroids BMJ 1981; 283:349–350.CrossRefGoogle ScholarPubMed
Tricker, R., Casaburi, R., Storer, T.W., Clevenger, B., Berman, N., Shirazi, et al.The effects of supraphysiological doses of testosterone on angry behavior in healthy eugonadal men: a clinical research center study J. Clin. Endocrinol. Metab. 1996; 81:3754–3758.Google ScholarPubMed
Trout, G.J., Kazlauskas, R.Sports drug testing—an analyst’s perspective Chem. Soc. Rev. 33(1)2004 1–13. (10)CrossRefGoogle ScholarPubMed
Walters, M.J., Ayers, R.J., Brown, D.J.Analysis of illegally distributed anabolic steroid products by liquid chromotography with identity confirmation by mass spectrometry or infrared spectrophotometry J. Assoc. Off. Anal. Chem. 73(6)1990 904–926.Google ScholarPubMed
Wichstrom, L., Pedersen, W.Use of anabolic–androgenic steroids in adolescence: winning, looking good or being bad? J. Stud. Alcohol 62(1)2001 5–13.CrossRefGoogle ScholarPubMed
Wilson, I.C., Prange, A.J., Lara, P.P.Methyltestosterone with imipramine in men: conversion of depression to paranoid reaction Am. J. Psychiatry 1974; 131:21–24.CrossRefGoogle ScholarPubMed
Yesalis, C.E., Bahrke, M.S.Anabolic–androgenic steroids and related substances Curr. Sports Med. Rep. 1(4)2002 246–252.CrossRefGoogle ScholarPubMed
Yates, W.R., Perry, P.J., MacIndoe, J.et al.Psychosexual effects of three doses of testosterone cycling in normal men Biol. Psychiatry 1999; 45:254–260.CrossRefGoogle ScholarPubMed
Ziegler, P., Jonnalagadda, S.S., Nelson, J.A., Lawrence, C., Baciak, B.Energy and macronutrient intakes of elite figure skaters J. Am. Diet. Assoc. 101(3)2001 319–325.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.