The use of anabolic androgenic steroids: A focus on polypharmacy

Abstract

Introduction. Anabolic androgenic steroids, such as testosterone and its synthetic analogue, nandrolone, have clear clinical indications. However, their abuse is practiced to enhance physical performance in professional, recreational and non-professional athletes; outside of sports, their nonmedical use is associated with different social groups (criminal activities, substance abuse). Polypharmacy. Testosterone and its synthetic analogues are also used for nonmedical purposes, mainly administered in supraphysiological doses in cycles lasting a few weeks. In order to potentiate the anabolic properties and control the adverse effects, the users also administer other pharmacological agents. Thus, growth hormone and insulin are complement to anabolic steroids; clenbuterol, amphetamine and thyroid hormones stimulate body fat loss; diuretics reduce the body weight and improve muscle definition; and erythropoietin increases the training capacity and accelerates the recovery after hard competitions. To control adverse effects, cardiovascular drugs, central nervous system depressants, central nervous system stimulants, human chorionic gonadotropin, sexual enhancement drugs, estrogen antagonists, analgesics/opioids, nonsteroidal anti-inflammatory drugs and others, are administered. Probenecid, finasteride and diuretics mask the administration of other doping agents. Additionally, during the last two decades, attention has increasingly been focused on the relationship between the use of anabolic androgenic steroids and psychoactive substances (alcohol, cannabis, amphetamines, cocaine, hallucinogens). Conclusion. Supraphysiological doses and polypharmacy additionally increase the risk of adverse effects, including withdrawal syndrome; therefore, prevention of nonmedical use of anabolic androgenic steroids should be a public health priority.