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Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use: A Controlled Study of 160 Athletes

Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use: A Controlled Study of 160... Abstract Background: We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them. Methods: We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed. Results: Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol—high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes—mania, hypomania, or major depression—in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P<.001) and significantly more frequently than nonusers (P<.01). Users rarely abused other drugs simultaneously with steroids. Conclusion: Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression. References 1. Haupt HA, Rovere GD. Anabolic steroids: a review of the literature . Am J Sports Med . 1984;12:469-484.Crossref 2. Pope HG Jr, Katz DL. Psychiatric effects of anabolic steroids . Psychiatr Ann . 1992;22:24-29.Crossref 3. Pope HG Jr, Katz DL, Champoux R. Anabolic-androgenic steroid use among 1010 college men . Physician Sportsmed . 1988;16:75-81. 4. Buckley WA, Yesalis CE, Friedl KE, Anderson W, Streit A, Wright J. Estimated prevalence of anabolic steroid use among male high school seniors . JAMA . 1988;260:3441-3445.Crossref 5. DuRant RH, Rickert VI, Ashworth CS, Newman C, Slavens G. Use of multiple drugs among adolescents who use anabolic steroids . N Engl J Med . 1993;328:922-926.Crossref 6. Altschule MD, Tillotson KJ. The use of testosterone in the treatment of depressions . N Engl J Med . 1948;239:1036-1038.Crossref 7. Vogel W, Klaiber EL, Braverman DM. A comparison of the anti-antidepressant effect of a synthetic androgen (mesterolone) and amitriptyline in depressed men . J Clin Psychiatry . 1985;46:6-8. 8. Wilson IC, Prange AJ Jr, Lara PP. Methyltestosterone with imipramine in men: conversion of depression to paranoid reaction . Am J Psychiatry . 1974;131:21-24. 9. Shahidi NT, Diamond LK. Testosterone-induced remission in aplastic anemia of both acquired and congenital types: further observations in 24 cases . N Engl J Med . 1961;264:953-967.Crossref 10. Griggs RC, Pandya S, Florence JM, Brooke MH, Kingston W, Miller JP, Chutkow J, Herr BE, Moxley RT. Randomized controlled trial of testosterone in myotonic dystrophy . Neurology . 1989;39:219-222.Crossref 11. O'Carroll R, Shapiro C, Bancroft J. Androgens, behavior, and nocturnal erection in hypogonadal men: the effects of varying the replacement dose . Clin Endocrinol . 1985;23:527-538.Crossref 12. Davidson JM, Cavhargo CA, Smith ER. Effects of androgen on sexual behavior in hypogonadal men . J Clin Endocrinol Metab . 1979;48:955-958.Crossref 13. Alén M, Häkkinen K, Komi PV. Changes in neuromuscular performance and muscle fiber characteristics of elite power athletes self-administering androgenic and anabolic steroids . Acta Physiol Scand . 1984;122:535-544.Crossref 14. Crist DM, Peake GT, Egan PA, Waters DL. Body composition response to exogenous GH during training in highly conditioned adults . J Appl Physiol . 1988;65:579-584. 15. Friedl KE, Dettori JR, Hannan CJ, Patience THE, Plymate SR. Comparison of the effect of high-dose testosterone and 19-nortestosterone to a replacement dose of testosterone on strength and body composition in normal men . J Steroid Biochem Mol Biol . 1991;40:607-612.Crossref 16. Su TP, Pagliaro M, Ollo C, Pickar D, Wolkowitz O, Rubinow DR. Neuropsychiatric effects of anabolic steroids . JAMA . 1993;269:2760-2764.Crossref 17. Annitto WR, Layman WA. Anabolic steroids and acute schizophrenic episode . J Clin Psychiatry . 1980;41:143-144. 18. Freinhar JP, Alvarez W. Androgen-induced hypomania . J Clin Psychiatry . 1985;46:354-355. 19. Pope HG Jr, Katz DL. Bodybuilders' psychosis . Lancet . 1987;i:863.Crossref 20. Tennant F, Black DL, Voy RO. Anabolic steroid dependence with opioid-type features . N Engl J Med . 