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Exogenous anabolic androgen steroid use is associated with adverse cardiovascular outcomes. A 53‐year‐old bodybuilder presented with 3 months of exertional dyspnoea. Physical examination showed tachycardia and pan‐systolic murmur; an echocardiogram showed a left ventricular ejection fraction (EF) of 15%. Evaluations included normal coronary angiogram, iron panel and thyroid studies, a negative viral panel (human immunodeficiency virus, Lyme disease, and hepatitis), and urine toxicology. He admitted to intramuscular anabolic steroid use; his testosterone level was 30 160.0 ng/dL (normal 280–1100 ng/dL). In addition to discontinuation of anabolic steroid use, he was treated with guideline‐directed heart failure medical therapy. Repeat echocardiogram at 6 months showed an EF of 54% and normalized testosterone level of 603.7 ng/dL. Anabolic steroid use is a rare, reversible cause of cardiomyopathy in young, otherwise healthy athletes; a high index of suspicion is required to prevent potentially fatal side effects.

INTRODUCTION What Are Anabolic Steroids? Why a Book About Anabolic Steroids? SOCIAL HISTORY OF ANABOLIC STEROIDS Early Discoveries of the Anabolic and Androgenic Properties of Testosterone Effects of Testicular Extract (Testosterone) and Related Substances upon Humans Early Uses of Testosterone and its Derivatives The Use of Testosterone and Anabolic Steroids for Ergogenic Purposes The Use of Anabolic Steroids in Sports The Non-competitive use of Anabolic Steroids Prevalence Studies Needle and Syringe Exchange Figures for Prevalence of AS Use Social Implications of the Psychological Effects of AS Use Current Therapeutic Applications of Anabolic Steroids Legal Status of Anabolic Steroids Anabolic Steroids: A Social Problem? THE MEDICAL ASPECTS OF AS MISUSE Myocardinal Hypertrophy and Cardiomyopathy Myocardinal Infarction and Cerebrovascular Accidents Blood Pressure Liver Function Lipid Profiles Embolism Hormones Thyroid Genito-urinary Conditions Sexual Behaviour Changes in Metabolism Dermatology Immunity Infections Musculoskeletal Problems Injecting Problems Women's Health Adolescence Psychological Effects Medical Uses General Practitioner Surveys A SPORTING PERSPECTIVE Performance Enhancement through History Anabolic Steroids The Response of Sport Eastern European Doping 'Regimes' Tour de France 1998 Nandrolone Doping Outside of the Olympics The Future The IOC Prohibited Substance List World Anti-Doping Agency (WADA) Summary REGIMES, COUNTERFEITS AND PROFILES Cost Counterfeits and Fakes Drugs Other than Anabolic Steroids Drug Profiles REFERENCES INDEX

Anabolic steroids

Anabolic-androgenic steroid (AAS) use has always been associated with professional athletes and bodybuilders. Many scandals have shed light on the power of anabolic steroids in enhancing human physique and performance, making them ripe for abuse amongst recreational users. However, there are many dangers of anabolic steroid use that have yet to be uncovered or are slowly making their way into becoming general knowledge, especially as it relates to cardiovascular disease (CVD). These risks may remain masked for years before they are discovered, by which time it may be too late to reverse all the detrimental effects. In this article, we report a case of an otherwise healthy 46-year-old Caucasian male with an admitted history of recent anabolic steroid use who arrived in the emergency department with complaints of left lower extremity swelling and pain, spontaneous bruising of the calf, and shortness of breath for two days. After a thorough evaluation, he was discovered to have underlying essential hypertension (HTN) and heart failure with areduced ejection fraction of 30%. The patient was educated on the likely effects of steroid use on his condition and the ramifications ofhaving uncontrolled HTN and heart failure. He was advised to discontinue steroid use and begin medical management of these conditions. Ultimately, there isn't an established symptom profile for patients using anabolic steroids, and this unique case of a patient with vague symptomatology who was discovered to have underlying congestive heart failure (CHF) and uncontrolled HTN outlines the need for a thorough investigation of cardiac and vascular body systems in this subset of patients.

Eleventh-grade students at seven high schools in central Arkansas were surveyed regarding anabolic steroid use, risk-taking behavior, satisfaction with body image, and attitudes and beliefs regarding anabolic steroids. A total of 1492 adolescents were surveyed. Fifty-one (7.6%) of 672 males and 12 (1.5%) of 806 females admitted anabolic steroid use. Fourteen students did not specify gender. Bivariate comparisons showed significant differences between users and nonusers in risk-taking behaviors and degree of satisfaction with body image and muscles. Users were more likely than nonusers to approve of anabolic steroid use in sports and to believe that anabolic steroid use could improve one's health. Multivariate analyses found gender, knowledge of beneficial side effects, knowing other anabolic steroid users, age, and race to be significantly related to anabolic steroid use. Information about steroids' effects seldom came from physicians, but often came from peers. Anabolic steroid use was strongly motivated by social influences, some knowledge of beneficial effects, and denial of adverse effects in white adolescent males in our study population.

