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Introduction: Women who use drugs, particularly those using anabolic‐androgenic steroids (AAS), encounter heightened social risks influenced by the legal status of AAS, varying regionally. In jurisdictions where AAS are legal, medical guidance and prescription are common, while in illegal regions, there are challenges associated with acquisition and safer usage. Therefore, we aimed to explore the experiences of women who use AAS in Australia, where these substances are criminalised, with a focus on the challenges they encounter in acquiring and using these drugs. Methods: We focused on data from six women in a broader study interviewing 15 AAS users. The data were subjected to iterative inductive analysis, resulting in two theme‐categories. Results: Women who use AAS face distinct challenges in accessing reliable suppliers, with men seemingly having 'easier' access. Women experience this disparity as increasing their vulnerability to unsafe products, further compounded by their lack of knowledge regarding these substances. Moreover, mislabelling and counterfeiting of female‐specific AAS substances is described to further compound these risks, reflecting the participants' expressed need for enhanced intervention and quality control in the AAS market. Discussion and Conclusions: Ensuring product reliability, transparency and accountability are perceived as essential for the health and safety of women who use AAS. To address these issues, interventions should provide women with comprehensive drug checking services tailored to their health needs. 'Steroid literacy' must be an integral component, equipping women with knowledge to make informed decisions in the gendered AAS market. [ABSTRACT FROM AUTHOR]

Introduction: To ascertain the adverse health outcomes experienced by those using prescribed testosterone and non‐prescribed anabolic–androgenic steroids presenting to general practitioner (GP) clinics. Methods: Retrospective clinical audit from nine GP clinics in major metropolitan areas across three Australian states. Data included demographic and individual characteristics (age, sexuality, body mass index, smoking status and HIV status); performance and image‐enhancing drug use (type, reasons for use, patient‐reported adverse effects); and blood biochemistry measurements (lipid profiles, liver function tests and red blood cell tests). Adverse health outcomes included evidence of polycythaemia, hypertension, liver abnormalities and hypercholesterolemia. Results: Three hundred men were identified as either using prescribed testosterone (66%; n = 197) or non‐prescribed anabolic–androgenic steroids (AAS) (34%; n = 103). Individuals in the prescribed group were more likely to be older (p < 0.001), gay or bisexual (p < 0.001) and living with diagnosed HIV (p < 0.001) compared to individuals in the non‐prescribed group. Abnormal liver function, polycythemia and gynecomastia were the top three adverse events experienced. When adjusting for age, sexuality, HIV status and smoking status, those who used non‐prescribed AAS were more likely to experience any adverse event (aPR = 1.28; 95% CI 1.01–1.60; p = 0.038), hypertension (aPR = 1.86; 95% CI 1.19–2.91; p = 0.006) and liver abnormalities (aPR = 1.51; 95% CI 1.04–2.20; p = 0.030) compared to those using prescribed testosterone. Discussion and Conclusion: For GPs who have clients who may be using, or who they suspect of using, AAS, these findings highlight the importance of not only exploring a patient's history of the adverse effects they have experienced, but that measuring for these other conditions may provide a more accurate clinical picture. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions YouTube personalities (YP) have amassed significant followings by distributing health information. There is concern that YP involved in anabolic androgenic steroid (AAS) communities are sharing information on how people should approach initiating AAS use. This research sought to explore how YP are using their platform to distribute information on AAS initiation, what information is being presented and how people are responding.This mixed methods research utilised a netnographic approach, a method adapted from traditional ethnographic techniques for the study of online sociocultural phenomena. The research included a selection of YouTube videos (n = 37) and user comments replying to the videos (n = 584).YP addressed the positives and negatives of AAS initiation (76%; n = 28 and 76%; n = 28 respectively), provided harm reduction strategies (76%; n = 28), and advice on which AAS people should use (97%; n = 36). A qualitative thematic analysis of the comments found two overarching themes: ‘Authenticity, capital and the influence of the YP on their audiences’ and ‘The evolving landscape of enhancement and health’. Viewers engaged with the videos due to the YPs lived experience using AAS, and YP influenced the health behaviours of viewers. Many believed that the videos were useful for health and lifestyle enhancement purposes.YP are disseminating diverse information on AAS initiation which is derived from their lived experience using AAS. Harm reduction is a key component of the YPs' message and viewers responded positively to a balanced and honest assessment of AAS initiation which is perceived to respect their personal autonomy. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Trenbolone, a potent anabolic‐androgenic steroid (AAS), is used for its muscle growth benefits but poses significant health risks, including psychosocial issues. Existing research among humans is limited by lack of targeted investigation. This study addresses gaps in existing research by leveraging the ethnopharmacological expertise of trenbolone consumers. By engaging with the community's connoisseurship, we sought to enhance harm reduction strategies and foster collaboration between consumers, scholars and health practitioners.An international sample of trenbolone consumers (N = 30) were interviewed. Interviews explored trenbolone use, knowledge levels and harm reduction strategies. Analysis involved an iterative categorisation approach, incorporating the lead author's lived experience with trenbolone.Participants described trenbolone as both a physical enhancer and a source of psychological boosts, tempered by adverse effects such as emotional volatility and intrusive thoughts. Despite warnings about its dangers the drug's allure was amplified by social media and community visibility. Consumers spoke of a developing connoisseur‐like knowledge about trenbolone through personal and shared experiences. Through this collective expertise, they developed harm reduction strategies such as conservative dosing and regular health monitoring.This study demonstrates the importance of integrating ethnopharmacological‐connoisseurship from the image and performance enhancing drug community to develop a contextually relevant understanding of AAS use—trenbolone being one of these. By elevating community insights, we advocate for a collaborative approach to harm reduction. Ultimately, we call for partnerships between researchers, health professionals and consumers to enhance health and reduce harm in image and performance enhancing drug communities. [ABSTRACT FROM AUTHOR]

Background: Long-term use of supraphysiologic doses of anabolic-androgenic steroids (AAS) has been associated with impaired visuospatial memory in young men but little is known about its cognitive effects in middle-aged men.Objectives: We compared cognition in middle-aged men with histories of long-term AAS use and age-matched non-users.Methods: We administered cognitive tests from the CANTAB battery to 76 weightlifters aged 37–60 years (mean [SD] 48.5 [6.5] years), of whom 51 reported at least 2 years of cumulative AAS use and 25 reported no AAS exposure.Results: We found no significant AAS user versus non-user group differences on visuospatial, verbal memory, emotional recognition, or executive function tasks (corrected p’s ≥ .00089; effect sizes ≤ .5).Conclusions: Our null visuospatial task findings contrast with our prior younger cohort study (mean age 37.1 [7.1] years), in which we found impaired visuospatial task performance in people who use AAS, and with other reports of cognitive impairments in younger men use AAS. Men who use AAS may develop early visuospatial memory deficits that stabilize by middle age while middle-aged non-users’ performance may “catch up” due to normal age-related visuospatial declines. Similar effects could contribute to our null findings on other tasks. Between-study cohort substance use differences or environmental factor differences that modify cognition, such as study geographical location and time of year, also could contribute to our discordant findings. Since young adult male AAS users experience increased mortality from unnatural causes, improving our understanding of AAS cognitive effects in this age group is important. [ABSTRACT FROM AUTHOR]