1988;319:578.Crossref 21. Pope HG Jr, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use . Am J Psychiatry . 1988;145:487-490. 22. Choi PYL, Parrott AC, Cowan D. High-dose anabolic steroids in strength athletes: effects upon hostility and aggression . Hum Psychopharmacol . 1990;5:349-356.Crossref 23. Lefavi RG, Reeve TG, Newland MC. Relationship between anabolic steroid use and selected psychological parameters in male bodybuilders . J Sport Behav . 1990;13:157-166. 24. Perry PJ, Yates WR, Andersen KH. Psychiatric symptoms associated with anabolic steroids: a controlled, retrospective study . Ann Clin Psychiatry . 1990;2:11-17.Crossref 25. Moss HB, Panzak GL, Tarter RE. Personality, mood, and psychiatric symptoms among anabolic steroid users . Am J Addictions . 1992;1:315-324.Crossref 26. Malone DA Jr, Dimeff R, Lombardo JA. The psychiatric effects of anabolic steroids. Presented at the 144th Annual Meeting of the American Psychiatric Association; May 13, 1991; New Orleans, La. 27. Kashkin KB, Kleber HD. Hooked on hormones?: an anabolic steroid addiction hypothesis . JAMA . 1989;262:3166-3170.Crossref 28. Brower KJ. Addictive potential of anabolic steroids . Psychiatr Ann . 1992;22:30-34.Crossref 29. Conacher GN, Workman DG. Violent crime possibly associated with anabolic steroid use . Am J Psychiatry . 1989;146:679. 30. Pope HG Jr, Katz DL. Homicide and near-homicide by anabolic steroid users . J Clin Psychiatry . 1990;51:28-31. 31. Dalby JT. Brief anabolic steroid use and sustained behavioral reaction . Am J Psychiatry . 1992;149:271-272. 32. Bahrke MS, Wright JE, O'Connor JS, Strauss RH, Catlin DH. Selected psychological characteristics of anabolic-androgenic steroid users . N Engl J Med . 1990;323:834-835. 33. Bahrke MS, Wright JE, Strauss RH, Catlin DH. Psychological moods and subjectively perceived behavioral and somatic changes accompanying anabolicandrogenic steroid use . Am J Sports Med . 1992;20:717-724.Crossref 34. Spitzer RL, Williams JBW, Gibbon M. Structured Clinical Interview for DSM-III-R (SCID) . New York: New York State Psychiatric Institute; 1989. 35. Linden R, Jonas JM, Pope HG Jr. Pathological gambling and major affective disorder: preliminary findings . J Clin Psychiatry . 1986;47:201-203. 36. Hudson JI, Pope HG Jr, Jonas JM, Yurgelun-Todd D, Frankenburg FR. A controlled family history study of bulimia . Psychol Med . 1987;17:883-890.Crossref 37. Jackson AS, Pollock ML. Generalized equations for predicting body density of man . Br J Nutr . 1978;40:497-504.Crossref 38. Catlin DH, Kammerer RC, Hatton CK, Sekera MH, Merdink JM. Analytical chemistry at the games of the XXIIIrd Olympiad in Los Angeles, 1984 . Clin Chem . 1987;33:319-327. 39. Catlin DH, Cowan DA. Detecting testosterone administration . Clin Chem . 1992;38:1685-1686. 40. Tilkian SM, Conover MB, Tilkian AG. Clinical Implications of Laboratory Tests . 3rd ed. St Louis, Mo: Mosby—Year Book Inc; 1983. 41. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 42. Williams JBW, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG Jr, Rounsaville B, Wittchen H-U. The Structured Clinical Interview for DSM-III-R (SCID), II: multisite test-retest reliability . Arch Gen Psychiatry . 1992;49:630-636.Crossref 43. MacMahon B, Pugh TF. Epidemiology: Principles and Methods . Boston, Mass: Little Brown & Co Inc; 1970:276. 44. Friedl K, Yesalis CE. Self-treatment of gynecomastia in bodybuilders who use anabolic steroids . Physician Sportsmed . 1989;17:67-79. 45. Lenders JWM, Demacher PNM, Vos JA, Jansen PLM, Hoïtsma AJ, van't Laar A, Thien T. Deleterious effects of anabolic steroids on serum lipoproteins, blood pressure and liver function in amateur bodybuilders . Int J Sports Med . 1988;9:19-23.Crossref 46. Pope HG Jr, Katz DL, Hudson JI. Anorexia nervosa and 'reverse anorexia' among 108 male bodybuilders . Compr Psychiatry . 1993;34:406-409.Crossref 47. Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study . New York, NY: Free Press; 1991. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use: A Controlled Study of 160 Athletes