To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts. The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 +/- 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis. The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation. The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

Purpose: To examine the prevalence and awareness of anabolic-androgenic steroid (AAS) use among male bodybuilders visiting gyms in Jazan region, Saudi Arabia. Methods: A cross-sectional survey was conducted among 500 male bodybuilders visiting gyms in the Jazan region of Saudi Arabia. Information on demographics, as well as the use of AAS, was included in a self-administered questionnaire. Results: The prevalence of AAS in Jazan was 31.0 % (95 % CI, 26.9 - 49.6), and it was higher among those in the 30 - 34 years 45.3 % (95 % CI, 36.9 - 54.0). Its prevalence was also significantly higher among athletes who received higher education 37.4% (95 % CI, 31.8 - 43.4). The most common types of AAS used are Deca-Durabolin (57.6 %) and testosterone (52 %). Thirty percent of the participants who used AAS suffered from depression and aggressive behavior while 18 % of them were hypertensive. The participants were not well aware of the adverse effects of anabolic steroids use. Conclusion: The prevalence of the anabolic steroids is high among bodybuilding males visiting gyms in Jazan region, Saudi Arabia. Health educational programs are required to increase the awareness about the side effects of anabolic steroids among bodybuilders. Keywords: Anabolic steroids, Bodybuilders, Deca-durabolin, Testosterone

Effect of an anabolic steroid education program on knowledge and attitudes of high school football players

Anabolic steroid abuse: a paradox of manliness

Necrotizing myositis of the deltoid following intramuscular injection of anabolic steroid

INTRODUCTION: Illicit use of anabolic androgenic steroids (AAS) has been growing among athletes and bodybuilders for cosmetic and performance purposes. We report a case of one of the possible hepatic complications of AAS, acute cholestatic syndrome (ACS), in a male with anabolic steroid abuse. CASE DESCRIPTION/METHODS: 27-year-old Polish man with no past medical history presented with jaundice, itching of the body, dark-colored urine, clay-colored stools for 5 weeks. No abdominal pain was reported. Patient reported taking for 4 months 4 types of AAS (testosterone, oxandrolone, methasterone and trenbolone) for body building, which he stopped taking 6 weeks prior to initial presentation due to fatigue. Vitals were normal, and on exam he appeared to be a muscular, jaundiced male with scratch marks on his skin. Abdominal exam revealed a non-tender, non-distended abdomen, with difficulty palpating the liver edge due to the muscularity. Laboratory tests were significant for total bilirubin of 34.8 mg/dL with direct of 23.5 mg/dL, AST 55 U/L, ALT 70 U/L, ALP 212 U/L, GGT 57 U/L, INR 1, creatinine 1.1 mg/dL. Liver ultrasound showed hepatomegaly with no biliary dilation and patent hepatic and portal veins. A liver biopsy was obtained showing portal neutrophil predominant inflammation with occasional eosinophils, mild portal fibrosis and cholestasis, suggestive of drug-induced hepatotoxicity. Liver function tests normalized after 4 months of cessation of AAS use, with resolution of his jaundice and pruritis. DISCUSSION: Body builders usually prefer polydrug use of AAS to maximize the desired effects and hypothetically reduce side effects at the same time. But contrary to their belief, the concomitant use of different illicit AAS may be a factor in their toxicity, making difficult to link an adverse effect with a specific substance. Acute cholesta tic syndrome, has been associated with use of the 17α – alkylated anabolic steroids ( i.e. oxandrolone, methasterone), thought related to an increase of reactive oxygen. This leads to prolonged direct toxic effects and intrahepatic cholestasis, though the pathophysiology remains unclear. ACS usually occurs 1-4 months after steroid initiation presenting with nausea, fatigue, pruritis; later, jaundice, dark urine, with significantly elevated total bilirubin and ALP but mild aminotransferase elevation can be seen. Management consists of stopping anabolic steroid use, supportive care and symptomatic treatment of pruritis.

