Use Of Anabolic Androgenic Steroids Research Articles

Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men

This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.

No association between psychiatric symptoms and doses of anabolic steroids in a cohort of male and female bodybuilders.

The use of androgenic‐anabolic steroids (AAS) can be associated with psychiatric symptoms such as insomnia, anxiety and increased aggressiveness. Although dose‐dependent effects have been observed in some controlled studies, this association is not always seen in the ecological use of AAS. This study utilized WADA's steroid profile of suspicious use of AAS, urinary detection of AAS metabolites and measurement of sexual hormones to confirm recent use of AAS in a cohort of 103 bodybuilders (75 males, 28 females). The majority of participants (61.2%) presented symptoms of agitation, insomnia, increased aggressiveness or depression in the last 3 months. About one‐third of participants presented scores on the HAM‐A anxiety scale equivalent to moderate to severe symptoms of anxiety. A minority of participants (12.6%) presented high to moderate scores on the BPQ aggressiveness scale. The majority of participants (73.8%) presented hyperthymic temperament in the BRIEF‐TEMPS scale. There was no significant difference in the presence of psychiatric symptoms between males and females and no association between psychiatric symptoms and estimated weekly doses of AAS. A negative association was observed between scores on the BPQ scale (verbal aggression, anger and total score) and the time of AAS use. We discuss differences of AAS use between male and female bodybuilders and the screening of AAS use in the general population. Our findings highlight the importance of mental health awareness among people using AAS.

Potential Association between the Use of Anabolic Steroids and COVID-19 Infection

Anabolic androgenic steroids (AASs) are synthetic analogs of testosterone that can affect the immune system. Bodybuilders and sportsmen are at risk of abusing AASs. The aim of this study was to investigate the association between AASs use and coronavirus disease (COVID-19). This cross-sectional study included adults aged 18 years and above. Between 16 April and 23 June 2021, gym-attending participants completed an online survey. Multivariable analysis was performed using multiple logistic regression to identify factors associated with COVID-19 diagnosis and severity. Current use of AASs was reported in 7.5% of the 520 study participants. Approximately 20% of the study participants reported that they had contracted COVID-19, approximately half of whom reported moderate to severe disease. Contracting COVID-19 was reported more frequently by current users than by non-current users (35.90% vs. 18.92%, p = 0.011). Multivariable analysis revealed that contracting COVID-19 was nearly five times more likely among current users of AASs than among non-current users (OR = 4.89, 95% CI: 1.69–14.13). Current use of AASs was also associated with greater odds of moderate to severe COVID-19 disease (OR = 3.71, 95% CI: 1.04–13.21). Our findings suggest that the use of AASs could be an underlying risk factor for COVID-19 severity.

Anabolic Androgenic Steroids in Orthopaedic Surgery: Current Concepts and Clinical Applications.

Despite the well-documented effects of testosterone and its synthetic derivatives—collectively termed anabolic androgenic steroids (AASs)—on the musculoskeletal system, the therapeutic use of these agents has received limited investigation within the field of orthopaedic surgery. In the last 2 decades, preclinical and clinical research has started to identify promising applications of the short-term use of AASs in the perioperative period. There is evidence to suggest that AASs may improve postoperative recovery after anterior cruciate ligament reconstruction and total joint arthroplasty. In addition, AASs may augment the biological healing environment in specific clinical scenarios including muscle injury, fracture repair, and rotator cuff repair. Current literature fails to present strong evidence for or against the use of AASs in orthopaedics, but there is continuous research on this topic. The purpose of this study was to provide a comprehensive overview of the current status of AAS applications in orthopaedic surgery, with an emphasis on preclinical data, clinical studies, and future directions.