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1994.03950050035004
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them. Methods: We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed. Results: Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol—high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes—mania, hypomania, or major depression—in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P<.001) and significantly more frequently than nonusers (P<.01). Users rarely abused other drugs simultaneously with steroids. Conclusion: Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression. References 1. Haupt HA, Rovere GD. Anabolic steroids: a review of the literature . Am J Sports Med . 1984;12:469-484.Crossref 2. Pope HG Jr, Katz DL. Psychiatric effects of anabolic steroids . Psychiatr Ann . 1992;22:24-29.Crossref 3. Pope HG Jr, Katz DL, Champoux R. Anabolic-androgenic steroid use among 1010 college men . Physician Sportsmed . 1988;16:75-81. 4. Buckley WA, Yesalis CE, Friedl KE, Anderson W, Streit A, Wright J. Estimated prevalence of anabolic steroid use among male high school seniors . JAMA . 1988;260:3441-3445.Crossref 5. DuRant RH, Rickert VI, Ashworth CS, Newman C, Slavens G. Use of multiple drugs among adolescents who use anabolic steroids . N Engl J Med . 1993;328:922-926.Crossref 6. Altschule MD, Tillotson KJ. The use of testosterone in the treatment of depressions . N Engl J Med . 1948;239:1036-1038.Crossref 7. Vogel W, Klaiber EL, Braverman DM. A comparison of the anti-antidepressant effect of a synthetic androgen (mesterolone) and amitriptyline in depressed men . J Clin Psychiatry . 1985;46:6-8. 8. Wilson IC, Prange AJ Jr, Lara PP. Methyltestosterone with imipramine in men: conversion of depression to paranoid reaction . Am J Psychiatry . 1974;131:21-24. 9. Shahidi NT, Diamond LK. Testosterone-induced remission in aplastic anemia of both acquired and congenital types: further observations in 24 cases . N Engl J Med . 1961;264:953-967.Crossref 10. Griggs RC, Pandya S, Florence JM, Brooke MH, Kingston W, Miller JP, Chutkow J, Herr BE, Moxley RT. Randomized controlled trial of testosterone in myotonic dystrophy . Neurology . 1989;39:219-222.Crossref 11. O'Carroll R, Shapiro C, Bancroft J. Androgens, behavior, and nocturnal erection in hypogonadal men: the effects of varying the replacement dose . Clin Endocrinol . 1985;23:527-538.Crossref 12. Davidson JM, Cavhargo CA, Smith ER. Effects of androgen on sexual behavior in hypogonadal men . J Clin Endocrinol Metab . 1979;48:955-958.Crossref 13. Alén M, Häkkinen K, Komi PV. Changes in neuromuscular performance and muscle fiber characteristics of elite power athletes self-administering androgenic and anabolic steroids . Acta Physiol Scand . 1984;122:535-544.Crossref 14. Crist DM, Peake GT, Egan PA, Waters DL. Body composition response to exogenous GH during training in highly conditioned adults . J Appl Physiol . 1988;65:579-584. 15. Friedl KE, Dettori JR, Hannan CJ, Patience THE, Plymate SR. Comparison of the effect of high-dose testosterone and 19-nortestosterone to a replacement dose of testosterone on strength and body composition in normal men . J Steroid Biochem Mol Biol . 1991;40:607-612.Crossref 16. Su TP, Pagliaro M, Ollo C, Pickar D, Wolkowitz O, Rubinow DR. Neuropsychiatric effects of anabolic steroids . JAMA . 1993;269:2760-2764.Crossref 17. Annitto WR, Layman WA. Anabolic steroids and acute schizophrenic episode . J Clin Psychiatry . 1980;41:143-144. 18. Freinhar JP, Alvarez W. Androgen-induced hypomania . J Clin Psychiatry . 1985;46:354-355. 19. Pope HG Jr, Katz DL. Bodybuilders' psychosis . Lancet . 1987;i:863.Crossref 20. Tennant F, Black DL, Voy RO. Anabolic steroid dependence with opioid-type features . N Engl J Med . 1988;319:578.Crossref 21. Pope HG Jr, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use . Am J Psychiatry . 