Background/Objectives: Illegal anabolic-androgenic steroids are a significant lifestyle factor in infertility. The aim of our study was to analyze clinical cases resulting from their use for their frequency, geographical location, dynamics, substances used, the age and gender of the users, and the types of clinical complications. Methods: Publications were obtained by searching PubMed for the following terms: 'anabolic-androgenic steroids' and 'clinical case'. Publications from 1973 to 2022 were qualified for the analysis. Results: An increasing trend in the number of clinical cases resulting from the use of steroids, as well as the number of substances used simultaneously, was observed. The substances changed over the decades, but in the last 20 years, testosterone, nandrolone, stanozolol, methandienone, trenbolone, and methenolone have predominated. Cardiological side effects predominated in each period, with a continuous increase in their occurrence. The most common among these were myocardial infarctions and hypertrophic cardiomyopathy. The next most numerous adverse events involved psychiatric, endocrinological, hepatic, and oncological problems. We demonstrated a possible relationship between the use of individual steroids and medical issues; the strongest associations were between testosterone and endocrine complications, and methylstenbolone and hepatic complications. Conclusions: There has been an increasing trend in case reports describing serious health problems associated with the use of anabolic-androgenic steroids, a tendency to use several substances simultaneously, and a preferential use of substances with a high potential of causing serious side effects. These phenomena mainly concern men, with an average age of 30, and the health problems that dominate in clinical case reports—including serious cardiological, psychiatric, endocrinological, hepatic, and oncological diseases—may potentially affect reproductive health and pose a challenge for reproductive medicine. [ABSTRACT FROM AUTHOR]

Anabolic‐androgenic steroids (AASs) impairment of reproduction has been reported. We investigated dose‐ and time‐dependent effects of Nandrolone decanoate (ND) on reproductive system in comparison with Testosterone enanthate (TE). Male Wistar rats were administrated with 1, 3, and 9 mg/kg/weeks ND or 1 and 3 mg/kg/weeks TE for 8 weeks, and testicular phenotype and reproductive hormones were assessed at 4 and 8 weeks post‐treatments. AASs × treatment period interaction was significant for gonadosomatic index (GSI), testosterone (T), 17β‐estradiol (E2), and luteinizing hormone (LH). At 4 weeks post‐treatment, GSI was decreased in rats treated with 3 mg/kg/weeks ND and T was decreased in all ND‐treated groups, while no significant changes in LH levels were observed. At 8 weeks post‐treatment, GSI was decreased in rats treated with 1 and 3 mg/kg/weeks ND and with 3 mg/kg/weeks TE, T was decreased in all groups, and E2 and LH were increased and decreased, respectively, in rats treated with 9 mg/kg/weeks ND and with 3 mg/kg/weeks TE. The testes showed histopathological defects in both ND‐ and TE‐treated rats suggesting a delay in seminiferous cycle. This study shows AASs‐induced hypogonadism at low‐dose that coincided with inhibition of T biosynthesis and disruption of T feedback on pituitary. [ABSTRACT FROM AUTHOR]

Existing data reveals prevalent performance and image-enhancing drug (PIED) use in specific global regions and higher rates among athletes, however, research on performance-enhancement experiences among elite untested athletes is lacking. Drawing on conceptual frameworks that emphasize the intersection of context and practice, this research aims to gain insights into the subjective perspectives, motivations, and challenges faced by athletes in managing and optimizing their performance while using PIEDs. In-depth interviews were conducted with seventeen strength sports athletes, including powerlifters and bodybuilders, who had competed at national and/or international levels within untested federations. Thematic analysis was employed to examine the interview data within a social constructivist ontology. Findings revealed that PIEDs have dual roles as tools for enhanced recovery and heightened training stress, a delicate balance that aligns with Foucault's notion of self-transformation through technological advancements. These substances exerted power beyond consumption events with long-term psychological effects such as anxiety and irrational behavior emerging as key concerns. Peers with lived experience were key actors in the relationship between responsible drug management, however, the need for informed guidance was acknowledged. Non-human actors, notably biometric data tracking, played a pivotal role in guiding substance consumption. The study underscores the need for further research and tailored frameworks to support the health and well-being of athletes in this domain while addressing the broader implications of PIED use in public health discourse. Specifically, this study highlights the significance of integrating lived experiences and social contexts, emphasizing the need for nuanced harm-reduction strategies in this space. [ABSTRACT FROM AUTHOR]

Background: The use of Anabolic-androgenic steroids (AAS) among gym members has become a significant concern due to their impact on physical training and performance. Research worldwide indicates a notable prevalence of AAS use among athletes and gym attendees, often involving substances that are neither safe nor legal. Objectives: This study aims to determine the prevalence of AAS use among gym attendees in Amman, Jordan, and to explore the knowledge, attitudes, and behaviors associated with AAS use. Methods: The study involved 399 participants from 35 randomly selected gyms in the metropolitan area of Amman, Jordan. A cluster sampling technique was used to select a diverse and representative sample of gym attendees. Data was collected using a self-administered questionnaire that assessed AAS use, knowledge, attitudes, and behavioral factors. Statistical analyses were conducted using chisquare tests to explore the relationships between AAS use and categorical variables, while logistic regression was employed to identify predictors of AAS use. Results: The analysis revealed significant associations between AAS use and various factors, including knowledge, attitudes, behavioral factors, and demographic variables such as gender, age, exercise frequency, reasons for exercise, and total exercise duration. The study identified key predictors of AAS use among gym attendees in Amman, highlighting the importance of demographic and behavioral factors. Conclusion: The findings underscore the need for targeted interventions to address misconceptions and promote safer practices among gym-goers in Amman. The study provides critical insights that can guide the development of strategies, policy adjustments, and educational initiatives aimed at reducing AAS misuse and fostering a healthier gym culture in the region. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to explore women's perception of men with different addictions in terms of their short- and long-term mate value. Objectives: 2,525 women (age range: 18–40, M = 28.35, SD = 6.39) were randomized to six conditions in a vignette-based experiment where a male of otherwise high mating value was described as suffering from either gambling, gaming, cannabis, anabolic androgenic steroid, and alcohol addiction or as not suffering from addiction (control). Results: Regarding long-term mate value of the target, the control target was rated higher than each of the targets. The gaming target was rated higher than the alcohol, cannabis, and gambling targets. Finally, the AAS target was rated as higher on long-term mate value than the alcohol and gambling addiction targets. Conclusions: Overall, women seem to perceive risk-taking in the face of uncertainty, reflected by gambling addiction, as an attractive behavioral tendency in men in terms of short-term mating. In contrast, potential long-term mates with gaming or chemical addictions are viewed more negatively, probably because it signals inadequate time and resources to be invested in a relationship. [ABSTRACT FROM AUTHOR]

Abstract Supraphysiological doses of anabolic–androgenic steroids (AAS) is popular among recreational weightlifters and bodybuilders due to the performance-enhancing properties but is also associated with adverse cardiovascular effects. The knowledge about how AAS affect the vasculature is limited, although results from previous studies suggest alterations in vasoreactivity and morphology. In the present study we investigate the association between long-term use of AAS and vascular function. Hundred and twenty-three males were included in the study, 56 of them current AAS users and 67 weightlifting controls. Vascular function was evaluated by carotid artery reactivity and flow-mediated dilation. AAS users had significantly reduced carotid artery reactivity (p

Abstract Background Gender nonconformity (GNC) is an under-researched area of adolescent health that is of increasing interest to researchers and general public. However, little is known about whether it is associated with anabolic-androgenic steroids (AAS) misuse. We aimed to investigate the association among high school students using a cross-sectional design. Methods We pooled the 6 school districts data from the Youth Risk Behavior Survey in 2017 and 2019. We compared the prevalence of AAS misuse among gender nonconforming and conforming students. AAS misuse was determined on the reported experience of lifetime non-prescription steroid use. GNC was derived from perceived gender expression and sex. We estimated the sex-stratified adjusted odds ratios (AORs) for the association of GNC with AAS misuse after adjusting for race/ethnicity, grade, and sexual orientation. Results The study population consisted of 17,754 US high school students including 9143 (49.67%) female students. Among female students, GNC was significantly associated with moderate (AOR, 3.69; 95% CI 1.28–10.62; P = 0.016) and severe (AOR, 5.00; 95% CI 1.05–23.76; P = 0.043) AAS misuse, but not with any AAS misuse (AOR, 0.85; 95% CI 0.34–2.14; P = 0.734). Among male students, GNC was significantly associated with any (AOR, 4.75; 95% CI 2.93–7.69; P

