Effects Of Anabolic-androgenic Steroids Use Research Articles

Anabolic-androgenic steroid use among Iranian male gym-goers

ABSTRACT Background Anabolic-androgenic steroids (AAS) have positive anabolic effects on muscle mass. Some bodybuilders use high doses of AAS to build more muscle mass and strength. This study was conducted to measure the extent of AAS use among Iranian male bodybuilders and associated risk factors. Methods A cross-sectional study was carried out among 588 male bodybuilders from July to August 2020 in Isfahan. Isfahan city was divided into 15 clusters according to Isfahan municipal districts. In each cluster, three clubs were randomly selected. A self-administered questionnaire including demographic information and AAS usage data was completed by a consecutive sample of bodybuilders. Results One hundred and seventy-one (29.1%) participants were current users and 32 (7.7%) planned to use AAS in the future. AAS users had higher incomes, longer gym memberships, and more weekly sessions. They significantly used more supplements and other substances including growth hormone, caffeine, insulin, and glucocorticoid. The most prevalent AAS was testosterone enanthate. Income, length, and frequency of workouts could predict AAS use. Conclusion Increasing AAS consumption seems to become a public health concern that suggests the need to develop some new policies and programs which would educate and inform bodybuilders and coaches about the adverse effects of AAS use.

Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100 men.

An estimated 4-6% of fitness center visitors uses anabolic-androgenic steroids (AAS). Reliable data about adverse reactions of AAS are scarce. The HAARLEM study aimed to provide insight into the positive and negative effects of AAS use. One hundred men (≥18 years) who intended to start an AAS cycle on short notice were included for follow-up. Clinic visits took place before (T0 ), at the end (T1 ), and three months after the end of the AAS cycle (T2 ), and one year after the start of the cycle (T3 ), and comprised a medical history, physical examination, laboratory analysis, and psychological questionnaires. During the follow-up period, four subjects reported a serious adverse event, that is, congestive heart failure, acute pancreatitis, suicidal ideation, and exacerbation of ulcerative colitis. All subjects reported positive side effects during AAS use, mainly increased strength (100%), and every subject reported at least one negative health effect. Most common were fluid retention (56%) and agitation (36%) during the cycle, and decreased libido (58%) after the cycle. Acne and gynecomastia were observed in 28% and 19%. Mean alanine transaminase (ALT) and creatinine increased 18.7 U/l and 4.7 µmol/L, respectively. AAS dose and cycle duration were not associated with the type and severity of side effects. After one-year follow-up (T3 ), the prevalence of observed effects had returned to baseline. There was no significant change in total scores of questionnaires investigating wellbeing, quality of life, and depression. In conclusion, all subjects experienced positive effects during AAS use. Four subjects experienced a serious adverse event. Other side effects were mostly anticipated, mild, and transient.

P2545Long-term use of anabolic-androgenic steroids in male weightlifters is associated with left ventricular systolic dysfunction

Abstract Background Illicit use of anabolic-androgenic steroids (AAS) is widespread and has adverse psychological and cardiovascular effects. Few well-powered studies have explored the effect of long-term AAS-use on left ventricular systolic function. Purpose To explore the relationship between long-term use of AAS and left ventricular mass and systolic function. Methods We included male weightlifters with a history of >1 year of cumulative AAS-use and male weightlifters unexposed to AAS. We performed echocardiography in all and assessed left ventricular mass using 2D echocardiographic linear measurements and Cube formula, left ventricular ejection fraction (EF) ad modum Simpson, and left ventricular global longitudinal strain (GLS) by speckle-tracking echocardiography. Results We recruited 100 male weightlifters, 58 of whom were previous or current AAS-users with mean±SD AAS-use of 10.4±7.0 years, and 42 unexposed weightlifters. There were no difference in age (35.5±9.2 vs. 35.3±7.5 years, p=0.8) nor body mass index (BMI) (BMI 31.4±5.0 vs. 30.1±3.5, p=0.6) between AAS-exposed and unexposed weightlifters. Compared with unexposed weightlifters, AAS-exposed weightlifters demonstrated thicker interventricular septum (11.2±2.4 vs. 9.2±1.3 mm, p<0.001), thicker left ventricular posterior wall dimension (10.1±2.1 vs. 8.9±1.3 mm, p<0.001), and higher left ventricular mass index (99.7±25.4 vs. 78.4±12.1 g/m2, p<0.001). Both left ventricular EF and left ventricular GLS were decreased in AAS-exposed weightlifters compared with unexposed weightlifters (49±9 vs. 53±6%, p=0.02, and −15.6±2.6 vs. −18.3±2.1%, p<0.001) (Figure). Conclusion AAS use in male weightlifters was associated with increased left ventricular mass and impaired left ventricular systolic function. Our results suggest considerable adverse cardiac effects of AAS use, but the results need confirmation in prospective observational trials.

