Abstract
Abstract. The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users’ trust in physicians and drives them into the arms of so-called “gurus.” The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.
Zusammenfassung. Die Häufigkeit des Gebrauchs von anabolen androgenen Steroiden (AAS; Anabolika) im Freizeitsport wird unterschätzt. Durch den Einfluss der sozialen Medien wird eine weitere Zunahme des AAS-Gebrauchs im Freizeitsport und in der Allgemeinbevölkerung erwartet. Der AAS-Gebrauch geht mit bedeutenden Folgen für die körperliche und psychische Gesundheit einher, die psychiatrischen Folgen beinhalten auch das Risiko einer Abhängigkeitsentwicklung. Die weitverbreitete Stigmatisierung des AAS-Gebrauchs auch durch Fachleute untergräbt häufig das Vertrauen der Konsumenten in die behandelnden Ärzt_innen und treibt sie in die Arme sogenannter «Gurus». Die Verschärfung der Antidoping-Praktiken im Sport und eine ausschliesslich prohibitive Grundhaltung konnten das Problem im Freizeitsport bisher nicht überzeugend eindämmen. Strategien der Schadensminderung könnten Patienten_innen die nötige Hilfe durch Grundversorger erleichtern.
Résumé. La fréquence de l’utilisation de stéroïdes anabolisants androgènes (SAA; anabolisants) dans le sport de loisir est sous-estimée. L’influence des médias sociaux devrait entraîner une nouvelle augmentation de la consommation de SAA dans le sport de loisir et dans la population générale. La consommation de SAA a des conséquences importantes sur la santé physique et mentale, et les conséquences psychiatriques comportent également le risque de développer de la dépendance. La stigmatisation généralisée de l’utilisation des SAA, y compris par les professionnels, sape souvent la confiance des consommateurs envers les médecins traitants et les pousse dans les bras de soi-disant «gourous». Le renforcement des pratiques antidopage dans le sport et une attitude exclusivement prohibitive n’ont pas encore permis d’endiguer le problème de manière convaincante dans le sport de loisir. Des stratégies de réduction des risques pourraient permettre aux patients de recevoir l’aide dont ils ont besoin de la part des médecins de premier recours.
Bibliography
Anabolic-androgenic steroids and related substances. Curr Sports Med Rep . 2002; 1 (4):246–252.
.Adverse health consequences of performance-enhancing drugs: An endocrine society scientific statement. Endocr Rev . 2014; 35 (3):341–375.
.Anabolic steroid-induced hypogonadism: Diagnosis and treatment. Fertil Steril . 2014; 101 (5):1271–1279.
.Characteristics and Attitudes of Men Using Anabolic Androgenic Steroids (AAS): A Survey of 2385 Men. Am J Mens Health . 2020; 14 (6).
.Nutritional supplements cross-contaminated and faked with doping substances. J Mass Spectrom ; 2008; 43 :892–902.
.Social Media, Body Image and Resistance Training: Creating the Perfect ’Me’ with Dietary Supplements, Anabolic Steroids and SARM’s. Sport Med – Open . 2021; 7 (1):81.
.#studydrugs – Persuasive posting on Instagram. Int J Drug Policy . 2021; 95 :103100.
.#StatusOfMind: Social media and young people’ s mental health and wellbeing . London; RSPH:2017. https://www.rsph.org.uk/static/uploaded/d125 b27c-0b62-41c5-a2c0155a8887c01.pdf; letzter Zugriff: 09.02.2022.
.Prevalence, Attitude, Knowledge, and Practice of Anabolic Androgenic Steroid (AAS) Use Among Gym Participants. Mater Socio Medica . 2018; 30 (1):49.
.Identifying a typology of men who use anabolic androgenic steroids (AAS). Int J Drug Policy . 2018; 55 :105–112.
,Muskeldysmorphie. Swiss Med Forum . 2019; 19 (9–10):153–158.
