Materiały źródłowe

• #1 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  Anabolic steroids (anabolic-androgenic steroids) are often used to enhance physical performance and promote muscle growth. When used inappropriately, chronically at high doses and without medical supervision, they can cause erratic and irrational behavior and a wide range of physical adverse effects. […] Anabolic steroids are used illicitly to increase lean muscle mass and strength; resistance training and a certain diet can enhance these effects. […] Estimates of lifetime incidence of anabolic steroid abuse range from 0.5 to 5% of the population, but subpopulations vary significantly (eg, higher rates for bodybuilders and competitive athletes). […] Although elite athletes are tested for anabolic steroid use by anti-doping agencies, there is no practical diagnostic test to evaluate for surreptitious anabolic steroid use in the general patient population.

• #2 Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

  https://www.mdpi.com/2227-9032/9/1/97

  Anabolic-androgenic steroids (AASs) are a large group of molecules including endogenously produced androgens, such as testosterone, as well as synthetically manufactured derivatives. AAS use is widespread due to their ability to improve muscle growth for aesthetic purposes and athletes’ performance, minimizing androgenic effects. AAS use is very popular and 1–3% of US inhabitants have been estimated to be AAS users. However, AASs have side effects, involving all organs, tissues and body functions, especially long-term toxicity involving the cardiovascular system and the reproductive system, thereby, their abuse is considered a public health issue. […] The aim of the proposed review is to highlight the most recent evidence regarding the mechanisms of action of AASs and their unwanted effects on organs and lifestyle, as well as suggesting that AAS misuse and abuse lead to adverse effects in all body tissues and organs.

• #3 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Anabolic steroid misuse is a growing problem in the United States. According to the 2003 Youth Risk and Behavior Surveillance System, 6.1 percent of high school students had taken steroid pills or shots without a valid prescription during their lifetime. Overall, the prevalence of lifetime illegal steroid use was higher among white (6.2%) and Hispanic (7.2%) than black (3.6%) students. Males were more likely than females to engage in illegal steroid use during their lifetime (6.8% v 5.3%). Adolescents who misuse steroids are also more likely to use other illicit substances including alcohol, cigarettes, and marijuana. […] […] A complete physical examination provides important evidence about a patient whom you suspect may be misusing anabolic steroids. Many of these exam findings manifest because anabolic steroids are synthetic versions of the primary male sex hormone, testosterone. The physician should look for the presence of: Acne, Gynecomastia, Cutaneous striae (especially in the deltopectoral area), Testicular atrophy, Needle stick marks in the buttocks, thighs, or deltoids, Elevated blood pressure. […]

• #4 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538174/

  A comprehensive history and physical examination are needed to diagnose AAS abuse. […] Exogenous administration of androgens should be suspected in a patient who is in a competitive sport or activity, who demonstrates behavioral changes such as aggression, depression, or irritability, or with blood work changes such as deficient luteinizing hormone (LH) concentration, high hematocrit, and low sex hormone-binding globulin (SHBG). […] According to the current evidence, the most effective treatment for AAS is the discontinuation of AAS use, treatment of withdrawal symptoms, a combination of behavioral therapy, and symptomatic treatments. […] Timely identification of the anabolic steroid abuse and appropriate referral for treatment is highly warranted. […] Clinicians should target treating depression, body-image, and dysmorphia and associated detrimental behavioral patterns in groups at risk of anabolic-androgenic steroid misuse.

• #5 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538174/

  A comprehensive history and physical examination are needed to diagnose AAS abuse. […] Exogenous administration of androgens should be suspected in a patient who is in a competitive sport or activity, who demonstrates behavioral changes such as aggression, depression, or irritability, or with blood work changes such as deficient luteinizing hormone (LH) concentration, high hematocrit, and low sex hormone-binding globulin (SHBG). […] According to the current evidence, the most effective treatment for AAS is the discontinuation of AAS use, treatment of withdrawal symptoms, a combination of behavioral therapy, and symptomatic treatments. […] Timely identification of the anabolic steroid abuse and appropriate referral for treatment is highly warranted. […] Clinicians should target treating depression, body-image, and dysmorphia and associated detrimental behavioral patterns in groups at risk of anabolic-androgenic steroid misuse.

