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Review
. 2010 Jun;58(1):111-21.
doi: 10.1016/j.yhbeh.2009.09.006. Epub 2009 Sep 18.

Illicit Anabolic-Androgenic Steroid Use

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Free PMC article
Review

Illicit Anabolic-Androgenic Steroid Use

Gen Kanayama et al. Horm Behav. .
Free PMC article

Abstract

The anabolic-androgenic steroids (AAS) are a family of hormones that includes testosterone and its derivatives. These substances have been used by elite athletes since the 1950s, but they did not become widespread drugs of abuse in the general population until the 1980s. Thus, knowledge of the medical and behavioral effects of illicit AAS use is still evolving. Surveys suggest that many millions of boys and men, primarily in Western countries, have abused AAS to enhance athletic performance or personal appearance. AAS use among girls and women is much less common. Taken in supraphysiologic doses, AAS show various long-term adverse medical effects, especially cardiovascular toxicity. Behavioral effects of AAS include hypomanic or manic symptoms, sometimes accompanied by aggression or violence, which usually occur while taking AAS, and depressive symptoms occurring during AAS withdrawal. However, these symptoms are idiosyncratic and afflict only a minority of illicit users; the mechanism of these idiosyncratic responses remains unclear. AAS users may also ingest a range of other illicit drugs, including both "body image" drugs to enhance physical appearance or performance, and classical drugs of abuse. In particular, AAS users appear particularly prone to opioid use. There may well be a biological basis for this association, since both human and animal data suggest that AAS and opioids may share similar brain mechanisms. Finally, AAS may cause a dependence syndrome in a substantial minority of users. AAS dependence may pose a growing public health problem in future years but remains little studied.

Figures

Figure 1
Figure 1
Some time points in the evolution of illicit AAS use (adapted from Kanayama et al., 2008).
Figure 2
Figure 2
Examples of lifetime course of AAS use and other substance abuse in five men with a history of AAS dependence (adapted from Kanayama et al., 2009b).

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