.Internationale Klassifikation psychischer Störungen (ICD 10). 2015.
.DSM-5: Die Aufhebung der Unterscheidung von Abhängigkeit und Missbrauch und die Öffnung für Verhaltenssüchte. Sucht . 2011; 57 :45–48.
.Hooked on Hormones? JAMA . 1989; 262 (22):3166.
.Addiction to Anabolic-androgenic Steroids: A Review. Br J Pharm Res . 2017; 16 (3):1–6.
.Psychological and Behavioral Effects of Anabolic-Androgenic Steroids. Int J Sport Exerc Psychol . 2005; 3 (4):428–445.
.Anabolic steroid abuse and dependence. Curr Psychiatry Rep . 2002; 4 (5):377–387.
.Men’s experiences of using anabolic androgenic steroids. Int J Qual Stud Health Well-being . 2021; 16 (1).
.The neurobiology and addiction potential of anabolic androgenic steroids and the effects of growth hormone. Brain Res Bull . 2016; 126 :127–137.
.Role of dopamine receptor subtypes in the acquisition of a testosterone conditioned place preference in rats. Neurosci Lett . 2000; 282 (1–2):17–20.
.Anabolic androgenic steroids affects alcohol intake, defensive behaviors and brain opioid peptides in the rat. Pharmacol Biochem Behav . 2000; 67 (2):271–279.
.Fitness supplements as a gateway substance for anabolic-androgenic steroid use. Psychol Addict Behav . 2012; 26 (4):955–962.
.Male anabolic androgenic steroid users with personality disorders report more aggressive feelings, suicidal thoughts, and criminality. Med . 2020; 56 (6):1–12.
,Anabolic – Androgenic Steroids as a Gateway to Opioid Dependence. N Engl J Med . 2000; 342 (20):
.1532 –1532 .Risk factors for anabolic-androgenic steroid use among weightlifters: A case-control study. Drug Alcohol Depend . 2003; 71 (1):77–86.
.Multisubstance use as a feature of addiction to anabolic-androgenic steroids. Eur Addict Res . 2009; 15 (2):99–106.
.Interactions Between Opioids and Anabolic Androgenic Steroids: Implications for the Development of Addictive Behavior. Int Rev Neurobiol . 2012; 102 :189–206.
.Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Compr Psychiatry . 1993; 34 (6):406–409.
.Anabolic-androgenic steroid dependence: An emerging disorder. Addiction . 2009; 104 :1966–1978.
.Zum Medikamentenmissbrauch im Breiten- und Freizeitsport. Frankfurt/M; Deutscher Olympischer Sportbund: 2010. https://cdn.dosb.de/user_upload/Sport_pro_Gesundheit/Medikamentenmissbrauch/ExpertiseMedikamentenmissbrauch_im_Breiten-und_Freizeitsport.pdf; letzter Zugriff: 09.02.2022.
.Polypharmacy among anabolic-androgenic steroid users: A descriptive metasynthesis. Subst Abus Treat Prev Policy . 2015; 10 (1).
.Diagnosis and Management of Anabolic Androgenic Steroid Use. Journal of Clinical Endocrinology and Metabolism. J Clin Endocrinol Metab . 2019; 104 :2490–500.
.A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids. J Health Psychol . 2019; 24 :1595–1612.
.Androgen Misuse and Abuse. Endocr Rev . 2021 Jul 16; 42 (4):457–501.
.Treating Steroid Abuse: A Psychiatric Perspective. Clin Pediatr (Phila). 1991; 30 (9):538–542.
.The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review. Heal Soc Care Community . 2017; 25 (5):1459–1531.
.Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access. BMC Public Health . 2019; 19 (1):1024.
.Anabolic steroids in the UK: an increasing issue for public health. Drugs Educ Prev Policy . 2017; 24 (3):278–285.
.A league of their own: Demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. J Int Soc Sports Nutr . 2007; 4 (1):1–14.