• #6 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Anabolic steroid misuse is a growing problem in the United States. According to the 2003 Youth Risk and Behavior Surveillance System, 6.1 percent of high school students had taken steroid pills or shots without a valid prescription during their lifetime. Overall, the prevalence of lifetime illegal steroid use was higher among white (6.2%) and Hispanic (7.2%) than black (3.6%) students. Males were more likely than females to engage in illegal steroid use during their lifetime (6.8% v 5.3%). Adolescents who misuse steroids are also more likely to use other illicit substances including alcohol, cigarettes, and marijuana. […] […] A complete physical examination provides important evidence about a patient whom you suspect may be misusing anabolic steroids. Many of these exam findings manifest because anabolic steroids are synthetic versions of the primary male sex hormone, testosterone. The physician should look for the presence of: Acne, Gynecomastia, Cutaneous striae (especially in the deltopectoral area), Testicular atrophy, Needle stick marks in the buttocks, thighs, or deltoids, Elevated blood pressure. […]

• #7 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Anabolic steroid misuse is a growing problem in the United States. According to the 2003 Youth Risk and Behavior Surveillance System, 6.1 percent of high school students had taken steroid pills or shots without a valid prescription during their lifetime. Overall, the prevalence of lifetime illegal steroid use was higher among white (6.2%) and Hispanic (7.2%) than black (3.6%) students. Males were more likely than females to engage in illegal steroid use during their lifetime (6.8% v 5.3%). Adolescents who misuse steroids are also more likely to use other illicit substances including alcohol, cigarettes, and marijuana. […] […] A complete physical examination provides important evidence about a patient whom you suspect may be misusing anabolic steroids. Many of these exam findings manifest because anabolic steroids are synthetic versions of the primary male sex hormone, testosterone. The physician should look for the presence of: Acne, Gynecomastia, Cutaneous striae (especially in the deltopectoral area), Testicular atrophy, Needle stick marks in the buttocks, thighs, or deltoids, Elevated blood pressure. […]

• #8 Anabolic steroid use disorder – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/987

  Anabolic-androgenic steroid (AAS) use refers to the use of testosterone (or its derivatives, or other drugs that increase endogenous testosterone production) for non-medical purposes to enhance athletic performance, or to create a more muscular physical appearance. […] Users take other drugs to minimise the unwanted effects of AASs, or to mask their use. […] Focus of treatment is supporting AAS discontinuation and managing complications associated with chronic AAS use. […] Key diagnostic factors include increased weight gain and muscular build, increased appetite, consumption of nutritional supplements, use of other drugs to counteract adverse effects of AAS use, aggression and mood swings, gynaecomastia, hirsutism, voice pitch alterations, clitoral hypertrophy, and testicular atrophy. […] Diagnostic investigations include urine toxicology testing, testosterone to epitestosterone ratio, serum testosterone, LH, and FSH, and other relevant tests.

• #9 Anabolic steroid use disorder – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/987

  Key diagnostic factors include increased weight gain and muscular build, increased appetite, consumption of nutritional supplements, use of other drugs to counteract adverse effects of AAS use, aggression and mood swings, gynecomastia, hirsutism, voice pitch alterations, clitoral hypertrophy, and testicular atrophy. […] Diagnostic tests include urine toxicology testing, testosterone to epitestosterone ratio, serum testosterone, LH, and FSH, CBC, serum glucose, serum electrolytes, lipid panel, LFTs, creatine kinase, hepatitis serology, and HIV serology. […] Emerging tests include nuclear medicine cardiovascular imaging.

• #10 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #11 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #12 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #13 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #14 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Laboratory findings can provide further evidence to support clinical data. Blood tests may reveal: Elevated glucose, Decreased HDL levels, Increased LDL levels, Abnormal liver function tests. […] […] If the physical exam and routine laboratory testing support the preliminary diagnosis of anabolic steroid use, a physician should test directly for the presence of anabolic steroids after discussing the rationale for the testing with the patient. At this point, the patient may admit to inappropriate use of anabolic steroids. If a patient who is a minor refuses testing and denies steroid use, the physician should speak with the minor’s parents or legal guardian before proceeding.

• #15 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Laboratory findings can provide further evidence to support clinical data. Blood tests may reveal: Elevated glucose, Decreased HDL levels, Increased LDL levels, Abnormal liver function tests. […] […] If the physical exam and routine laboratory testing support the preliminary diagnosis of anabolic steroid use, a physician should test directly for the presence of anabolic steroids after discussing the rationale for the testing with the patient. At this point, the patient may admit to inappropriate use of anabolic steroids. If a patient who is a minor refuses testing and denies steroid use, the physician should speak with the minor’s parents or legal guardian before proceeding.