Androgen Regulation of the Mesocorticolimbic System and Executive Function.

Multiple lines of evidence indicate that androgens, such as testosterone, modulate the mesocorticolimbic system and executive function. This review integrates neuroanatomical, molecular biological, neurochemical, and behavioral studies to highlight how endogenous and exogenous androgens alter behaviors, such as behavioral flexibility, decision making, and risk taking. First, we briefly review the neuroanatomy of the mesocorticolimbic system, which mediates executive function, with a focus on the ventral tegmental area (VTA), nucleus accumbens (NAc), medial prefrontal cortex (mPFC), and orbitofrontal cortex (OFC). Second, we present evidence that androgen receptors (AR) and other steroid receptors are expressed in the mesocorticolimbic system. Using sensitive immunohistochemistry and quantitative polymerase chain reaction (qPCR) techniques, ARs are detected in the VTA, NAc, mPFC, and OFC. Third, we describe recent evidence for local androgens (“neuroandrogens”) in the mesocorticolimbic system. Steroidogenic enzymes are expressed in mesocorticolimbic regions. Furthermore, following long-term gonadectomy, testosterone is nondetectable in the blood but detectable in the mesocorticolimbic system, using liquid chromatography tandem mass spectrometry. However, the physiological relevance of neuroandrogens remains unknown. Fourth, we review how anabolic-androgenic steroids (AAS) influence the mesocorticolimbic system. Fifth, we describe how androgens modulate the neurochemistry and structure of the mesocorticolimbic system, particularly with regard to dopaminergic signaling. Finally, we discuss evidence that androgens influence executive functions, including the effects of androgen deprivation therapy and AAS. Taken together, the evidence indicates that androgens are critical modulators of executive function. Similar to dopamine signaling, there might be optimal levels of androgen signaling within the mesocorticolimbic system for executive functioning. Future studies should examine the regulation and functions of neurosteroids in the mesocorticolimbic system, as well as the potential deleterious and enduring effects of AAS use.

Bigger, Faster, Stronger! An Overview of Anabolic Androgenic Steroids and their Use and Impact on the Sport Industry

The use of anabolic androgenic steroids (AAS) in sport is no longer confined to the power disciplines and has become a wide-spread issue throughout the general population. AAS are synthetic versions of the male hormone testosterone and display both anabolic and androgenic properties. It is the anabolic properties that are responsible for the muscle binding characteristics and are the main attraction for users. The primary purpose of this review was to provide an overview of the use of AAS in the sports industry by outlining the history of AAS use, the role of AAS in the Olympic success of Soviet athletes and the German Democratic Republic. Furthermore, case studies of the high profile cases of Ben Johnson, Marion Jones and Lance Armstrong were also examined along with the consequences of their drug use. Also outlined are the reasons for AAS use, the variety of ways in which they are used and short and long-term adverse side effects associated with their use. This research has highlighted problems with previous AAS literature as there is a lack of research into the long-term side effects of AAS use.