Anabolic-androgenic steroid use among bodybuilders in Erbil city

Background and objective: Anabolic-androgenic steroids are synthetic testosterone derivatives with a longer duration of action than physiological androgens. They are abused by bodybuilders because of their potential to enhance muscle strength. Serious medical and psychological complications may be associated with their non-medical use. This study aimed to determine the prevalence of anabolic androgenic steroids among bodybuilders and their awareness of health-related risks. Methods: A cross-sectional study was carried out from the 1st of January 2019 to the end of July 2019 in 18 randomly selected gym centers in Erbil city, Iraq using stratified random sampling. A self-administered questionnaire was distributed to 400 bodybuilders to assess the prevalence and knowledge of using Anabolic-androgenic steroids. Results: The study showed a high prevalence of Anabolic-androgenic steroid consumption (26.3%) among gym users in Erbil city. Anabolic-androgenic steroid use was significantly higher among participants with a longer duration of bodybuilding practice ≥4 years (P = 0.001). Anabolic-androgenic steroid abuse was significantly associated with drinking alcohol, smoking cigarettes, and using growth hormones. Trainers were the commonest source of recommendation. Conclusion: The prevalence of anabolic androgenic steroids abuse is high among bodybuilders in Erbil city. Public health awareness is essential and may help avoid the propagation of the problem. Keywords: Anabolic steroids; Gym users; Bodybuilders; Knowledge, Erbil.

Harnessing the global expertise in drug use and drug prevention in physical activity settings: results from the Anabolic Steroid Prevention Survey

Recent decades have seen increased efforts internationally to prevent the use of anabolic androgenic steroids (AAS) and other image and performance-enhancing drugs (IPEDs) in gyms and fitness environments. Yet, very little is known about effective prevention strategies. This study aimed to identify key risk factors for AAS use and assess the relevance of these risk factors as targets of intervention. Seventy four (n = 74) IPED experts participated in the Anabolic Steroid Prevention Survey (response rate: 62.4%). A total of 18 psychosocial and two behavioral risk factors identified in a literature review were rated by participants along two dimensions: importance and preventability. The results show that most IPED experts (91%) believe that preventing AAS use in gyms is important to public health, and that AAS use can be prevented to a certain degree (91%), but not eliminated altogether (85%). Based on participants’ assessment, six risk factors were categorised as very promising (e.g. the descriptive norm and poor knowledge on AAS alternatives), 10 as promising (e.g. body dissatisfaction and drive for muscularity), and four as unpromising but worthy of consideration (e.g. AAS-using peers and perceived benefits of AAS use). To effectively prevent AAS use in gyms, interventions should attempt to reduce these risk factors.

Editorial introductions.

Current Opinion in Endocrinology and Diabetes was launched in 1994, with Obesity added to the title in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of endocrinology and diabetes are divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Shruthi MahalingaiahShruthi MahalingaiahShruthi Mahalingaiah, MD, MS is an assistant professor of environmental, reproductive, and women's health in the Department of Environmental Health at the Harvard T.H. Chan School of Public health, USA. She serves clinically as a physician specializing in ovulation disorders, reproductive endocrinology and infertility at the Massachusetts General Hospital in the Department of Obstetrics and Gynecology. As a physician scientist, her major focus on polycystic ovarian syndrome (PCOS). She serves as the Director for Clinical Research for the Division of REI and seeks to create harmonized datasets for trainees, faculty and staff to explore research questions in OB/GYN. Her clinical and epidemiological research also focuses on menstrual cycle health and identifying environmental exposures associated with the development of PCOS and metabolic sequelae in order to develop risk reduction strategies through exposure modification and behavioral change. She has developed pictorial tools for population based self-assessment of androgen excess, with inclusion of broad symptoms such as scalp hair loss as well as hirsutism and cystic acne. Her research team is located at the Harvard T. H. Chan School of Public Health where she is an assistant professor of Environmental, Reproductive, and Women's Health in the Department of Environmental Health and is funded through research grants from March of Dimes, National Institutes of Health, National Science Foundation, Apple, and National Institute of Environmental Health Sciences. Dominic SagoeDominic SagoeDominic Sagoe is a Professor of Psychology at the Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway. He is a member of the World Anti-Doping Agency's Doping Prevalence Expert Group, and founder and leader of the Human Enhancement and Body Image Lab (HEBI Lab) at the University of Bergen. Dominic obtained a PhD in Psychology from the University of Bergen in 2015 with the thesis: “Nonmedical anabolic-androgenic steroid use: Prevalence, attitudes, and social perception”. His research specialization is epidemiological and psychosocial aspects of human enhancement drug (HED) use, particularly androgens, and body image. He has published numerous peer-reviewed articles in this specialty and other addictions, and has collaborated with many academics, researchers, policymakers, and health professionals around the world.

