Abstract
Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic use consistent with drug dependence, there are no formal definitions of androgen intoxication. Consequently, the purpose of this paper is to establish a testable theory of androgen intoxication. We present evidence and theorize that synthetic androgen intoxication can be defined by a pattern of poor self-regulation characterized by increased propensity for a range of behaviors (e.g., aggression, sex, drug seeking, exercise, etc.) via androgen mediated effects on general brain arousal. This theory posits that androgens reduce threshold for emotional reactivity, motor response, and alertness to sensory stimuli and disrupt inhibitory control over the behaviors associated with synthetic androgen use. These changes result from alteration to basic neurocircuitry that amplifies limbic activation and reduces top-down cortical control. The implications for this definition are to inform APED specific hypotheses about the behavioral and psychological effects of APED use and provide a basis for establishing clinical, legal, and public health guidelines to address the use and misuse of these substances.
Highlights
Establishing a Testable Definition of Androgen IntoxicationWe propose the term “androgen intoxication” to describe the core behavioral and psychological phenomena associated with APED use
Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic use consistent with drug dependence, there are no formal definitions of androgen intoxication
Summary
We propose the term “androgen intoxication” to describe the core behavioral and psychological phenomena associated with APED use. Days to months shifts in emotional, cognitive, and motivation—reward systems that have the potential for functional impairment This definition allows clinicians to conceptualize changes in the likelihood of these behaviors based on the context in which the individual uses these substances. Forensic analysis of drug-facilitated sexual assault requires some clear definition of the intoxication effects likely to impair judgment, reduce inhibition, and otherwise alter the likelihood of the assault (Anderson et al, 2017). Despite this parallel, we acknowledge that there is unlikely to be a reliable threshold (e.g., blood alcohol content above 0.8) for establishing intoxication for synthetic androgens. The shift in emotion, cognition, and behavior is more likely to be observed in specific contexts (e.g., in threatening situation, in proximity to rewards like sex or drugs, or decisions that involve risk assessment)
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