Prevalência do uso e conhecimento de esteroides anabolizantes androgênicos por estudantes e professores de educação física que atuam em academias de ginástica

INTRODUÇÃO: Os esteroides anabólicos androgênicos (EAA) são substâncias, quimicamente semelhantes à testosterona, utilizadas para o tratamento/controle de diversas doenças. Contudo, tais substâncias estão sendo empregadas de forma não terapêutica e indiscriminada com finalidades de melhora da performance esportiva e principalmente estética. OBJETIVO: analisar a prevalência do uso e o conhecimento de EAA por estudantes e professores de educação física que atuam em academias de ginástica de Belém, PA. Utilizou-se para a coleta de dados um questionário fechado e anônimo, aplicado a 117 pesquisados. A comparação da prevalência do uso e o grau de conhecimento dos pesquisados sobre EAA foi realizada através de estatística não paramétrica, prova de X² (Qui-quadrado), considerando o intervalo de confiança de 95% e p < 0,05. A média de idade dos participantes da pesquisa foi de 28,0 ± 6,3 anos e a prevalência do uso de EAA foi de 31,6% do total de sujeitos pesquisados. A prevalência maior foi entre os profissionais especialistas (39,3%), tendo como principal motivação para o uso de EAA a estética com 75,6%. Em relação ao conhecimento, verificou-se que as drogas classificadas como EAA foram: Durateston®, Deca-Durabolin®, oxandrolona/Winstrol®. Entretanto, estes profissionais confundiram-se ao apontar outras substâncias como sendo EAA, entre elas: hormônio do crescimento e óleos localizados. Entre os efeitos colaterais, os mais citados foram: acne, engrossamento da voz e agressividade; contudo, efeitos colaterais mais prejudiciais como câncer e aromatização foram menos assinalados. RESULTADOS: Demonstraram que a prevalência de uso de EAA foi significativa (p < 0,03) entre os estudantes e professores de educação física que atuam em academias de Belém, PA, revelando assim prováveis desconhecimentos destes sobre alguns dos efeitos colaterais, podendo implicar no uso indiscriminado destas drogas.

Psychological and Physical Impact of Anabolic‐Androgenic Steroid Dependence

To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence. Subanalysis of data from the Anabolic 500, a cross-sectional survey. One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009. Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users. Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

The Anabolic Androgenic Steroid Fluoxymesterone Inhibits 11 -Hydroxysteroid Dehydrogenase 2-Dependent Glucocorticoid Inactivation

Anabolic androgenic steroids (AAS) are testosterone derivatives used either clinically, in elite sports, or for body shaping with the goal to increase muscle size and strength. Clinically developed compounds and nonclinically tested designer steroids often marketed as food supplements are widely used. Despite the considerable evidence for various adverse effects of AAS use, the underlying molecular mechanisms are insufficiently understood. Here, we investigated whether some AAS, as a result of a lack of target selectivity, might inhibit 11β-hydroxysteroid dehydrogenase 2 (11β-HSD2)-dependent inactivation of glucocorticoids. Using recombinant human 11β-HSD2, we observed inhibitory effects for several AAS. Whereas oxymetholone, oxymesterone, danazol, and testosterone showed medium inhibitory potential, fluoxymesterone was a potent inhibitor of human 11β-HSD2 (half-maximal inhibitory concentration [IC(50)] of 60-100nM in cell lysates; IC(50) of 160nM in intact SW-620, and 530nM in MCF-7 cells). Measurements with rat kidney microsomes and lysates of cells expressing recombinant mouse 11β-HSD2 revealed much weaker inhibition by the AAS tested, indicating that the adverse effects of AAS-dependent 11β-HSD2 inhibition cannot be investigated in rats and mice. Furthermore, we provide evidence that fluoxymesterone is metabolized to 11-oxofluoxymesterone by human 11β-HSD2. Structural modeling revealed similar binding modes for fluoxymesterone and cortisol, supporting a competitive mode of inhibition of 11β-HSD2-dependent cortisol oxidation by this AAS. No direct modulation of mineralocorticoid receptor (MR) function was observed. Thus, 11β-HSD2 inhibition by fluoxymesterone may cause cortisol-induced MR activation, thereby leading to electrolyte disturbances and contributing to the development of hypertension and cardiovascular disease.