Background: Anabolic-androgenic steroid (AAS) dependence affects approximately 30% of people who use AAS. Presently, measures to assess and diagnose AAS dependence are adapted from scales specific to other forms of drug misuse (e.g., alcohol), containing issues with internal consistency and breadth of construct capture. Additionally, there are no measures available to assess AAS craving, which represents a potentially important coeval factor to AAS dependence. Therefore, this study aimed to develop and provide evidence of validity for measures of AAS dependence and AAS craving. Methods: Data were collected from male and female strength athletes who use AAS across two samples (nsample 1 = 206; nsample 2 = 224). Sample 1 completed the new measures alongside instruments assessing theoretically related constructs (Doping Moral Disengagement, Doping Self-Regulatory Efficacy Scale, craving items from the Wisconsin Smoking Withdrawal Scale, AAS adapted Diagnostic and Statistical Manual for Mental Disorder 4th Edition), whereas Sample 2 completed the new instruments. Results: Exploratory and Confirmatory Factor Analyses (CFA) with Sample 1 data were used to finalize the item sets for both measures and determine the factorial structures of the AAS Dependence Scale (AASDS) and AAS Craving Scale (AASCS). The AASDS consists of 15-items across five first-order factors that are represented by one second-order factor. The AASCS consists of 16-items across four first-order factors that are represented by one second-order factor. Evidence supporting the concurrent, convergent and discriminant validity of scores obtained with both scales was provided through their associations with the theoretically related variables. CFA with the data from Sample 2 confirmed the factor structures for both scales. Conclusion: The AASDS and AASCS represent valid and reliable measures of AAS dependence and AAS craving for use in research with strength athletes who use AAS. [ABSTRACT FROM AUTHOR]

Background and aim Method Results Conclusion Evidence suggests there has been an increase in anabolic‐androgenic steroid (AAS) use among women, driven by the evolving landscape of women's participation in sport. However, the extent of use is unknown. This systematic review aimed to estimate the prevalence of women's AAS use.We conducted a systematic review of peer‐reviewed articles in English, focusing on AAS use among women aged 18 and above. We excluded grey literature and studies that measured doping through some form of analysis (e.g. urine or hair). Searched databases were MEDLINE, CINAHL, PsycINFO, SocINDEX, SPORTDiscus, Embase and Cochrane Library. Titles and abstracts for all articles were screened, followed by full‐text assessment and data extraction of included articles by multiple authors for accuracy. The pooled prevalence of lifetime use was determined using a random effects model and the risk of bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool.Based on 18 studies, participant numbers averaged 669 per study (median = 189; range = 16 to 7051). The overall pooled AAS use prevalence was 4% (95% confidence interval [CI] = 2–9%) with high heterogeneity overall (I2 = 95%). In the subgroup analysis, AAS use prevalence was 16.8% (95% CI = 11.0–24.9%, I2 = 44%) in the bodybuilder subgroup, 4.4% (95% CI = 1.2–15.1%, I2 = 93%) in athletes/recreational gym user subgroup, and 1.4% (95% CI = 0.4–4.7%, I2 = 96%) in the general population/other subgroup. Meta‐regression demonstrated significantly higher AAS use in bodybuilders compared with the other subgroup (P = 0.011).Anabolic‐androgenic steroid use among women appears to be substantially higher among bodybuilders and athletes/recreational gym users than the general female population. [ABSTRACT FROM AUTHOR]

Long-term use of anabolic-androgenic steroids (AAS) might lead to distressing withdrawal symptoms following cessation. This paper aims to share challenges in recruiting patients to a pilot intervention study with parallel substance use disorder (SUD) treatment and to explore barriers to participation among AAS forum members. Eligible AAS-dependent men were recruited to receive hormone therapy for 16 weeks, and exclusion reasons were registered. Audience engagement from social media advertisements was measured. Information about the study was posted in an AAS online forum, and discussion among forum members was thematically analyzed. Twelve of 81 potential participants were included, whereas ten completed the intervention. Participants were excluded due to residency outside the study area, illicit substance use or severe medical conditions. Challenges in recruitment were linked to the COVID-19 pandemic, funding and advertisements on social media. AAS forum members suggested modifications to the intervention, were skeptical to the SUD-patient requirement, feared prosecution or other negative outcomes and/or preferred to seek online advice on self-initiated testosterone replacement therapy or post cycle therapy. AAS-related online recommendations among peers, criminalized AAS use setting and obligatory SUD treatment might have affected recruitment. Based on lessons learned, recommendations for future similar studies are presented. [ABSTRACT FROM AUTHOR]

Androgens, formerly known as anabolic‐androgenic steroids, mimic the effects of testosterone and are being increasingly abused for nonmedical purposes such as body and performance enhancement. Androgen abuse is associated with increased mortality, and multisystem adverse effects have been reported, including cardiovascular toxicity, infertility, hypogonadism, hepatotoxicity, and mental health disorders. Men may present with the negative health consequences of androgen abuse even despite cessation for a number of years. There is frequently a reluctance to disclose androgen abuse, and substances are often sourced from the black market, which is not regulated and where the products sold may be counterfeit. All men should be encouraged to stop androgen abuse. Managing associated adverse effects will be organ‐specific and is complex due to physical and neuropsychiatric symptoms, substance dependence, and high rates of relapse. Given the broad reach and prolonged adverse effects of androgen abuse, clinicians across medical specialties should have an awareness of androgen abuse, its increasing prevalence, and the harms it poses to men and their families. This narrative review aims to summarize the adverse effects and risks associated with androgen abuse. [ABSTRACT FROM AUTHOR]

Objective: To identify the lifetime prevalence and correlates of appearance- and performance-enhancing drugs and substances (APEDS) use among a national sample of US college and university students. Participants: Student participants from the 2020–2021 Healthy Minds Study (N = 7,401; ages 18–30 years). Methods: Lifetime prevalence of five forms of APEDS was estimated. Modified Poisson regression analyses were conducted to determine the sociodemographic correlates of protein and creatine supplement use. Results: Lifetime protein (23.8%) and creatine (7.7%) supplement use were most common among the sample. Older age within young adulthood, male sex, perceiving oneself to be normal weight or somewhat overweight, any athletics participation, and 2–3 or ≥ 5 h/week of exercise were associated with greater likelihood of lifetime protein and creatine supplement use. Conclusions: Awareness and prevention efforts on the potential harms of APEDS use are needed on campuses, particularly among males and those who participate in athletics and high-frequency exercise. [ABSTRACT FROM AUTHOR]

