Addiction to Anabolic-Androgenic Steroids – A New Disease!

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As we all know, anabolic-androgenic steroids are used to gain lean muscle mass; in the process either getting big (as in bodybuilding) or improving sporting performance (as in track and field). While casual and limited use of these AAS appears to be harmless, those who indulge in regular and chronic use tend to get addicted; they exhibit dependence on these substances with adverse functional, physiological, and psychological effects. Stoppage of administration of AAS is also associated with severe withdrawal symptoms in such individuals.

What Are Anabolic-Androgenic Steroids?

Anabolic-Androgenic Steroids (AAS) are a group of (natural, semi-synthetic and synthetic,) hormones that are similar in structure to (or derived from) the male hormone, testosterone (Pope & Brower, 2009).

In bodybuilding and athletic circles, AAS are used to enhance muscle mass. The theory is that AAS in combination with weight training and appropriate diet will make you bigger, stronger and faster than you can ever be by just being a ‘natural’ athlete (Kouri, Pope, Jr., Katz, & Oliva, 1995). This has lead to athletes self prescribing and overdosing on AAS and subsequently their abuse. Apparently, this has been going on for decades (Wade, 1972).

Although these substances are banned by the World Anti-Doping Association (WADA), you may still argue about the ‘risk-benefit’ ratio for use of AAS in athletes – there being a semblance of justification where there is much to gain from the slightest of advantage over your opponent – especially at the highest level. However, in individuals who are not going to participate in any sporting events there is no justification whatsoever for use of AAS. Yet, in such individuals wanting to look leaner and muscular, the use of AAS has gone through the roof (Pope & Brower, 2009; Hildebrandt, Schlundt, Langenbucher, & Chung, 2006; Buckley et al., 1988; Kanayama, Pope, Jr., & Hudson, 2001; Parkinson & Evans, 2006).

Role of Muscle Dysmorphia in Use of AAS

Muscle dysmorphia is a disorder in which the individual has a distorted image of his own body. Often referred to as ‘revere anorexia nervosa’, it is characterized by a fear that one is not muscular enough. This leads to an effort to do ‘anything possible’ to get big! Individuals with such thinking are more likely to abuse AAS over a longer period of time.

Furthermore, the misperception in the media that being bigger and more muscular is healthier or fitter may have played a big role in increasing the use of AAS, especially among the younger population.

According to a study conducted in 2009, the ‘lifetime prevalence of AAS use is at least 3%’ meaning tens of millions of young men have used it at some point in their lives (Kanayama, Brower, Wood, Hudson, & Pope, Jr., 2009). Women are less likely to abuse these substances since being ‘more muscular’ isn’t something that very many women would identify with; the severe effects – deepening of voice, ‘male pattern of distribution of hair’ and others are not too appealing to women either.

AAS Dependence

There is, now, ever increasing scientific evidence that dependence to AAS is on the rise (Kanayama et al., 2009). AAS dependent individual tend to inject larger doses that those who use AAS casually (Brower, Blow, Young, & Hill, 1991). Also, they are more likely to try different AAS agents simultaneously (Gridley & Hanrahan, 1994) and for longer ‘cycles’ (Copeland, Peters, & Dillon, 2000).

Furthermore, AAS dependents are more likely to exhibit adverse behavioural patterns like ‘roid rage’ (Copeland et al., 2000).

To conclude, AAS dependence seems to be a valid medical disorder. The prevalence and incidence of regular AAS abuse and dependence has reached such alarming proportions that it warrants more research into the causes of AAS dependence (why only certain individual progress from casual use to dependence), as well as designing and implementation of methods to prevent it.

References

Brower, K. J., Blow, F. C., Young, J. P., & Hill, E. M. (1991). Symptoms and correlates of anabolic-androgenic steroid dependence. Br. J Addict., 86, 759-768.

Buckley, W. E., Yesalis, C. E., III, Friedl, K. E., Anderson, W. A., Streit, A. L., & Wright, J. E. (1988). Estimated prevalence of anabolic steroid use among male high school seniors. JAMA, 260, 3441-3445.

Copeland, J., Peters, R., & Dillon, P. (2000). Anabolic-androgenic steroid use disorders among a sample of Australian competitive and recreational users. Drug Alcohol Depend., 60, 91-96.

Gridley, D. & Hanrahan, S. (1994). Anabolic-androgenic steroid use among male gymnasium participants: knowledge and motives. Sports Health, 12, 11-14.

Hildebrandt, T., Schlundt, D., Langenbucher, J., & Chung, T. (2006). Presence of muscle dysmorphia symptomology among male weightlifters. Compr.Psychiatry, 47, 127-135.

Kanayama, G., Brower, K. J., Wood, R. I., Hudson, J. I., & Pope, H. G., Jr. (2009). Anabolic-androgenic steroid dependence: an emerging disorder. Addiction, 104, 1966-1978.

Kanayama, G., Pope, H. G., Jr., & Hudson, J. I. (2001). “Body image” drugs: a growing psychosomatic problem. Psychother.Psychosom., 70, 61-65.

Kouri, E. M., Pope, H. G., Jr., Katz, D. L., & Oliva, P. (1995). Fat-free mass index in users and nonusers of anabolic-androgenic steroids. Clin J Sport Med, 5, 223-228.

Parkinson, A. B. & Evans, N. A. (2006). Anabolic-androgenic steroids: a survey of 500 users. Med Sci.Sports Exerc., 38, 644-651.

Pope, H. & Brower, K. (2009). Androgenic-Androgenic Steroid-Related Disorders. In V.Sadock (Ed.), Comprehensive Textbook of Psychiatry (Ninth Edition ed., pp. 1419-1431). Philadelphia, PA: Lippincott, Williams & Wilkins.

Wade, N. (1972). Anabolic Steroids: Doctors Denounce Them, but Athletes Aren’t Listening. Science, 176, 1399-1403.

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About the author

Dr. Deepak S Hiwale
Dr. Deepak S Hiwale

Dr. Deepak S Hiwale, a.k.a "The Fitness Doc" specializes in sports medicine in addition to being an elite personal trainer. He currently runs an elite personal training company in West London. As a sports injury and fitness writer-presenter, he tries to disseminate as much knowledge as possible for the benefit of all. MBBS (University of Pune); MSC, Sports and Exercise Medicine (University of Glasgow); Diploma in Personal Training (YMCA Dip. PT, London).

Follow "The Fitness Doc" on LinkedIn: drdeepakhiwale, Facebook: conditioning.clinic and Instagram: dr.dee.hiwale

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Dr. Deepak S Hiwale

Dr. Deepak S Hiwale

Dr. Deepak S Hiwale, a.k.a "The Fitness Doc" specializes in sports medicine in addition to being an elite personal trainer. He currently runs an elite personal training company in West London. As a sports injury and fitness writer-presenter, he tries to disseminate as much knowledge as possible for the benefit of all. MBBS (University of Pune); MSC, Sports and Exercise Medicine (University of Glasgow); Diploma in Personal Training (YMCA Dip. PT, London).

Follow "The Fitness Doc" on LinkedIn: drdeepakhiwale, Facebook: conditioning.clinic and Instagram: dr.dee.hiwale