• #16 Anabolic steroid use disorder – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/987

  Key diagnostic factors include increased weight gain and muscular build, increased appetite, consumption of nutritional supplements, use of other drugs to counteract adverse effects of AAS use, aggression and mood swings, gynecomastia, hirsutism, voice pitch alterations, clitoral hypertrophy, and testicular atrophy. […] Diagnostic tests include urine toxicology testing, testosterone to epitestosterone ratio, serum testosterone, LH, and FSH, CBC, serum glucose, serum electrolytes, lipid panel, LFTs, creatine kinase, hepatitis serology, and HIV serology. […] Emerging tests include nuclear medicine cardiovascular imaging.

• #17 Anabolic steroid use disorder – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/987

  Key diagnostic factors include increased weight gain and muscular build, increased appetite, consumption of nutritional supplements, use of other drugs to counteract adverse effects of AAS use, aggression and mood swings, gynecomastia, hirsutism, voice pitch alterations, clitoral hypertrophy, and testicular atrophy. […] Diagnostic tests include urine toxicology testing, testosterone to epitestosterone ratio, serum testosterone, LH, and FSH, CBC, serum glucose, serum electrolytes, lipid panel, LFTs, creatine kinase, hepatitis serology, and HIV serology. […] Emerging tests include nuclear medicine cardiovascular imaging.

• #18 Anabolic steroid use disorder – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/987

  Key diagnostic factors include increased weight gain and muscular build, increased appetite, consumption of nutritional supplements, use of other drugs to counteract adverse effects of AAS use, aggression and mood swings, gynecomastia, hirsutism, voice pitch alterations, clitoral hypertrophy, and testicular atrophy. […] Diagnostic tests include urine toxicology testing, testosterone to epitestosterone ratio, serum testosterone, LH, and FSH, CBC, serum glucose, serum electrolytes, lipid panel, LFTs, creatine kinase, hepatitis serology, and HIV serology. […] Emerging tests include nuclear medicine cardiovascular imaging.

• #19 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. […] It might be useful to measure serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. […] Exogenous testosterone and anabolic steroids decrease gonadotropin levels. […] When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. […] However, if high levels of testosterone are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that chemically is nearly identical to testosterone) is measured. A testosterone:epitestosterone ratio 6:1 is suggestive of exogenous testosterone use. […] The main treatment for users of anabolic steroids is cessation of use. […] Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.

• #20 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. […] It might be useful to measure serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. […] Exogenous testosterone and anabolic steroids decrease gonadotropin levels. […] When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. […] However, if high levels of testosterone are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that chemically is nearly identical to testosterone) is measured. A testosterone:epitestosterone ratio 6:1 is suggestive of exogenous testosterone use. […] The main treatment for users of anabolic steroids is cessation of use. […] Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.

• #21 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. […] It might be useful to measure serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. […] Exogenous testosterone and anabolic steroids decrease gonadotropin levels. […] When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. […] However, if high levels of testosterone are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that chemically is nearly identical to testosterone) is measured. A testosterone:epitestosterone ratio 6:1 is suggestive of exogenous testosterone use. […] The main treatment for users of anabolic steroids is cessation of use. […] Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.

• #22 Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

  https://www.mdpi.com/2227-9032/9/1/97

  In addition, recent studies reported that miRNAs may play a role in multiple human diseases including AAS adverse effects, suggesting a possible role of these markers in identifying serum or tissue biomarkers with anti-doping potential. However, further studies are needed in this field, given that there is no reliable test to diagnose AAS abuse. […] Given the high mortality of atherosclerotic disease and AAS-induced cardiomyopathy, as well as the risk of sudden cardiac death reported in the literature, primary and secondary prevention are crucial in AAS users in order to avoid serious consequences.

• #23 Anabolic Steroid Addiction & Abuse | North Jersey Recovery Center

  https://northjerseyrecovery.com/anabolic-steroid-addiction-and-abuse/

  Anabolic steroid addiction and abuse has become a growing concern for basically anyone who is heavily immersed in the fitness world. […] Anabolic steroid addiction and abuse is without a doubt, something that has potential for addiction. […] Many people who use them become psychologically and physically addicted. […] Physical dependence is well-documented for many types of steroids, both of the glucocorticoid and anabolic variety. […] People whose systems have adapted to the presence of steroid support may experience crisis or withdrawal, when steroid use abruptly stops. […] Currently, the Fifth Edition of the DSM-5 has not provided criteria for steroid addiction. However, researchers have adjusted the current DSM-5 criteria for substance addiction to address steroid abuse disorder.