Use of anabolic-androgenic steroids (AAS) is associated with adverse cardiovascular (CV) effects, including potential prothrombotic effects. This study aimed to assess platelet activation and aggregation, coagulation, and fibrinolysis, in long-term AAS users compared to non-using strength-trained athletes. Thirty-seven strength-trained men using AAS were compared to seventeen non-using professional strength-trained athletes at similar age (median 33 years). AAS use was verified by blood and urine analyses. Platelet Function Analyzer 100 (PFA-100) and whole blood impedance aggregometry with thrombin, arachidonic acid, and ADP as agonists, were performed to evaluate platelet aggregation. ELISA methods were used for markers of platelet activation. Fibrinogen, D-dimer, the coagulation inhibitors protein S and C activity, and antithrombin were measured by routine. Fibrinolysis was evaluated by Plasminogen Activator Inhibitor-1 (PAI-1) activity. There were no significant differences in platelet aggregation between the two groups. Von Willebrand factor was lower among the AAS users (p < 0.01), and P-Selectin was slightly higher (p = 0.05), whereas CD40 Ligand, β-thromboglobulin, and thrombospondin did not differ significantly. No differences were found in the assessed coagulation inhibitors. Higher D-dimer levels (p < 0.01) and lower PAI-1 activity (p < 0.01) were found among the AAS users. The investigated long-term users of AAS did not exhibit elevated platelet activity compared to strength-trained non-using athletes. However, AAS use was associated with higher D-dimer levels and lower PAI-1 activity. These findings suggest that any prothrombotic effect of long-term AAS use may predominantly involve other aspects of the hemostatic system than blood platelets. [Display omitted] • Anabolic steroids are associated with an increased risk of cardiovascular diseases. • It has been hypothesized that anabolic steroids might have a prothrombotic effect. • The prothrombotic effects of anabolic androgenic steroids are still unclear. • We found an increased activation of coagulation and fibrinolysis. • No increase of blood platelet activation was observed. [ABSTRACT FROM AUTHOR]

Introduction : The existing body of literature on harm reduction for those who use anabolic–androgenic steroids (AASs) predominantly concentrates on men, thereby neglecting the unique challenges faced by women in this context. Using a risk environment framework, the aim of this study was to examine the gendered harm reduction practices of male and female AAS users. The study explores their awareness of the potential harms associated with AAS use, the strategies they employ to manage those risks, and the support systems they utilize for harm reduction. Methods : The study employed purposive sampling to recruit 25 individuals (16 females and nine males) who used AAS. In-depth, semi-structured interviews were conducted and transcribed; thematic analysis was employed. Results : Both male and female users were aware of the risks and side effects of AAS. They also often trusted coaches for advice regarding AAS use, and some found peer support for open discussions. Participants also indicated the importance of verifying the legitimacy and safety of AAS. Men considered these to be manageable while women aimed to avoid them, particularly the masculinizing effects. Women downplayed the persistence of side effects and fertility challenges. Harm reduction strategies involved both men and women monitoring their health through personal cues and blood tests. However, women placed a greater emphasis on various physiological measures in their health monitoring practices. Post-cycle therapy was less discussed among women. Discussion : Overall, the study provides insights into the awareness, strategies, and support systems employed by men and women who use AAS for harm reduction purposes. There is a need to adopt a comprehensive harm reduction approach that recognizes the unique needs and experiences of women who use AAS. We emphasize the need for comprehensive education, supportive healthcare providers, and responsible coaching to minimize potential risks and ensure the well-being of individuals using AAS. [ABSTRACT FROM AUTHOR]

Abstract Anabolic‐androgenic steroids (AASs) impairment of reproduction has been reported. We investigated dose‐ and time‐dependent effects of Nandrolone decanoate (ND) on reproductive system in comparison with Testosterone enanthate (TE). Male Wistar rats were administrated with 1, 3, and 9 mg/kg/weeks ND or 1 and 3 mg/kg/weeks TE for 8 weeks, and testicular phenotype and reproductive hormones were assessed at 4 and 8 weeks post‐treatments. AASs × treatment period interaction was significant for gonadosomatic index (GSI), testosterone (T), 17β‐estradiol (E2), and luteinizing hormone (LH). At 4 weeks post‐treatment, GSI was decreased in rats treated with 3 mg/kg/weeks ND and T was decreased in all ND‐treated groups, while no significant changes in LH levels were observed. At 8 weeks post‐treatment, GSI was decreased in rats treated with 1 and 3 mg/kg/weeks ND and with 3 mg/kg/weeks TE, T was decreased in all groups, and E2 and LH were increased and decreased, respectively, in rats treated with 9 mg/kg/weeks ND and with 3 mg/kg/weeks TE. The testes showed histopathological defects in both ND‐ and TE‐treated rats suggesting a delay in seminiferous cycle. This study shows AASs‐induced hypogonadism at low‐dose that coincided with inhibition of T biosynthesis and disruption of T feedback on pituitary.

Introduction and objective Anabolic-androgenic steroids (AAS) are a group of doping substances. They cause muscle hypertrophy and an increase in strength. Moreover, they may lead to dangerous side effects. Knowledge of the side effects of AAS use is necessary because in clinical practice we often encounter patients who decide to supplement with steroids. The aim of the study is to present information on the epidemiology, mechanism of action, methods of detecting AAS, the impact of the substance on the male and female body, and a description of organ side effects, highlighting: the cardiovascular system, the nervous system and the psyche. Review methods Literature search was conducted in the PubMed database with inclusion criteria ‘free full texts’ and publications date between 2015 – 2024. A total of 7272 results were found; 30 publications were ultimately included in the review. Abbreviated description of the state of knowledge Overusing AAS is very popular among people training at the gym. They have an anabolic effect on muscle tissue. They contribute to infertility in men and masculinization in women. Stimulation of androgen receptors above physiological doses of AAS leads to vascular changes that, in extreme cases, may lead to sudden cardiac death. Moreover, they accelerate brain aging. An increase in aggression and risky sexual behavior has been observed among people using doping. The diagnostic material used in anti-doping tests is urine and blood serum. Summary AAS abuse is a serious public health problem. Men who want to improve their figure and decide to use doping are particularly at risk. Due to the easy availability of steroids, society should be made aware of the negative effects of steroid use.

Bodybuilding, as a high-performance sport, requires regular strength and resistance exercises with the principal objective of increasing muscle hypertrophy. However, many bodybuilders resort to the use of anabolic-androgenic steroids (AASs) to improve their performance in a short period of time. This study employs a survey-type, cross-sectional, descriptive–analytical method to evaluate the profile of bodybuilding athletes in the State of Sergipe, Brazil, and verify the level of knowledge/awareness about the health risks and impacts resulting from the use of such substances. Finite- and convenience-type populations are assessed, including individuals of both sexes, aged older than 18 years, self-declared bodybuilding athletes residing in the State of Sergipe, Brazil, and participating in regional and/or state competitions. As a result, no significant relationships were determined between sex (p = 0.492), age (p = 0.460), family income (p = 0.141), and medical follow-up sessions. For the variables level of education and medical follow-up vs. no follow-up sessions, a significant result was achieved (p = 0.01), with 74.3% of individuals reporting having follow-up treatment and 25.7% responding that they had no follow-up treatment, a percentage representing the group that completed their higher education. The substances most used by the athletes were Sustanon 250 or Durateston, Nandrolone Decanoate (Deca or Deca-Durabolin), and Testosterone. The most-reported acute side effects were acne at 33.8% (n = 20), irritability at 32.1% (n = 19), alopecia (hair loss), and nervousness at 23.7% (n = 14). The most-reported chronic side effects were arterial hypertension at 36.0% (n = 9), liver disease at 28.0% (n = 7), and cancer (non-specific) at 8.0% (n = 2). We concluded that, regardless of the athletes’ socioeconomic profiles, the use of AASs was high, with two or more substances being used in combination and for a prolonged period. Thus, it is necessary to promote awareness campaigns regarding the use of AASs and their effects on high-performance and recreational athletes.

Abstract Background While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic–androgenic steroid (AAS) consumers. Objective This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist’s regarding AAS harm reduction. Methods Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. Results While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. Conclusions Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.