.The stigma of anabolic steroid use. J Drug Issues . 2016; 46 (4):446–456.
.Psychological Treatment of Anabolic-Androgenic Steroid-Dependent Individuals. J Subst Abuse Treat . 1992; 9 :229–235.
.Anabolic steroid abuse and dependence in clinical practice. Phys Sportsmed . 2009; 37 (4):131–140.
.Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review. J Gen Intern Med . 2021 Jul; 36 (7):2055–2064.
.Associations of anabolic-Androgenic steroid use with other behavioral disorders: An analysis using directed acyclic graphs. Psychol Med . 2018; 48 (15):2601–2608.
.Anabolic-androgenic steroids and the risk of imprisonment. Drug Alcohol Depend . 2019; 203 :92–97.
.Anabolic androgenic steroids and aggression: Studies using animal models. In: Ann N Y Acad Sci 2004;399–415.
.Sport, doping and male fertility. Reprod Biol Endocrinol . 2018 Nov 12; 16 (1):114.
,Testosterone replacement therapy: The Emperor’s new clothes. Rejuvenation Res . 2017; 20 (1):9–14.
.Psychiatric complications of anabolic steroid abuse. Psychosomatics . 2005; 46 :285–290.
.Koukoulis GN, Hadjichristodoulou CS, Toli PN. Psychiatric and hostility factors related to use of anabolic steroids in monozygotic twins. Eur Psychiatry . 2006; 21 (8):563–569.
.,Koukoulis GN, Hadjichristodoulou CS. Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. Eur Psychiatry . 2006; 21 (8):551–562.
.,Behavioural manifestations of anabolic steroid use. CNS Drugs . 2005; 19 :571–595.
.Use of anabolic androgenic steroids in substance abusers arrested for crime. Drug Alcohol Depend . 2010; 111 (3):222–226.
.Neuropsychiatric and behavioral involvement in aas abusers. A literature review. Medicina (Lithuania). 2019; 55 .
.Testosterone, mood, behaviour and quality of life. Andrology . 2020; 8 (6):1598–1605.
.Outpatient clinic for users of anabolic androgenic steroids: an overview. Neth J Med . 2018; 76 (4):167–175.
.Bundesärztekammer . Doping und ärztliche Ethik. Dtsch Arztebl . 2009; 106 (8):360–365.Human Enhancement: aus Altbekanntem auf Neues schliessen. Schweiz Ärzteztg . 2013; 94 (08):283–285.
.SAMW . Schlussfolgerungen und Empfehlungen der Arbeitsgruppe «Human Enhancement» Medizin für Gesunde? Schweiz Ärzteztg . 2013; 94 (16):607–611.Bundesärztekammer . Doping und ärztliche Ethik. Dtsch Arztebl . 2009; 106 (8):360–365.Medical advisors on doping. Sportwissenschaft . 2012; 42 (3):178–187.
.Bundesamt für Gesundheit, BAG . Nationale Strategie Sucht 2017–2024. Bern; BAG: 2015; 87 .Bestandesaufnahme und Bedarfserhebung Schadensminderung Resultate der Befragung in Kantonen und Gemeinden . Bern; Infodrog: 2018. https://www.infodrog.ch/files/content/schadensminderung_de/Bestandesaufnahme_Bedarfserhebung_Schadensminderung.pdf; letzter Zugriff: 09.02.2022.
.Harm reduction strategies for androgen users: providing appropriate support and improving engagement with healthcare. Curr Opin Endocrinol Diabetes Obes . 2021; 28 (6):630–635.
.Performance and image enhancing drug interventions aimed at increasing knowledge among healthcare professionals (HCP): reflections on the implementation of the Dopinglinkki e-module in Europe and Australia in the HCP workforce. Int J Drug Policy . 2021; 95 .
,Anabolic-androgenic steroids (AAS) users on AAS use: Negative effects, “code of silence”, and implications for forensic and medical professionals. J Forensic Leg Med . 2019; 68 .
.