Anabolic Androgenic Steroid Abuse: Multiple Mechanisms of Regulation of GABAergic Synapses in Neuroendocrine Control Regions of the Rodent Forebrain

Anabolic androgenic steroids (AAS) are synthetic derivatives of testosterone originally developed for clinical purposes but are now predominantly taken at suprapharmacological levels as drugs of abuse. To date, almost 100 different AAS compounds that vary in metabolic fate and physiological effects have been designed and synthesised. Although they are administered for their ability to enhance muscle mass and performance, untoward side effects of AAS use include changes in reproductive and sexual behaviours. Specifically, AAS, depending on the type of compound administered, can delay or advance pubertal onset, lead to irregular oestrous cyclicity, diminish male and female sexual behaviours, and accelerate reproductive senescence. Numerous brains regions and neurotransmitter signalling systems are involved in the generation of these behaviours, and are potential targets for both chronic and acute actions of the AAS. However, critical to all of these behaviours is neurotransmission mediated by GABA(A) receptors within a nexus of interconnected forebrain regions that includes the medial preoptic area, the anteroventral periventricular nucleus and the arcuate nucleus of the hypothalamus. We review how exposure to AAS alters GABAergic transmission and neural activity within these forebrain regions, taking advantage of in vitro systems and both wild-type and genetically altered mouse strains, aiming to better understand how these synthetic steroids affect the neural systems that underlie the regulation of reproduction and the expression of sexual behaviours.

Use And Knowledge Concerning Anabolic-androgenic Steroids (AAS) Among Male Brazilian Bodybuilders

Athletes, especially bodybuilders, have recognized for several decades that use of AAS can promote muscle growth. More recently, AAS use by non-athletes has also become popular simply as an easy way to "look good". The use of AAS is a serious problem in general. In Brazil, use represents a public health concern. Unfortunately, the risk factors for this type of drug abuse are little studied. PURPOSE: To analyze the use and knowledge concerning AAS among male bodybuilders in a fitness center in Recife, City of Pernambuco, State of Northeast Brazil. METHODS: An anonymous questionnaire with 13 objective questions and 2 open-ended questions was distributed to male members of the fitness center. Twenty-seven volunteers, between the ages of 18 and 50, completed the questionnaire. The questionnaire included a general information section, which ended with the question, 'What is your opinion of AAS?'. Another section asked about patterns of use, effects of AAS use, and reasons leading to initial use of AAS. RESULTS: 85.2% of the participants had a basic knowledge of AAS; 33.3% related AAS to various adverse health problems, and 29.6% to the potential for death; 25.9% learned about AAS from health professionals, 18.5% from a fitness center member, and 22.2% from TV; 30% had used AAS in pursuit of the "perfect body" and to increase muscle mass; 11% decided to use AAS to enhance appearance and to boost self-esteem; AAS were administered by a friend in 11% of cases and by a pharmacist in 4% of the cases. Regarding adverse health effects following AAS use, 11% reported increased acne and 4% lower libido. Eleven percent purchased AAS without a prescription and 4% from a fitness friend. Thirty-seven percent didn't know how nutritional supplements differed from AAS. CONCLUSION: Although, AAS are illegal, use appears to have increased significantly over the past three decades among recreational athletes. The use of AAS is a growing concern that presents an interesting public health challenge in Brazil. AAS are being used, with associated risk factors, to achieve what many consider socially desirable outcomes: being physically fit, healthy, and attractive. Our research emphasizes the necessity for an effective prevention and education campaign that addresses the problems related to the misuse of AAS.