Women's Experiences of Using Anabolic Androgenic Steroids.

Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21–56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.

Summary and comments: Anabolic-Androgenic Steroid Use in Sports, Health, and Society

O Colégio Americano de Medicina Desportiva (ACSM) publicou em agosto (2021) uma atualização da declaração de consenso sobre o consumo de estrogénios estrogénicos anabolizantes (EAA). A edição anterior datava de 1987 e devido ao acumular de enorme quantidade de informação desde essa data tornou-se necessário fazer esta atualização. O documento refere que o paradigma de utilização dos EAA mudou, pois, se no passado os maiores consumidores encontravam-se no desporto de competição, atualmente o maior consumo ocorre nos atletas de recreação com o objetivo de, ilicitamente, melhorarem o rendimento e o aspeto físico. O ACSM declara que o uso de EAA pelos atletas é proibido pelas várias organizações desportivas, pelo que discorda da sua utilização. Os Prof. Drs. Carla Rêgo, Osvaldo Correia, Hélder Dores e os Drs. Rui Escaleira e Jaime Milheiro comentam este tema.

Cardiovascular risk associated with long-term anabolic-androgenic steroid abuse: an observational study from Norway

Abstract Background The use of anabolic-androgenic steroids (AAS) has become highly prevalent among recreational weightlifters. Numerous case reports have suggested an association between AAS use and a vast range of different cardiovascular diseases, including sudden cardiac death (SCD) and coronary artery disease (CAD). Few clinical studies have evaluated the risk of SCD and the prevalence of CAD in individuals with long-term AAS use. Purpose To evaluate the risk of ventricular arrhythmias and the prevalence of CAD among men with long-term AAS use. Methods Strength-trained men with at least three years of cumulative AAS use were recruited from recreational gyms. The control group consisted of strength-trained competing athletes who self-reported never using any performance enhancing drugs (non-users). AAS use was verified by sophisticated blood and urine analyses. Study participants went through a comprehensive cardiovascular evaluation including exercise ECG, 24 h ECG, heart rate variability (HRV) measures, signal averaged ECG (SAECG) and QT dispersion (QTd). Coronary computed tomography angiography (CCTA) was performed in AAS users. Not all participants had all tests. Results We included 51 AAS users and 21 non-users. Median age (25th-75th percentile) was 33 (29–37) years in the user group and 33 (29–42) years in the non-user group. Forty-eight (94%) of the users had been using AAS for five years or more. Characteristics are presented in the table. AAS users had significantly lower HDL values compared to non-users (p<0.001). No signs of ischemia or arrhythmias were detected during exercise ECG, however maximal exercise capacity was lower than in the control group and also compared to age-standardized values. A considerable, but statistically non-significant reduction was seen in overall HRV estimated as the standard deviation of the RR intervals for normal sinus beats (SDNN) (p=0.05). No difference was seen regarding left ventricular late potentials or QTd (table). Eight (19%) of the forty-two AAS users undergoing CCTA had at least a mild degree of CAD, and four of them three-vessel disease. Conclusion No ECG-findings indicated an increased risk of ventricular arrhythmias among the long-term AAS users. However, their maximal exercise capacity was lower than in controls, and one fifth of the long-term AAS users had verified CAD on CT coronary angiography. Funding Acknowledgement Type of funding sources: None. Table 1

Effect of Anabolic-Androgenic Steroids on Semen Parameters and Serum Sex Hormonal Levels in Egyptian Male Bodybuilders