• #24 Steroid Addiction: Signs, Symptoms, Effects and Treatment

  https://hopeharborwellness.com/steroid-addiction-treatment/

  Anabolic steroid addiction affects a significant portion of those who use steroids, with approximately 32% of users becoming dependent. This type of addiction can disrupt many aspects of life, including physical and mental health, relationships, and financial stability. […] Yes, contrary to common misconceptions, anabolic steroids can indeed be addictive. While they do not induce a conventional high or buzz like many drugs, users can become both psychologically and physically dependent on them. […] According to the National Institute on Drug Abuse (NIDA), steroid addiction differs from mere abuse in several critical ways: Continued use despite adverse effects: Individuals may continue using steroids despite experiencing negative physical or psychological effects such as: Breast growth in men, Sexual dysfunction, High blood pressure, Elevated blood fats, Heart disease, Mood swings, Severe irritability, Aggressiveness.

• #25 Anabolic Steroid Addiction & Abuse | North Jersey Recovery Center

  https://northjerseyrecovery.com/anabolic-steroid-addiction-and-abuse/

  Anabolic steroid addiction and abuse has become a growing concern for basically anyone who is heavily immersed in the fitness world. […] Anabolic steroid addiction and abuse is without a doubt, something that has potential for addiction. […] Many people who use them become psychologically and physically addicted. […] Physical dependence is well-documented for many types of steroids, both of the glucocorticoid and anabolic variety. […] People whose systems have adapted to the presence of steroid support may experience crisis or withdrawal, when steroid use abruptly stops. […] Currently, the Fifth Edition of the DSM-5 has not provided criteria for steroid addiction. However, researchers have adjusted the current DSM-5 criteria for substance addiction to address steroid abuse disorder.

• #26 Steroid Addiction: Signs, Symptoms, Effects and Treatment

  https://hopeharborwellness.com/steroid-addiction-treatment/

  Anabolic steroid addiction affects a significant portion of those who use steroids, with approximately 32% of users becoming dependent. This type of addiction can disrupt many aspects of life, including physical and mental health, relationships, and financial stability. […] Yes, contrary to common misconceptions, anabolic steroids can indeed be addictive. While they do not induce a conventional high or buzz like many drugs, users can become both psychologically and physically dependent on them. […] According to the National Institute on Drug Abuse (NIDA), steroid addiction differs from mere abuse in several critical ways: Continued use despite adverse effects: Individuals may continue using steroids despite experiencing negative physical or psychological effects such as: Breast growth in men, Sexual dysfunction, High blood pressure, Elevated blood fats, Heart disease, Mood swings, Severe irritability, Aggressiveness.

• #27 Steroid Addiction: Signs, Symptoms, Effects and Treatment

  https://hopeharborwellness.com/steroid-addiction-treatment/

  Anabolic steroid addiction affects a significant portion of those who use steroids, with approximately 32% of users becoming dependent. This type of addiction can disrupt many aspects of life, including physical and mental health, relationships, and financial stability. […] Yes, contrary to common misconceptions, anabolic steroids can indeed be addictive. While they do not induce a conventional high or buzz like many drugs, users can become both psychologically and physically dependent on them. […] According to the National Institute on Drug Abuse (NIDA), steroid addiction differs from mere abuse in several critical ways: Continued use despite adverse effects: Individuals may continue using steroids despite experiencing negative physical or psychological effects such as: Breast growth in men, Sexual dysfunction, High blood pressure, Elevated blood fats, Heart disease, Mood swings, Severe irritability, Aggressiveness.

• #28 Anabolic Steroids: Mental Health Effects, Use, and Misuse

  https://www.verywellmind.com/steroids-abuse-faq-69354

  Many people who misuse steroids spend large amounts of time and money to obtain the drugs they use. […] When they stop taking steroids, people can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids. […] One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to a suicide attempt. […] Treatment options recommended by the National Institute on Drug Abuse for anabolic steroid misuse are based more on case studies and physician experience rather than controlled studies. […] Treatment for anabolic steroid withdrawal often involves supportive care to manage physical symptoms, psychoeducation to help people understand the effects of steroid use, and evaluation for depression and suicidal thoughts. […] Because the dangers of anabolic steroid misuse are so great and because there does exist a potential for some people to develop addictive-like behavior related to steroid use, efforts should be concentrated on preventing the use in the first place, especially among young student-athletes.