1988;145:487-490. 22. Choi PYL, Parrott AC, Cowan D. High-dose anabolic steroids in strength athletes: effects upon hostility and aggression . Hum Psychopharmacol . 1990;5:349-356.Crossref 23. Lefavi RG, Reeve TG, Newland MC. Relationship between anabolic steroid use and selected psychological parameters in male bodybuilders . J Sport Behav . 1990;13:157-166. 24. Perry PJ, Yates WR, Andersen KH. Psychiatric symptoms associated with anabolic steroids: a controlled, retrospective study . Ann Clin Psychiatry . 1990;2:11-17.Crossref 25. Moss HB, Panzak GL, Tarter RE. Personality, mood, and psychiatric symptoms among anabolic steroid users . Am J Addictions . 1992;1:315-324.Crossref 26. Malone DA Jr, Dimeff R, Lombardo JA. The psychiatric effects of anabolic steroids. Presented at the 144th Annual Meeting of the American Psychiatric Association; May 13, 1991; New Orleans, La. 27. Kashkin KB, Kleber HD. Hooked on hormones?: an anabolic steroid addiction hypothesis . JAMA . 1989;262:3166-3170.Crossref 28. Brower KJ. Addictive potential of anabolic steroids . Psychiatr Ann . 1992;22:30-34.Crossref 29. Conacher GN, Workman DG. Violent crime possibly associated with anabolic steroid use . Am J Psychiatry . 1989;146:679. 30. Pope HG Jr, Katz DL. Homicide and near-homicide by anabolic steroid users . J Clin Psychiatry . 1990;51:28-31. 31. Dalby JT. Brief anabolic steroid use and sustained behavioral reaction . Am J Psychiatry . 1992;149:271-272. 32. Bahrke MS, Wright JE, O'Connor JS, Strauss RH, Catlin DH. Selected psychological characteristics of anabolic-androgenic steroid users . N Engl J Med . 1990;323:834-835. 33. Bahrke MS, Wright JE, Strauss RH, Catlin DH. Psychological moods and subjectively perceived behavioral and somatic changes accompanying anabolicandrogenic steroid use . Am J Sports Med . 1992;20:717-724.Crossref 34. Spitzer RL, Williams JBW, Gibbon M. Structured Clinical Interview for DSM-III-R (SCID) . New York: New York State Psychiatric Institute; 1989. 35. Linden R, Jonas JM, Pope HG Jr. Pathological gambling and major affective disorder: preliminary findings . J Clin Psychiatry . 1986;47:201-203. 36. Hudson JI, Pope HG Jr, Jonas JM, Yurgelun-Todd D, Frankenburg FR. A controlled family history study of bulimia . Psychol Med . 1987;17:883-890.Crossref 37. Jackson AS, Pollock ML. Generalized equations for predicting body density of man . Br J Nutr . 1978;40:497-504.Crossref 38. Catlin DH, Kammerer RC, Hatton CK, Sekera MH, Merdink JM. Analytical chemistry at the games of the XXIIIrd Olympiad in Los Angeles, 1984 . Clin Chem . 1987;33:319-327. 39. Catlin DH, Cowan DA. Detecting testosterone administration . Clin Chem . 1992;38:1685-1686. 40. Tilkian SM, Conover MB, Tilkian AG. Clinical Implications of Laboratory Tests . 3rd ed. St Louis, Mo: Mosby—Year Book Inc; 1983. 41. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 42. Williams JBW, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG Jr, Rounsaville B, Wittchen H-U. The Structured Clinical Interview for DSM-III-R (SCID), II: multisite test-retest reliability . Arch Gen Psychiatry . 1992;49:630-636.Crossref 43. MacMahon B, Pugh TF. Epidemiology: Principles and Methods . Boston, Mass: Little Brown & Co Inc; 1970:276. 44. Friedl K, Yesalis CE. Self-treatment of gynecomastia in bodybuilders who use anabolic steroids . Physician Sportsmed . 1989;17:67-79. 45. Lenders JWM, Demacher PNM, Vos JA, Jansen PLM, Hoïtsma AJ, van't Laar A, Thien T. Deleterious effects of anabolic steroids on serum lipoproteins, blood pressure and liver function in amateur bodybuilders . Int J Sports Med . 1988;9:19-23.Crossref 46. Pope HG Jr, Katz DL, Hudson JI. Anorexia nervosa and 'reverse anorexia' among 108 male bodybuilders . Compr Psychiatry . 1993;34:406-409.Crossref 47. Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study . New York, NY: Free Press; 1991.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: May 1, 1994

References