AbstractIntroductionMethodsResultsConclusionsThis study addresses the dearth of research on specific anabolic-androgenic steroids (AAS), focusing on the contentious substance Trenbolone. With increased potency and risks, Trenbolone’s effects, both in animal studies and among human users, raise concerns for neurodegeneration, genotoxicity, and significant social harms. Despite these risks, people persist using Trenbolone and other AAS, navigating the harm-to-benefit ratio. The study explores the representation of Trenbolone in online AAS forums, to gain nuanced insight into dynamics of identity and behavior specific to the Trenbolone context.We employed a digital ethnographical approach to collect data from four Australian AAS forums. Grounded in a social constructivist framework and recognizing the influential role of identity and social categorization in shaping behaviors within these digital communities, we utilized inductive thematic analysis to identify patterns and themes from user discussions about Trenbolone.Three key themes were developed: shared cultural language and beliefs, experienced users’ perceptions of Trenbolone mastery and risk avoidance, and the normalization of problematic use of Trenbolone and signs of dependence within the community. The findings reveal a nuanced interplay of language, beliefs, and behaviors, providing insights into how the community navigates its cultural norms, showcases expertise, and collectively grapples with usage patterns.We delineate the emergence of a 'Trenbolone prototype’ within online AAS-using communities. The findings point to a potential disconnect between community beliefs and empirical evidence on Trenbolone’s health effects. Addressing these disparities, public health campaigns should align with the community’s language and norms for effective harm reduction. [ABSTRACT FROM AUTHOR]

Bodybuilding, as a high-performance sport, requires regular strength and resistance exercises with the principal objective of increasing muscle hypertrophy. However, many bodybuilders resort to the use of anabolic-androgenic steroids (AASs) to improve their performance in a short period of time. This study employs a survey-type, cross-sectional, descriptive–analytical method to evaluate the profile of bodybuilding athletes in the State of Sergipe, Brazil, and verify the level of knowledge/awareness about the health risks and impacts resulting from the use of such substances. Finite- and convenience-type populations are assessed, including individuals of both sexes, aged older than 18 years, self-declared bodybuilding athletes residing in the State of Sergipe, Brazil, and participating in regional and/or state competitions. As a result, no significant relationships were determined between sex (p = 0.492), age (p = 0.460), family income (p = 0.141), and medical follow-up sessions. For the variables level of education and medical follow-up vs. no follow-up sessions, a significant result was achieved (p = 0.01), with 74.3% of individuals reporting having follow-up treatment and 25.7% responding that they had no follow-up treatment, a percentage representing the group that completed their higher education. The substances most used by the athletes were Sustanon 250 or Durateston, Nandrolone Decanoate (Deca or Deca-Durabolin), and Testosterone. The most-reported acute side effects were acne at 33.8% (n = 20), irritability at 32.1% (n = 19), alopecia (hair loss), and nervousness at 23.7% (n = 14). The most-reported chronic side effects were arterial hypertension at 36.0% (n = 9), liver disease at 28.0% (n = 7), and cancer (non-specific) at 8.0% (n = 2). We concluded that, regardless of the athletes' socioeconomic profiles, the use of AASs was high, with two or more substances being used in combination and for a prolonged period. Thus, it is necessary to promote awareness campaigns regarding the use of AASs and their effects on high-performance and recreational athletes. [ABSTRACT FROM AUTHOR]

The nonmedical use of anabolic–androgenic steroids (AAS) by athletes and the general population is a public health concern. One particular concern relates to the link between AAS use and violence. Although there is a growing body of research on the association between AAS and violence, results as to what the relationship is seem to be mixed. The aim of this meta-analysis is to improve our understanding of what the current evidence base indicates regarding the relationship between the use of AAS and interpersonal violence. In total, 14 studies with a total of 16 samples met the inclusion criteria, comprising a total sample size of 137,055 participants. The findings show that there is a significant association between AAS use and interpersonal violence (r =.21 [95% confidence intervals (CI): 0.15, 0.27], p <.00001), although small. It is however unclear what the direction of this relationship is as almost all studies failed to demonstrate whether AAS use occurred prior or subsequent to the violent behavior. Risk of bias for most studies was moderate or high. Three potential moderators, AAS use via self-report or testing, interpersonal violence via self-report or criminal records of violent behavior, and proportion of males, were nonsignificant. Although a meta-analytic relationship between AAS use and interpersonal violence was found, it is unclear to what extent AAS causes violent acts. We need to carefully consider the role of mediating factors, and that the relationship between the two could be part of a broader context as opposed to AAS being the cause of violence. [ABSTRACT FROM AUTHOR]

Rationale: Anabolic-androgenic steroids (AAS) are used to improve physical performance and appearance, but have been associated with deficits in social cognitive functioning. Approximately 30% of people who use AAS develop a dependence, increasing the risk for undesired effects. Objectives: To assess the relationship between AAS use (current/previous), AAS dependence, and the ability to recognize emotional facial expressions, and investigate the potential mediating role of hormone levels. Methods: In total 156 male weightlifters, including those with current (n = 45) or previous (n = 34) AAS use and never-using controls (n = 77), completed a facial Emotion Recognition Task (ERT). Participants were presented with faces expressing one out of six emotions (sadness, happiness, fear, anger, disgust, and surprise) and were instructed to indicate which of the six emotions each face displayed. ERT accuracy and response time were recorded and evaluated for association with AAS use status, AAS dependence, and serum reproductive hormone levels. Mediation models were used to evaluate the mediating role of androgens in the relationship between AAS use and ERT performance. Results: Compared to never-using controls, men currently using AAS exhibited lower recognition accuracy for facial emotional expressions, particularly anger (Cohen's d = −0.57, pFDR = 0.03) and disgust (d = −0.51, pFDR = 0.05). Those with AAS dependence (n = 47) demonstrated worse recognition of fear relative to men without dependence (d = 0.58, p = 0.03). Recognition of disgust was negatively correlated with serum free testosterone index (FTI); however, FTI did not significantly mediate the association between AAS use and recognition of disgust. Conclusions: Our findings demonstrate impaired facial emotion recognition among men currently using AAS compared to controls. While further studies are needed to investigate potential mechanisms, our analysis did not support a simple mediation effect of serum FTI. [ABSTRACT FROM AUTHOR]

Introduction: AAS are a group of hormones that greatly influence the strength and size of muscle. They are widely used by athletes and bodybuilders. Yet research indicates that the use of these compounds has significant implications for male reproductive health as well. The aim of the study: This study was intended to analyze systematically the relationship between AAS use and men's reproductive health; looking at both what influence AAS has on semen quality and male hormone levels and how post-cycle treatment (PCT) might help in the restoration of any adverse effects caused by AS. Methods: This review was based on available data collected in the PubMed database and Google Scholar web search engine using anabolic-androgenic steroids, male fertility, hypogonadism, post-cycle therapy, and reproductive health. Results: Results suggest that AAS use can lead to testicular atrophy, while research shows that anabolic steroid abuse impairs normal sperm production. These findings include aspermia, oligospermia, or aspermatogenesis. The time period for recovery of sperm quality is also different after use of anabolic steroids, and all cases are expected to have a profound impact on spermatogenesis over the long term. Anabolic steroids may suppress the HPG axis and decrease the male's fertility hormone, testosterone. If PCT is combined with hCG or SERMs, a person's own regular hormone levels return after 10 weeks with good prospects for recovery from low testosterone. Conclusion: Studies show that the use of AAS seriously affects the male reproductive system and may even have long-term consequences for this function. PCT seems to offer a reasonable method for re-establishing the hormonal equilibrium and hence proving fertile offspring, which reinforces the need for careful AAS use and monitoring. Further research will be needed before any moves can be taken towards optimizing PCT regimes, in addition to the as-yet-determined long-term consequences for male fertility. [ABSTRACT FROM AUTHOR]