Abstract Background First identified in 1935, testosterone is the principal hormone controlling the development of androgenic-masculinizing effects in the male body, along with its anabolic properties that increase lean muscle mass. Objectives We aim at studying the influence of anabolic androgenic steroids on the semen parameters and serum sex hormonal levels in Egyptian male bodybuilders. Patients and Methods The type of study was cross sectional study. Study setting was conducted in Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. The study included 20 male body builders using AAS as the study group and 20 body builders who exercise only and not using AAS. 20 subjects who exercise only without androgenic anabolic steroids use. Results In the present study, there were statistical significant differences between ASS group and control group as regard semen volume, sperm concentration, total sperm count, sperm agglutination and rounded cells. Bodybuilders in ASS group had significantly lower semen volume, sperm concentration, total sperm count; and higher liquefaction, sperm agglutination, and rounded cells. Conclusion AAS has a negative impact on semen quality and sex hormone levels among male bodybuilders. In the present study, AAS users exhibited significantly lower plasma testosterone levels and increase FSH and decrease LH hormone higher frequencies of abnormal semen parameters than healthy control participants. These results should provoke concern, particularly because the use of anabolic steroids by exercising men for muscle building is based on self-designed personal schemes or is suggested by a partner, by field magazines, or by trainers at the gyms. Further, large-scale, studies are still needed to confirm our findings.

S2577 Development of Liver Cancers as an Unexpected Consequence of Anabolic Androgenic Steroid Use

S2577 Development of Liver Cancers as an Unexpected Consequence of Anabolic Androgenic Steroid Use

The effects of anabolic-androgenic steroids on DNA damage in bodybuilders’ blood lymphocytes

Background Nowadays bodybuilders use anabolic steroids frequently. Abuse of these substances can cause significant side effects; therefore, we aim to investigate the effect of anabolic steroids on DNA damage in bodybuilders’ blood lymphocytes. Methods and materials This case-control study was performed on 36 male bodybuilders in Gonabad. The case group included bodybuilders with a history of taking anabolic-androgenic steroids (n = 18), and the control group composed of bodybuilders who did not use anabolic-androgenic steroids (n = 18). Intravenous blood samples were obtained and then the lymphocytes, cells and electrophoresis of blood were extracted. Afterward, the coloured slides and DNA damage were measured using a fluorescent microscope and CometScore software. The DNA damage was compared using t-tests . Results Results showed that there was no significant difference between age, marital status, BMI, systolic and diastolic blood pressure in the case and control group. However, parameters related to the DNA damage including tail length, percent tail DNA, and tail moment were significantly higher in the case group. Conclusion The use of anabolic-androgenic steroids increases DNA damage in the bodybuilders’ blood lymphocytes.

Anabolic androgenic steroids used as performance and image enhancing drugs in professional and amateur athletes: Toxicological and psychopathological findings.

The use of anabolic androgenic steroids (AASs) as performance and image enhancing drugs (PIEDs), once restricted to professional athletes, now includes amateurs and regular gym visitors. AAS use is associated with psychopathology, yet this relationship is complex and not fully understood. We aimed to assess the presence of AASs and other misused substances in athletes' biological samples and link toxicological to psychopathological findings. A multicentre, cross-sectional study in fitness centres in Italy recruited 122 professional and amateur athletes training in several sports (84 men; age range=18-45 years). Athletes completed questionnaires, interviews, and toxicology testing for AASs, other PIEDs, illicit drugs, and non-prescribed psychotropics. Toxicology was conducted in blood, urine, and hair. Self-reported and toxicologically detected use rates of AASs and other misused substances showed slight-to-fair agreement (Fleiss' κ=0.104-0.375). There was slight-to-moderate agreement among the three biological samples used for AAS testing (κ=0.112-0.436). Thirty-one athletes (25.4%) tested positive for AASs. More sport hours/week, narcissistic or antisocial personality disorders, and higher nonplanning impulsiveness scores predicted AAS use (pseudo-R2 =0.665). AAS users did not differ significantly from non-users in major psychopathology, but their Hypomania Checklist-32 score, which also predicted AAS use, was significantly higher (p<0.001), suggesting increased odds for cyclothymic disorder or subthreshold hypomania. Our results have implications for studying AAS users, as they identify a cluster of variables that may be relevant in future understanding of AAS use risks (e.g., personality disorders). Possible disagreements between AAS assessment methods should be considered when implementing harm reduction interventions, such as needle and syringe distribution, health education, and counselling, as well as surveillance programmes.