Anabolic-Androgenic Steroid Use and Involvement in Violent Behavior in a Nationally Representative Sample of Young Adult Males in the United States

We examined the effects of anabolic-androgenic steroid use on serious violent behavior. Multivariate models based on data from the National Longitudinal Study of Adolescent Health (N = 6823) were used to examine the association between lifetime and past-year self-reported anabolic-androgenic steroid use and involvement in violent acts. Compared with individuals who did not use steroids, young adult males who used anabolic-androgenic steroids reported greater involvement in violent behaviors after we controlled for the effects of key demographic variables, previous violent behavior, and polydrug use.

Predictors of Future Anabolic Androgenic Steroid Use

To prospectively study the stability of anabolic androgenic steroid (AAS) use and predictors of AAS use, and to investigate whether AAS use alters the risk of later emotional and behavioral problems. Survey of a national sample of Norwegian high school students (age 15-19) in 1994 followed up in 1999 (N = 2924). Measures of frequent alcohol intoxication (50+ times per 12 months), cannabis use (12 months), hard drug use (12 months), being offered cannabis, eating problems, conduct problems, sexual debut before age 15, BMI, involvement in power sports, perceived physical appearance, and satisfaction with body parts were obtained. Life-time prevalence of AAS use were 1.9 and 0.8% in the follow-up period. Multivariate logistic regression revealed that future AAS use was predicted by young age, male gender, previous AAS use, involvement in power sports, and frequent alcohol intoxication. AAS use did not predict future emotional or behavioral problems other than reducing the risk of future frequent alcohol intoxication. Frequent alcohol intoxication and involvement in power sports appear to predict future AAS use. At the population level there was little stability in individual AAS use from adolescence to early adulthood. No detrimental effects of AAS use could be detected in this study, but low statistical power limits this conclusion.

Predicting intentions for long-term anabolic-androgenic steroid use among men: A covariance structure model.

Long-term use of anabolic-androgenic steroids (AASs) is associated with both positive and negative effects. The authors examined possible mechanisms by which these effects contribute to AAS satisfaction and predict intentions for future AAS use. Five hundred male AAS users completed an interactive Web-based instrument assessing the psychological and physical effects of AAS use. Covariance structure modeling was used to evaluate both direct and indirect effects of AAS consequences on satisfaction with AASs and intentions for future AAS use. Results suggest that gain in muscle mass and psychological benefits from AAS use uniquely contributed to both AAS satisfaction and intentions for future use. Side effects from AAS use also uniquely contributed to AAS satisfaction, but ancillary drug use was found to partially mediate this relationship, suggesting that the satisfaction of experienced AAS users is enhanced by their mastery of side effects through the use of ancillary drugs. The final model explained 29% of the variance in intentions for future AAS use. Mechanisms for sustained AAS use and implications for intervention and prevention strategies are discussed.

Anabolic Androgenic Steroids and Aggression: Studies Using Animal Models

The use of anabolic androgenic steroids (AASs) has escalated in teenagers and is associated with increased violence. Adolescent exposure to chronic high levels of AASs is of particular concern because puberty is a hormonally sensitive period during which neural circuitry for adult male patterns of behavior develop. Thus, teenage AAS use may have long-term repercussions on the potential for displaying aggression and violence. Animal models have contributed valuable information on the effects of AAS use. For example, studies in rodents confirmed that exposure to the AASs testosterone and nandrolone, but not stanozolol, does indeed increase aggression. A side effect of AAS use reported in humans is "'roid rage," characterized by indiscriminate and unprovoked aggression. Results of animal studies demonstrated that pubertal rats receiving AASs respond appropriately to social cues as they are more aggressive toward intact males than are castrates. Also, testosterone-treated males recognize appropriate environmental cues as they are most aggressive in their home cage. Thus, adolescent AAS exposure increases aggressive behaviors, but does not induce indiscriminate aggression. To assess whether AAS exposure increases aggression after provocation, rats were tested following a mild tail-pinch. In adolescent males, provocation increased aggression after withdrawal from testosterone, nandrolone, and stanozolol, an effect which persisted for many weeks. The data suggest that AASs sensitize animals to their surroundings and lower the threshold to respond to provocation with aggression. Thus, in humans, pubertal AAS exposure may not cause violent behaviors, but may increase the likelihood that aggressive acts will result in violence. This may persist into adulthood.