Millions of individuals have used illicit anabolic-androgenic steroids (AAS), but the long-term cardiovascular associations of these drugs remain incompletely understood. Boldjan is AAS medication which is used in veterinary medicine and by young adults aiming to have a better appearance improving their self-esteem. Therefore; the objective of the current investigation was to examine any potential preventative effects of amygdalin extract against anabolic steroid Boldjan induced cardic toxicity, injury and oxidative stress in male rat. Forty adult male Wistar rats were classified into five groups (Gp1, Control Gp; Gp2, Amygdalin Gp in which rats treated with amygdalin (100 mg/kg body weight/day) daily for 2 weeks; Gp3, Boldjan Gp in which rats treated with Boldjan (10 mg/Kg BW/week) for 4 weeks; Gp4, Boldjan  + Amygdalin). Boldjan induced a significant rises in serum lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase MB (CK MB), aspartate aminotransferase (AST), total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), and very-low-density lipoprotein–cholesterol (VLDL-C), cardiac injury, and malondialdehyde (MDA) levels and a significant depletion in serum high-density lipoprotein-cholesterol (HDL-C), cardiac reduced glutathione (GSH), Superoxide dismutase (SOD) and catalase (Cat) activities as compared to control Gp. In contrast, Amygdalin significantly reversed the Boldjan induced cardiac toxicity in post treated rats Gp (Boldjan  + Amygdalin). Amygdalin could be an efficient preventive supplement for mitigating Boldjan induced cardiac toxicity, possibly via controlling oxidative stress events. [ABSTRACT FROM AUTHOR]

Background: While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic–androgenic steroid (AAS) consumers. Objective: This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. Methods: Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. Results: While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. Conclusions: Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers. [ABSTRACT FROM AUTHOR]

Use of legal and illegal muscle-building drugs and dietary supplements has been linked to many adverse health and social outcomes. Research has shown that social media use is associated with the use of these drugs and dietary supplements; however, it remains unknown whether social media companies have specific policies related to the content and advertising of muscle-building drugs and dietary supplements on their platforms. Therefore, this study aimed to assess the content and advertising policies of eight popular social media companies related to muscle-building drugs and dietary supplements. Content and advertising policies for YouTube, TikTok, Instagram, Snapchat, Facebook, Twitter, Twitch, and Reddit were analyzed in November 2022 to determine whether there were any provisions related to legal (e.g., whey protein) and illegal (e.g., anabolic-androgenic steroids) muscle-building drugs and dietary supplements. Policies were classified as either none, restricted, or prohibited. All eight social media platforms had explicit policies prohibiting user-generated content and advertising of illicit drugs and substances (e.g., anabolic-androgenic steroids). User-generated content and advertising policies related to legal muscle-building dietary supplements across the platforms varied; however, none of the eight social media companies had a specific policy regarding user content. Findings underscore the need for stronger social media content and advertising policies related to legal muscle-building dietary supplements. [ABSTRACT FROM AUTHOR]

This study aimed to investigate how Anabolic–Androgenic Steroid (AAS) users and healthcare professionals perceive the criminalisation of AAS on users' ability to seek help and, ultimately, what effect this has on the health outcomes for these consumers. This study triangulated the views (N = 24) of male (n = 8) and female (n = 7) AAS users (M age = 35.4, SD = 9.1), as well as healthcare providers (n = 9), regarding how the criminalisation of AAS had an impact on consumers' health behaviours and help-seeking. Data were analysed thematically. An overarching narrative was developed regarding the "politicogenic drug effects" which emerge from the illegality of AAS with three overarching themes. First, participants expressed challenges in seeking help and support due to the stigma and fear associated with the illegal nature of AAS use. This fear stemmed from the criminalisation of AAS and the potential legal consequences. Participants also highlighted the social challenges and the need for secrecy surrounding AAS use, which further hindered open discussions and engagement with healthcare providers. The cohort emphasised the close-knit social networks among AAS users, offering support and shared experiences but also entangled in the criminality associated with AAS use. Moreover, participants acknowledged the difficulties in promoting harm reduction initiatives due to the need for secrecy and the potential social and economic disadvantages. The escalation of AAS criminalisation that has impacted both consumers and healthcare professionals has exacerbated the challenges associated with their interaction, further impeding a relationship already fraught with obstacles. Consequently, users remain entrenched within the illicit market, with few options for harm reduction intervention. The study advocates for a rethinking of AAS policies, considering a potential reclassification aligned with the United Kingdom's Class C framework to destigmatise use and promote harm reduction. This shift would require comprehensive research to assess its impact on public health, user behaviour, and harm reduction outcomes. [ABSTRACT FROM AUTHOR]

BackgroundThe use of Anabolic-androgenic steroids (AAS) among gym members has become a significant concern due to their impact on physical training and performance. Research worldwide indicates a notable prevalence of AAS use among athletes and gym attendees, often involving substances that are neither safe nor legal.ObjectivesThis study aims to determine the prevalence of AAS use among gym attendees in Amman, Jordan, and to explore the knowledge, attitudes, and behaviors associated with AAS use.MethodsThe study involved 399 participants from 35 randomly selected gyms in the metropolitan area of Amman, Jordan. A cluster sampling technique was used to select a diverse and representative sample of gym attendees. Data was collected using a self-administered questionnaire that assessed AAS use, knowledge, attitudes, and behavioral factors. Statistical analyses were conducted using chi-square tests to explore the relationships between AAS use and categorical variables, while logistic regression was employed to identify predictors of AAS use.ResultsThe analysis revealed significant associations between AAS use and various factors, including knowledge, attitudes, behavioral factors, and demographic variables such as gender, age, exercise frequency, reasons for exercise, and total exercise duration. The study identified key predictors of AAS use among gym attendees in Amman, highlighting the importance of demographic and behavioral factors.ConclusionThe findings underscore the need for targeted interventions to address misconceptions and promote safer practices among gym-goers in Amman. The study provides critical insights that can guide the development of strategies, policy adjustments, and educational initiatives aimed at reducing AAS misuse and fostering a healthier gym culture in the region.

BackgroundAnabolic-androgenic steroid (AAS) dependence affects approximately 30% of people who use AAS. Presently, measures to assess and diagnose AAS dependence are adapted from scales specific to other forms of drug misuse (e.g., alcohol), containing issues with internal consistency and breadth of construct capture. Additionally, there are no measures available to assess AAS craving, which represents a potentially important coeval factor to AAS dependence. Therefore, this study aimed to develop and provide evidence of validity for measures of AAS dependence and AAS craving.MethodsData were collected from male and female strength athletes who use AAS across two samples (nsample 1 = 206; nsample 2 = 224). Sample 1 completed the new measures alongside instruments assessing theoretically related constructs (Doping Moral Disengagement, Doping Self-Regulatory Efficacy Scale, craving items from the Wisconsin Smoking Withdrawal Scale, AAS adapted Diagnostic and Statistical Manual for Mental Disorder 4th Edition), whereas Sample 2 completed the new instruments.ResultsExploratory and Confirmatory Factor Analyses (CFA) with Sample 1 data were used to finalize the item sets for both measures and determine the factorial structures of the AAS Dependence Scale (AASDS) and AAS Craving Scale (AASCS). The AASDS consists of 15-items across five first-order factors that are represented by one second-order factor. The AASCS consists of 16-items across four first-order factors that are represented by one second-order factor. Evidence supporting the concurrent, convergent and discriminant validity of scores obtained with both scales was provided through their associations with the theoretically related variables. CFA with the data from Sample 2 confirmed the factor structures for both scales.ConclusionThe AASDS and AASCS represent valid and reliable measures of AAS dependence and AAS craving for use in research with strength athletes who use AAS.