Complete left bundle branch block (CLBBB) is a serious complication associated with transcatheter closure of perimembranous ventricular septal defect (pmVSD). The aim of the study was to evaluate various treatment strategies and prognosis of CLBBB after transcatheter closure of pmVSD in pediatric patients. Twenty five pediatric patients with CLBBB after transcatheter closure of pmVSD in our institution were retrospectively reviewed. Over a median follow-up of 6.7 (1.1–12.8) years, 14 cases were defined as early-onset CLBBB. Seven underwent early surgical device removal withing 1 month, 6 restored normal QRS interval, and 1 reverted to incomplete right bundle branch block. 3 underwent late surgical device removal (after 1 month of CLBBB discovery), 2 of them eventually underwent permanent pacemaker implantation, and 1 restored normal QRS interval. 4 cases received corticosteriod therapy, 2 restored normal QRS interval, 1 reverted to left anterior fascicular block, and 1 died of heart failure. 11 cases were defined as late-onset CLBBB and were given corticosteroid therapy as initial treatment. 2 restored normal QRS interval, 1 underwent surgical device removal and restored normal QRS interval, and 8 had persistent CLBBB (1 underwent cardiac transplantation, 1 underwent permanent pacemaker implantation, 4 had left ventricular enlargement with reduced ejection fraction, 2 maintained normal left ventricular size and function). Compared with patients who did not receive early device removal, patients who underwent early device removal were less likely to experience adverse events [0% (0/8) vs.53% (9/17), P = 0.022]. For patients who only received corticosteroid therapy, patients who were free from adverse events had significantly shorter QRS index [(7.90 ± 0.80) vs. (9.40 ± 1.23) ms/(kg/m2), P = 0.032]. Early surgical device removal was associated with favorable prognosis of CLBBB after pmVSD device closure. Corticosteroid therapy might be an alternative treatment strategy for CLBBB with relatively narrow QRS interval.

Electrocardiographic (ECG) changes during adenosine myocardial perfusion imaging (MPI) correlate with severe coronary artery disease and the presence of collaterals. However, the significance of these changes during adenosine MPI in patients with left ventricular hypertrophy (LVH) on baseline electrocardiogram is less well understood. To evaluate whether ECG changes on adenosine MPI predict ischaemia in patients with LVH. We reviewed retrospectively 454 consecutive patients who had undergone adenosine MPI at our institution. The baseline electrocardiogram was reviewed to determine whether or not LVH was present. All patients were administered adenosine at 140 microg x kg x min for a total of 6 min and Tc-sestamibi was injected at 3 min into the protocol. None of the patients underwent any form of exercise during the stress test. Of the 146 patients with LVH, 10 had stress ECG changes suggestive of ischaemia and 40 had evidence of ischaemia on MPI. Similarly, of the 308 patients without LVH, 43 had stress ECG changes suggestive of ischaemia and 68 had ischaemia on MPI. The sensitivity and specificity of stress ECG changes in predicting ischaemia on perfusion in patients with LVH were 12.5% and 95.3%, respectively, with a positive predictive value of 50% and a negative predictive value of 74.3%. ECG changes suggestive of ischaemia in patients with LVH are very specific for ischaemia on MPI, and their significance is similar to that in patients without LVH.

Os hormônios andrógeno-anabolizantes têm seu uso difundido entre os esportistas, usualmente para aumentar a massa e a potência musculares. Assim, através do uso de questionários auto-aplicáveis em um estudo transversal, foram entrevistados 305 atletas (escolhidos aleatoriamente) das academias de Santa Maria, RS, a fim de quantificar diversas variáveis relacionadas ao uso de esteróides anabolizantes (EA). A maioria dos participantes era de homens (81,1%) e a média de idade foi de 22 anos (DP ± 7). Enquanto 29% usavam aditivos alimentares, apenas 2% dos indivíduos admitiram ter usado EA (apesar de 46% dos entrevistados conhecerem algum usuário de EA). Dois terços dos usuários adquiriram a droga em farmácias (sem prescrição médica) e 35,1% desconheciam seus paraefeitos. Dos entrevistados, 28,4% acreditam que doses "adequadas" de EA não causam dano à saúde. Dessa forma, conclui-se que a principal medida preventiva à iniciação ao uso de EA é a educação dos atletas.

Anabolic androgenic steroids are being more popular between bodybuilders and people who are using gym to enhance their physiques. However, according to the increase of the laws prohibiting sales of these substances without physician prescription, the route of getting and administration practices have become more and more dangerous. Anabolic androgenic steroids include many synthetic derivatives of testosterone its play a significant role in medical treatment. These groups of medications are extensively abused at young ages to rising lean body mass and advance the athletic quality of performance. It has been described that anabolic steroids use can cause many long and short-term side effects, this study intended to assess the level of knowledge about AAS and its effects among gym users. 50 bodybuilders were using gym routinely and were using AASs for at least 2 months and another who were using gym routinely but never use AAS before were interviewed to show their knowledge about short and long term AASs using side effects. Participants used androgenic hormones for three main reasons health, social and personal, vast majority of the participants obtained the required results by using AAS, The majority of participants were going into the gym five to six times weekly for an hour daily. Enanthate was the main steroid abused by the participants and the gym coaches were the major source of selling steroids to the participants. The anabolic androgenic steroids had a harmful effect and abused by large number of young ages.