Double trouble? A mixed methods study exploring experiences with combined use of anabolic-androgenic steroids and psychoactive substances among women

Concurrent use of anabolic-androgenic steroids (AAS) and psychoactive substances (illicit drugs and alcohol) is found common in studies among men and involves a higher risk of adverse events than AAS use alone. However, women who use AAS represent an understudied group, and little is known about their pattern of psychoactive substance use and possible links to AAS use. The aim of this mixed methods paper is to a) examine lifetime and problem use of psychoactive substances and AAS, and b) explore experiences of AAS and psychoactive substance use including understandings of how these substances may be related among women with current or previous AAS use.Among sixteen women with current or previous AAS use, lifetime psychoactive substance and AAS use, AAS dependence and problem drug and alcohol use were assessed. In-depth semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analyzed thematically within a biopsychosocial framework applying pharmacological agency; the concept of bodily surveillance of effect and the ability to handle substances instrumentally to feel oneselves/ones bodies better.Twelve participants reported lifetime substance use, where cannabis, cocaine and amphetamines were most commonly used. Substance use problems were found among eight participants; five had lifetime AAS-dependence and clinically significant drug and/or alcohol dependence scores, two had lifetime AAS dependence, and one had clinically significant drug dependence scores. Psychoactive substance use was experienced as unrelated to AAS use or it could be used to counteract side effects of AAS. On the contrary, AAS was used to cope with the bodily and emotional change following withdrawal from psychoactive substances and to counteract bodily effects of long-term substance use. Being in substance use disorder (SUD) treatment after detoxification with affected mental health, a passive lifestyle and experiencing a transition from having an emaciated body, gaining weight and becoming unfit, was experienced to motivate AAS initiation during treatment.The polysubstance nature of AAS use including use of psychoactive substances and risk of developing SUDs poses a significant health risk. Health professionals need to understand motivations for combined use of AAS and psychoactive substances among women to be able to prevent harms and address individual treatment needs.

Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study.

Background: The use of anabolic androgenic steroids (AAS) is not uncommon among strength athletes. Several cross-sectional studies have linked AAS use to heart disease, but a causal role for AAS is not certain and it is unknown whether cardiac changes are reversible.Methods: Men of at least 18 years old intending to start an AAS cycle on short notice were included for comprehensive 3D echocardiographic examination before (T0), at the end of the cycle (T1), and 1 year after inclusion (T2) after a recovery period. Details of the AAS cycle performed and the use of other performance and image-enhancing drugs (PIEDs) as well as illicit drug use were recorded. Trend analysis and multivariable regression analysis were performed with mixed effects linear models.Results: Thirty-one subjects were included. Between start (T0) and end of the cycle (T1), after a median AAS cycle duration of 16 weeks, 3D left ventricular ejection fraction declined with 4.9% (CI −7.2 to −2.5, P < 0.001), E/A-ratio declined with−0.45 (CI −0.69 to −0.21, P < 0.001), and 3D left atrial volume increased with 9.2 ml (CI 2.9–15.4, P = 0.004). Left ventricular mass increased with 28.3 g (CI 14.2–42.4, P < 0.001) and was positively correlated with AAS average weekly dose. After a median recovery time of 8 months (T2), all parameters returned to baseline.Conclusion: AAS induce left ventricular hypertrophy and impaired systolic and diastolic function in amateur strength athletes. The structural cardiac changes are positively associated with AAS dose and complete recovery occurred after AAS were discontinued.

Testosterone, identity and the body: Exploring cultural definitions of disorder

Medically-sanctioned testosterone administration has seen increasingly widespread application in the treatment of gender dysphoria (GD). Yet, by comparison, this approach is not medically accepted for those who are experiencing muscle dysmorphia (MD), a specifier of body dysmorphic disorder (BDD), despite both conditions reflecting incongruences between self-perception, identity and phenotype, and both currently being classified as mental health disorders. Rather, by stark contrast, those with MD are largely treated with psychological intervention to accept themselves as they physically are and the illicit use of testosterone for muscle-related body perception purposes is generally subject to criminal justice enforcement actions. In this commentary, we examine attempts to distinguish between the use of testosterone for gender-affirming hormone therapy in the case of GD and for aesthetic (muscle enhancement) use in the case of MD, as well as explore the implications of this disparity. Moreover, we consider how such disparity in policy and practice may be understood, in part, as an example of a bias reflecting the selective pathologizing of anabolic-androgenic steroid (AAS) use, socio-cultural evolutions in gender identity and expression and, more broadly, the manner in which culture defines disorder and its appropriate response.