Background: With the online proliferation of illegal substances, the Internet offers a wide variety of information on the acquisition and intake of anabolic-androgenic steroids (AAS) and other performance and image enhancing drugs. This study focuses on investigating the characteristics of the online AAS market in Central Asia. Objectives: The primary objectives of this study were to investigate the accessibility and features of the online market for AAS in Central Asia. To achieve this, we employed a netnographic approach for a systematic exploration of websites advertising and selling AAS. The study aimed to conduct a comprehensive analysis of several key aspects, including the variety of AAS products offered, the quality of health advice provided the level of product availability, the procedures involved in making purchases, and the pricing structures within this market. Results: Twenty-one websites supplying AAS in Central Asia met our inclusion criteria. Using content analysis, data were gathered on AAS offerings, quality of health advice provided, availability, purchase process, and prices. Data were synthesized using descriptive statistics. Results indicate that AAS are easily accessible for purchase without valid medical prescription in the Central Asia online market. Most websites advertised the aesthetic and ergogenic benefits of AAS use without indicating the potential complications and adverse effects. Conclusions: Public health efforts to mitigate AAS use in Central Asia should consider both the online accessibility of AAS and the lack of accompanying information on potential complications as well as adverse effects associated with their use. Efforts must be intensified to curtail the proliferation of AAS and related misleading information on the Central Asian online market. [ABSTRACT FROM AUTHOR]

Objective: Symptomatic hypogonadism discourages men from stopping anabolic-androgenic steroids (AAS). Some men illicitly take drugs temporarily stimulating endogenous testosterone following AAS cessation (post-cycle therapy; PCT) to lessen hypogonadal symptoms. We investigated whether prior PCT use was associated with the normalization of reproductive hormones following AAS cessation. Methods: Retrospective analysis of 641 men attending a clinic between 2015-2022 for a single, nonfasting, random blood test <36 months following AAS cessation, with or without PCT. Normalized reproductive hormones (ie, a combination of reference range serum luteinizing hormone, follicle-stimulating hormone, and total testosterone levels) were the surrogate marker of biochemical recovery. Results: Normalization of reproductive hormones was achieved in 48.2% of men. PCT use was associated with faster biochemical recovery (13.0 (IQR8.0-19.0) weeks, PCT; 26.0 (IQR10.5-52) weeks, no-PCT; P < .001). Odds of biochemical recovery during multivariable analysis were: (1) higher with PCT (OR3.80) vs no-PCT (P = .001), in men stopping AAS ≤3 months previously; (2) reduced when 2 (OR0.55), 3 (OR0.46), or 4 (OR0.25) AAS were administered vs 1 drug (P = .009); (3) lower with AAS >6 vs ≤3 months previously (OR0.34, P = .01); (4) higher with last reported AAS >3 months (OR 5.68) vs ≤3 months (P = .001). PCT use was not associated with biochemical recovery in men stopping AAS >3 months previously. Conclusion: Without evidence-based withdrawal protocols, men commonly try avoiding post-AAS hypogonadism with PCT, which is illicit, ill-defined, and not recommended. Only half of men had complete biochemical testicular recovery after stopping AAS. The surprising association of self-reported PCT use with short-term biochemical recovery from AAS-induced hypogonadism warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Prior research has demonstrated associations between anabolic-androgenic steroid (AAS) use and features from several childhood and adolescent psychosocial domains including body image concerns, antisocial traits, and low levels of parental care. However, prior approaches have been limited by their focus on individual features and lack of consideration of the relevant causal structure. Methods: We re-analyzed data from a previous cross-sectional cohort study of 232 male weightlifters aged 18–40, of whom 101 had used AAS. These men completed retrospective measures of features from their childhood and early adolescence, including body image concerns, eating disorder psychopathology, antisocial traits, substance use, and family relationships. Using an approach informed by principles of causal inference, we applied four machine-learning methods – lasso regression, elastic net regression, random forests, and gradient boosting – to predict AAS use. Results: The four methods yielded similar receiver operating curves, mean area under the curve (range 0.66 to 0.72), and sets of highly important features. Features related to adolescent body image concerns (especially muscle dysmorphia symptoms) were the strongest predictors. Other important features were adolescent rebellious behaviors; adolescent feelings of ineffectiveness and lack of interoceptive awareness; and low levels of paternal care. Conclusions: Applying machine learning within a causally informed approach to re-analyze data from a prior study of weightlifters, we identified six factors (most prominently those related to adolescent body image concerns) as proposed causal factors for the development of AAS use. Compared with the prior analyses, this approach achieved greater methodologic rigor and yielded stronger and broader findings.

Abstract Background Anabolic–androgenic steroids (AAS) mimic the effects of testosterone and may include testosterone itself; they are used for body enhancement within the general population. AAS use has been linked with increased mortality, cardiovascular disease, mental health disorders, and infertility. AAS-induced hypogonadism can persist for an uncertain time period despite cessation, during which men may report physical and neuropsychiatric symptoms. In an attempt to mitigate these symptoms and expedite testicular recovery, many men self-administer post-cycle-therapy (PCT), typically involving human chorionic gonadotrophin (hCG) and selective oestrogen receptor modulators (SERMs), which are known to potently stimulate testicular function. However, this practice has no objective evidence of effectiveness to lessen the severity or duration of hypogonadal symptoms. Methods An anonymous survey of four-hundred-and-seventy men using AAS explored the symptoms they experienced when ceasing AAS use; the effect of PCT on relieving their symptoms, and their perceived role for health service support. Results The majority of respondents were white, aged 18–30 years old, and working in skilled manual work. 51.7% (n = 243) reported no issues with AAS use, but 35.3% reported increased aggression. 65.1% (n = 306) of respondents had attempted AAS cessation and 95.1% of these experienced at least one symptom upon AAS cessation. Low mood, tiredness and reduced libido were reported in 72.9%, 58.5% and 57.0% of men stopping AAS use, respectively, with only 4.9% reporting no symptoms. PCT had been used by 56.5% of respondents with AAS cessation and mitigated cravings to restart AAS use, withdrawal symptoms and suicidal thoughts by 60%, 60% and 50%, respectively. The effect of stopping AAS on body composition and recovery of testosterone or fertility was a concern in 60.5% and 52.4%, respectively. Most respondents felt PCT should be prescribed under medical supervision in the community. Conclusions Our survey suggests that the majority of men stopping AAS use are using some form of PCT. Some self-reported symptoms of AAS-induced hypogonadism such as cravings to restart AAS use reduce by 60% and suicidal thoughts reduce by 50%. These individuals are concerned about the negative effect of AAS use and cessation. This study provides crucial information for planning future research to evaluate the effects of PCT on symptoms when men stop AAS use.

