Abstract
Anabolic-androgenic steroids (AAS) encompass a broad group of natural and synthetic androgens. AAS misuse is highly prevalent on a global scale, with the lifetime prevalence of AAS misuse in males being estimated to be around 6%, with 15 to 25% of male gym attendees using it at any one time. AAS are associated with sudden cardiac death, neuropsychiatric manifestations, and infertility. The average AAS user is unlikely to voluntarily declare their usage to a physician, with around 1 in 10 actively engaging in unsafe injection techniques. The aim of this paper is to review the current evidence base on AAS with emphasis on mechanisms of action, adverse effects, and user profiles that are most likely to engage in AAS misuse. This paper also reviews terminologies and uses methods specific to the AAS user community.
Highlights
Background and IntroductionAnabolic-androgenic steroids (AAS) are more commonly referred to as anabolic steroids and encompass a diverse group of both synthetic and endogenous androgens [1]
Anecdotal reports of advice given by clinicians inaccurately purporting that AAS are ineffective for muscle growth have surfaced, with some commentors arguing that such blanket statements can prematurely sever any chance of developing rapport and generating critical discussion with AAS users [8]
Counteracting AAS side effects is one popular use case of Performance-Enhancing Drugs (PEDs) in the bodybuilding community, with a 2018 survey of 231 AAS users finding that 56% of participants reported that they had engaged in some form of postcycle therapy [50]
Summary
Anabolic-androgenic steroids (AAS) are more commonly referred to as anabolic steroids and encompass a diverse group of both synthetic and endogenous androgens [1]. E physiologic functions of DHT differ from testosterone in that it primarily signals through intracine and paracrine mechanisms in tissues where 5-alpha reductase is concentrated, exhibiting targeted local effects in contrast to the broader overarching effects of testosterone [20] An example of this is the prostate, where its levels are up to 10-fold higher than serum testosterone, due to high local concentrations of 5-alpha reductase [21]. Since androgen receptors are normally saturated by physiologic levels of testosterone, yet supraphysiologic doses of testosterone can increase muscle mass and body strength, the anabolic effects of exogenous testosterone may be explained by mechanisms other than androgen receptor modulation [26]. E structural modifications synthetic AAS have on endogenous testosterone were likely designed with specific intentions in mind, such as maximizing anabolic effects while simultaneously minimizing androgenic properties [33]. Dihydrotestosterone derivatives Oxandrolone (Anavar) Oxymetholone (Anadrol) Metenolone (Primobolan) Stanozolol (Winstrol)
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