Risk factors profile of young and older patients with myocardial infarction.

Myocardial infarction (MI) among young adults (<45 years) represents a considerable proportion of the total heart attack incidents. The underlying pathophysiologic characteristics, atherosclerotic plaque features, and risk factors profile differ between young and older patients with MI. This review article discusses the main differences between the younger and elderly MI patients as well as the different pathogenic mechanisms underlying the development of MI in the younger. Young patients with MI often have eccentric atherosclerotic plaques with inflammatory features but fewer lesions, and are more likely to be smokers, obese, and have poor lifestyle, such as inactivity and alcohol intake. Compared to older MI patients, younger are more likely to be men, have familial-combined hyperlipidaemia and increased levels of lipoprotein-a. In addition, MI in younger patients may be related to use of cannabis, cocaine use, and androgenic anabolic steroids. Genomic differences especially in the pathways of coagulation and lipid metabolism have also been identified between young and older patients with MI. Better understanding of the risk factors and the anatomic and pathophysiologic processes in young adults can improve MI prevention and treatment strategies in this patient group. Awareness could help identify young subjects at increased risk and guide primary prevention strategies. Additional studies focusing on gene pathways related to lipid metabolism, inflammation, and coagulation are needed.

Anabolic-Androgenic Steroid Use in Sports, Health, and Society.

This consensus statement is an update of the 1987 American College of Sports Medicine (ACSM) position stand on the use of anabolic-androgenic steroids (AAS). Substantial data have been collected since the previous position stand, and AAS use patterns have changed significantly. The ACSM acknowledges that lawful and ethical therapeutic use of AAS is now an accepted mainstream treatment for several clinical disorders; however, there is increased recognition that AAS are commonly used illicitly to enhance performance and appearance in several segments of the population, including competitive athletes. The illicit use of AAS by competitive athletes is contrary to the rules and ethics of many sport governing bodies. Thus, the ACSM deplores the illicit use of AAS for athletic and recreational purposes. This consensus statement provides a brief history of AAS use, an update on the science of how we now understand AAS to be working metabolically/biochemically, potential side effects, the prevalence of use among athletes, and the use of AAS in clinical scenarios.

Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review.

Anabolic–androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders; AASs are among the most used drugs for improving physical performance, as well as for aesthetic purposes. The use of AASs by professional and recreational athletes is increasing worldwide. This review focused on deaths related to AAS abuse and to investigation of the autopsy results and histopathological findings using a rigorous methodology protocol covering: a complete autopsy, histological analysis, and a broad toxicological investigation. Moreover, we aimed to define an investigative diagnostic protocol supporting forensic pathologists during the post-mortem investigation of AAS abusers. This review was conducted using PubMed Central and Google Scholar databases to find articles published between 1 January 1968 and 30 June 2021, using the following key terms: “(anabolic-androgenic steroids) AND (autopsy); (anabolic-androgenic steroids) AND (forensic)”. A total of 939 articles were screened and 926 did not meet the inclusion criteria. In conclusion, 14 articles were included in this systematic review, reporting 137 fatal cases of AAS abuse in total. The histopathologic studies showed myocardial damage characterized by myocyte hypertrophy, focal myocyte damage with myofibrillar loss, interstitial fibrosis, mostly subepicardial, and small vessel disease. Indeed, in AAS-related cases, autopsy plays a pivotal role in the study of AAS adverse effects and organ damage related to their use or abuse. This systematic review aimed to define a specific workflow in death cases related to AASs, suggesting important future insights to better clarify sudden deaths related to AASs, such as the use of miRNAs. The forensic community needs a unified approach in cases of suspected death related to the use of AASs. There are several occasions to apply this workflow, for example in cases of death of bodybuilders and of young people who die in gymnasiums or during sports activities.