Background: A growing number of athletes are using synthetic anabolic–androgenic steroids (AAS), comprised of testosterone and other derivatives, to enhance athletic performance and muscle mass. Over the years, numerous reports elucidated the side effects of the illegal use of AAS, such as infertility, and liver disorders. The effect of AAS on the hepatic and reproductive systems in Saudi athletes has not yet been studied. Therefore, this study examined the liver function and sex hormone parameters of AAS users as compared to non-users. Methods: Fasting blood samples were collected from 16 male Saudi athletes, 10 AAS-users (cases) and 6 non-users (controls) to measure liver function tests (ALT, AST, GGT, ALP, total protein, albumin, direct and total bilirubin) and muscle enzymes (CK, LDH), Fertility hormones (LH, FSH, total testosterone, estradiol, and prolactin) were included also. Furthermore, a self-reported questionnaire was obtained to identify the type of AAS used, the dosage, and the length of the course before sample collection. Results: The results show a statistically significant increase in ALT (P

Background: Anabolic–androgenic steroids (AAS) mimic the effects of testosterone and may include testosterone itself; they are used for body enhancement within the general population. AAS use has been linked with increased mortality, cardiovascular disease, mental health disorders, and infertility. AAS-induced hypogonadism can persist for an uncertain time period despite cessation, during which men may report physical and neuropsychiatric symptoms. In an attempt to mitigate these symptoms and expedite testicular recovery, many men self-administer post-cycle-therapy (PCT), typically involving human chorionic gonadotrophin (hCG) and selective oestrogen receptor modulators (SERMs), which are known to potently stimulate testicular function. However, this practice has no objective evidence of effectiveness to lessen the severity or duration of hypogonadal symptoms. Methods: An anonymous survey of four-hundred-and-seventy men using AAS explored the symptoms they experienced when ceasing AAS use; the effect of PCT on relieving their symptoms, and their perceived role for health service support. Results: The majority of respondents were white, aged 18–30 years old, and working in skilled manual work. 51.7% (n = 243) reported no issues with AAS use, but 35.3% reported increased aggression. 65.1% (n = 306) of respondents had attempted AAS cessation and 95.1% of these experienced at least one symptom upon AAS cessation. Low mood, tiredness and reduced libido were reported in 72.9%, 58.5% and 57.0% of men stopping AAS use, respectively, with only 4.9% reporting no symptoms. PCT had been used by 56.5% of respondents with AAS cessation and mitigated cravings to restart AAS use, withdrawal symptoms and suicidal thoughts by 60%, 60% and 50%, respectively. The effect of stopping AAS on body composition and recovery of testosterone or fertility was a concern in 60.5% and 52.4%, respectively. Most respondents felt PCT should be prescribed under medical supervision in the community. Conclusions: Our survey suggests that the majority of men stopping AAS use are using some form of PCT. Some self-reported symptoms of AAS-induced hypogonadism such as cravings to restart AAS use reduce by 60% and suicidal thoughts reduce by 50%. These individuals are concerned about the negative effect of AAS use and cessation. This study provides crucial information for planning future research to evaluate the effects of PCT on symptoms when men stop AAS use. [ABSTRACT FROM AUTHOR]

Objective: It remains unknown whethermyonuclei remain elevated post anabolic-androgenic steroid (AAS) usage in humans. Limited data exist on AAS-induced changes in gene expression. Design: Cross-sectional/longitudinal. Setting: University. Participants: Fifty-sixmen aged 20 to 42 years. IndependentVariables: Non-resistance-trained (C) or resistance-trained (RT), RT currently using AAS (RT-AS), of which if AAS usage ceased for$18 weeks resampled as Returning Participants (RP) or RT previously using AAS (PREV). MainOutcomeMeasures: Myonuclei per fiber and cross-sectional area (CSA) of trapeziusmuscle fibers. Results: There were no significant differences between C (n 5 5), RT (n 5 15), RT-AS (n 5 17), and PREV (n 5 6) for myonuclei per fiber. Three of 5 returning participants (RP1-3) were biopsied twice. Before visit 1, RP1 ceased AAS usage 34 weeks before, RP2 and RP3 ceased AAS usage#2 weeks before, and all had 28 weeks between visits. Fiber CSA decreased for RP1 and RP2 between visits (7566 vs 6629 mm2; 7854 vs 5677 mm2) while myonuclei per fiber remained similar (3.5 vs 3.4; 2.5 vs 2.6). Respectively, these values increased for RP3 between visits (7167 vs 7889 mm2; 2.6 vs 3.3). Conclusions: This cohort of past AAS users did not have elevated myonuclei per fiber values, unlike previous research, but reported AAS usage was much lower. Training and AAS usage history also varied widely among participants. Comparable myonuclei per fiber numbers despite decrements in fiber CSA postexposure adheres with the musclememory mechanism, but there is variation in usage relative to sampling date and low numbers of returning participants. [ABSTRACT FROM AUTHOR]

Anabolic-induced hypogonadism in men is characterized by suppressing the body's natural testosterone production because of anabolic steroid use. This article provides an overview of the pathophysiology of anabolic-induced hypogonadism, explores the motivations for men to use anabolic steroids, discusses adverse effects associated with anabolic steroid use, presents current treatment recommendations, and highlights implications for nurse practitioner clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background The masculinizing effects from anabolic–androgenic steroid (AAS) appear to be different between men and women, leading to calls for more gender-specific information regarding women and AAS use. This study sought to gather perspectives from both men and women on the unique challenges surrounding women’s use of AAS, irrespective of their personal use. Secondly, the study interrogated how women’s AAS practices differ from those of men specifically. Methods The data presented in this paper come from a subsample of participants who participated in a larger study investigating women and performance and image enhancing drug (PIED) use in Australia. Participants were included in the current analysis if they were: (i) males or females who competed with or coached female strength athletes using AAS and (ii) female and male strength athletes who used AAS. The final sample comprised 21 participants of which there was a proportion of males (n = 7) and females (n = 7) using AAS. Results Women’s choices in AAS selection were predominantly around oral compounds (e.g. Oxandrolone) as well as other PIEDs (e.g. Clenbuterol). Some women report the use of injectable AAS represents a change in the profile of the typical female user as it reportedly comes alongside drastic physical and psychological changes. Conclusions The unique challenges facing women who use AAS are largely isolation and stigma, with little evidence-based practice or education being available to them online or through peer-groups. Future work may consider piloting harm reduction strategies that may be co-designed with this group.

Abstract Background Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use. Methods The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi2 or Fisher exact tests for numerical and categorical variables, respectively. Results All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%). Conclusions Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs.

Introduction and aim. Anabolic-androgenic steroids (AAS) are used for the rapid enhancement of muscular mass and optimization of athletic performance. Their administration is frequently linked with a plethora of adverse health implications. The primary objective of this study is to provide a comprehensive analysis of multifaceted impacts of anabolic-androgenic steroids on the human body. Material and methods. A review of literature was performed by searching PubMed and GoogleScholar databases using the following key words: anabolic-androgenic steroids, muscular hypertrophy, female masculinization. Analysis of the literature. Anabolic-androgenic steroids are synthetically manufactured derivatives of testosterone. Given the widespread distribution of the androgen receptor, the effects of these steroids are broad, influencing almost all bodily functions. Their impacts include, promoting muscular hypertrophy including that of the cardiac muscle, premature epiphyseal closure, liver diseases, masculinization in females, feminization in males, and degradation in sperm quality. Conclusion. AAS consumption is a significant public health problem. While they may appeal to users by enhancing their physical attractiveness they carry multiple health consequences. Patients should be educated about the adverse effects of taking AAS so they can make informed decision about starting or stopping their use.

Anabolic-androgenic steroids (anabolic-androgenic steroids, AAS) are testosterone-derived compounds whose popularity and use are constantly growing. Chronic use of AAS leads to many hormonal and metabolic disorders in the human body, which often lead to permanent health damage. Changes affect the following systems: cardiovascular, musculoskeletal, reproductive, digestive, and nervous. We decided to collect the existing knowledge in the literature and enrich it with the latest research reports in the field of degenerative effects of AAS on the nervous system. The work aimed to increase public awareness of the dangers and consequences of AAS use and improve it with the latest research on the neurodegenerative effects of AAS. We hope that our work will contribute to raising public awareness and reducing the use of AAS. [ABSTRACT FROM AUTHOR]