Anabolic–androgenic steroids: User characteristics, motivations, and deterrents.

The use of anabolic-androgenic steroids (AAS) is increasing internationally. The present study addresses the paucity of information regarding the characteristics and motivations of AAS users. This sample of 100 AAS (94% male) users was unlike other samples of Australian illicit drug users. They were typically male, well educated, and employed and had a higher disposable income than the general Australian population. They were also involved in rigorous training directly related to their AAS use. Recreational drug use was low, with gay participants largely responsible for the polydrug use among this sample. The main motivations for AAS use were improved physical appearance and increased size. Different subgroups of users had varied expectations about the psychological effects of AAS use that were also important in motivating use. Concern about physical health was the main deterrent to use. This information will be useful in the development of educational initiatives.

Adverse effects of anabolic-androgenic steroids: a review

The use of anabolic-androgenic steroids (AS) is banned in most sporting activities. In September 1996, the British Government tightened up the legislation on AS by reclassifying them as class C, under the Misuse of Drugs Act. Generally, those who advocated this change in legislation, putting AS on par with, for example, cannabis and heroin, frequently referred to the dramatic adverse effects of AS. The aim of this review is to consider their side-effects relating to the cardiovascular system, liver and reproductive system, their cosmetic effects, and a selection of other effects reported in the literature. The picture that emerges from this is not necessarily dramatic and some explanations for this are offered. A distinction is made between adverse effects established as a consequence of clinical trials and case reports. Although self-reported side-effects should not be disregarded, the picture produced by these may be biased. When considering the adverse effects of AS use, it is important to bear in mind that the observed effects may be a synergistic action resulting from the use of several AS and other drugs used at the same time (polypharmacy), and the unknown content and quantity of preparations which are commonly obtained on the black market.

Anabolic-Androgenic Steroid Exposure During Adolescence and Aggressive Behavior in Golden Hamsters

Melloni, R.H., Jr., D. F. Connor, P. T. Xuan Hang, R. J. Harrison and C. F. Ferris. Anabolic-androgenic steroid exposure during adolescence and aggressive behavior in golden hamsters. Physiol Behav 61(3) 359–364, 1997.—Anabolic androgenic steroid (AAS) abuse by adolescents represents a significant health care risk due to the potential for long-term negative physical and psychological sequelae, including increased aggressive behavior. The current experiments examined the effects of AAS use in young male adolescent hamsters ( Mesocricetus auratus) and their consequences on aggressive behavior. It was hypothesized that AAS administration during adolescence predisposes hamsters to heightened levels of aggressive behavior (i.e., offensive aggression). To test this hypothesis, adolescent male hamsters were administered high doses of synthetic AAS to mimic a ‘heavy use’ self-administration regimen used by athletes. Immediately following the exposure to AAS, hamsters were tested for aggressive behavior using a resident-intruder model. Animals treated with high doses of AAS during their adolescent development showed heightened measures of offensive aggression (i.e., decreased latency to bite and increased total number of attacks and bites) during the test period, while measures of total activity (total contact time) between the animals remained unchanged. AAS-treated males did not differ in body weight from controls, suggesting that the increased aggression was not due to increased body mass. The results of this study show that exposure to AAS during adolescence facilitates aggressive response patterns, but does not alter body weight.

Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes.

We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them. We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed. Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol-high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes--mania, hypomania, or major depression--in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P < .001) and significantly more frequently than nonusers (P < .01). Users rarely abused other drugs simultaneously with steroids. Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression.