Strong muscles, weak heart: testosterone-induced cardiomyopathy.

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

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.

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.

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

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

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.

This study was conducted to find out the relationship among different aspects of cattle fattening and use of anabolic steroids and feed additives. The data were collected through an interview schedule from 150 respondents of 6 upazila of 3 districts who were involved in small scale cattle fattening. Parameters were studied in relation to socio-economic conditions of farmers and use of anabolic steroids and feed additives and their effects on animals and environment. In this study 72% farmers' were involved in agriculture, followed by 23.3% in livestock business. About 46% farmers had primary education, 10.7% had higher secondary school certificates, 5% obtained above higher secondary education and the rest of them were illiterate. Irrespective of literacy only 9.3% of the farmer had training. About 89.3% respondents used their own labors, 7.3% dependent on hired labor and the rest 3.3% get labour from both sources. Results showed that about 58% respondents used anabolic steroids for the duration of 3 to 6 months long cattle fattening (P<0.001) program. The chi-square (14.09) value of annual income indicates that with increase of annual income, use of anabolic steroids have decreased. The significant (P<0.01) association was observed in case of anabolic steroids and source of money, annual income, number of cattle fattening, breeds, fattening period, starting and finishing age. The rs value of annual income, source of money, starting and finishing age were positively correlated with feed additives. About 78% respondents used feed additives for cattle fattening from own resources (P<0.001) and most of cattle fattened for 3 to 6 months (P<0.01). The result demonstrated that respondents of low annual income used more anabolic steroid and feed additives as a growth promoter for cattle fattening and they prefer in powder form.DOI: http://dx.doi.org/10.3329/pa.v23i1-2.16553Progress. Agric. 23(1 & 2): 1 – 13, 2012

Anabolic steroid abuse: a paradox of manliness

Necrotizing myositis of the deltoid following intramuscular injection of anabolic steroid

Pathological cardiovascular manifestations are reported in four male patients, who had taken massive amounts of anabolic steroids while undergoing many years of strength training. One patient was referred because of ventricular fibrillation during exercise, one because of clinically manifest heart failure, and one because of arterial thrombus in his lower left leg. The fourth patient was persuaded to attend for a check-up because of a long history of massive use of anabolic steroids. All four patients had cardiac hypertrophy. Two of the patients had symptoms and signs of heart failure, and one of these two had a massive thrombosis in both right and left ventricles of his heart. After cessation of the use of anabolic steroids in the other patient with heart failure, left ventricular wall thickness reduced quickly from 12 to 10.5 mm, and fractional shortening increased from 14% to 27%. Endomyocardial biopsy revealed increased fibrosis in the myocardium in two of the three cases. HDL-cholesterol was 0.58 mmol.l-1 and 0.35 mmol.l-1 in the two patients still using multiple anabolic steroids at the time of investigation. The cardiovascular findings described in the present paper should warn all physicians and athletes about the possible serious acute and long-term side effects of the massive use of anabolic steroids.

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.

Distal triceps ruptures are rare, and complete ruptures are commonly treated with surgery. Studies of patients in small cohorts with distal triceps tear have reported outcomes and risk factors; however, large-scale data are scant. This study seeks to determine current trends, outcomes, and risk factors of distal triceps tears. Within a large insurance claims database, distal triceps repair patients were identified through Current Procedural Terminology coding with concomitant distal triceps International Classification of Diseases, 9th Revision/10th Revision diagnosis codes and 1-year active status before and after surgery. Demographics, total costs, 90-day complications, and revision rates within 1 year of index surgery were analyzed. Logistic regression was performed for revision and complication rates using sex, age, and comorbidities (anabolic steroid use, diabetes, ischemic heart disease, tobacco use, rheumatoid arthritis, and chronic kidney disease). A total of 8143 patients were included in the cohort. Male patients and patients aged 40 to 59 years comprised most of the study population. The postoperative complication rate was 5.8%, and the 1-year revision rate was 2.6%. Male sex, age >60 years, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease were statistically significant risk factors for higher 90-day complication rates. Anabolic steroid use significantly increased the risk of surgical revision. Distal triceps repairs in this large cohort study occur most frequently in men aged 40 to 59 years. Complications are generally low, with age >60 years, male sex, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease as risk factors for 90-day complications and prior anabolic steroid use as a risk factor for 1-year revision surgery. This information can help to improve education and expectations of this procedure.

Introduction: The use of anabolic androgenic steroids is particularly common in regular gyms and fitness centres participants. AAS are usually synthetic derivatives of testosterone with anabolic and androgenic effect. However, many people, including AAS users, do not realize how many side effects they can cause.The aim of the study: The aim of the study was to assess if people who regularly attend to the gym are aware of the side effects of using anabolic steroids by empirical research based on anonymous surveys.Materials and methods: The research material was collected using an anonymous online survey in April 2023. The obtained results were analyzed and verified on the basis of scientific literature and statistically processed using Microsoft Office Excel.Results: Of the 112 gym participants, 20,5% reported using anabolic-androgenic steroids in the past. Most of the people filling the questionnaire are aware of the negative health effects of AAS use. However, most of them can't name more than 4 side effects, which shows that knowledge about AAS is still unexplored by this social group.Conclusion: The use of anabolic androgenic steroids to increase muscle size and strength is widespread. Various side effects are very common when using AAS, some of them can seriously affect the health of the users. By raising awareness of side-effects that AAS can cause, it is possible to discourage many people from using these performance-enhancing substances.Keywords: Anabolic-androgenic steroids, testosterone, gym, doping, bodybuilding