• #29 Anabolic Steroids: Mental Health Effects, Use, and Misuse

  https://www.verywellmind.com/steroids-abuse-faq-69354

  Many people who misuse steroids spend large amounts of time and money to obtain the drugs they use. […] When they stop taking steroids, people can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids. […] One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to a suicide attempt. […] Treatment options recommended by the National Institute on Drug Abuse for anabolic steroid misuse are based more on case studies and physician experience rather than controlled studies. […] Treatment for anabolic steroid withdrawal often involves supportive care to manage physical symptoms, psychoeducation to help people understand the effects of steroid use, and evaluation for depression and suicidal thoughts. […] Because the dangers of anabolic steroid misuse are so great and because there does exist a potential for some people to develop addictive-like behavior related to steroid use, efforts should be concentrated on preventing the use in the first place, especially among young student-athletes.

• #30 Anabolic Steroids: Mental Health Effects, Use, and Misuse

  https://www.verywellmind.com/steroids-abuse-faq-69354

  Many people who misuse steroids spend large amounts of time and money to obtain the drugs they use. […] When they stop taking steroids, people can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids. […] One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to a suicide attempt. […] Treatment options recommended by the National Institute on Drug Abuse for anabolic steroid misuse are based more on case studies and physician experience rather than controlled studies. […] Treatment for anabolic steroid withdrawal often involves supportive care to manage physical symptoms, psychoeducation to help people understand the effects of steroid use, and evaluation for depression and suicidal thoughts. […] Because the dangers of anabolic steroid misuse are so great and because there does exist a potential for some people to develop addictive-like behavior related to steroid use, efforts should be concentrated on preventing the use in the first place, especially among young student-athletes.

• #31 Anabolic steroids | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/steroids

  Anabolic steroids are often referred to as a performance and image enhancing drug. Their use includes increasing sporting performance and outcomes. […] People who misuse anabolic steroids may include athletes, bodybuilders and people who feel they need to look muscular to feel good about themselves. […] The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. […] Anabolic steroids are also misused. People who illegally use anabolic steroids often do so to increase lean muscle mass, reduce fat and speed up recovery from injury. […] Anabolic steroids can produce many unpleasant and often permanent side effects, including damage to the gonads (testicles or ovaries), liver disease, malfunctions of the kidneys, liver or heart, 'roid rage’, which is characterised by uncontrollable outbursts of psychotic aggression, paranoia and mood swings, including deep depression. […] Withdrawal symptoms from steroids can include fatigue, weight loss due to lowered appetite, decreased strength, depression. […] Treatment options for drug dependence or addiction may include detoxification, individual counselling, group therapy.

• #32 Anabolic Steroids: Use and Misuse Nursing CE Course | NursingCE

  https://www.nursingce.com/ceu-courses/anabolic-steroids-use-and-misuse-nursing-ce-course

  AAS abuse is typically discovered based on a urine or blood sample. […] Despite this research in detecting AAS and other performance-enhancing substances, new compounds are continually being developed that are undetectable by current tests. […] Before treatment with AAS is initiated, the patient must have a documented diagnosis of hypogonadism. […] This diagnosis must be supported by low early morning testosterone levels on two separate days, as measured via serum blood draw. […] The use of AAS can also lead to the proliferation of androgen-based malignant cells. […] AAS use affects many body systems. […] AAS cannot cause users to feel high; however, these substances can be addictive, and users can become dependent on them. […] If a person abruptly stops using AAS, they can experience withdrawal effects, including fatigue, restlessness, loss of appetite, sleep problems, decreased sex drive, AAS cravings, mood swings, and depression, which can last for up to a year and lead to suicide in some cases. […] The literature highlights the need for increased research on AAS abuse and its complications.

• #33 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. […] It might be useful to measure serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. […] Exogenous testosterone and anabolic steroids decrease gonadotropin levels. […] When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. […] However, if high levels of testosterone are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that chemically is nearly identical to testosterone) is measured. A testosterone:epitestosterone ratio 6:1 is suggestive of exogenous testosterone use. […] The main treatment for users of anabolic steroids is cessation of use. […] Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.

• #34 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. […] It might be useful to measure serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. […] Exogenous testosterone and anabolic steroids decrease gonadotropin levels. […] When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. […] However, if high levels of testosterone are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that chemically is nearly identical to testosterone) is measured. A testosterone:epitestosterone ratio 6:1 is suggestive of exogenous testosterone use. […] The main treatment for users of anabolic steroids is cessation of use. […] Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.

• #35 Cutaneous implications of anabolic steroid misuse

  https://www.dermatologytimes.com/view/cutaneous-implications-anabolic-steroid-misuse

  Dermatologists must first understand the issue, Dr. Plewig says. […] „If a dermatologist sees a young man with a lot of muscle – much more than average – he has to be suspicious that the man is using anabolic steroids,” Dr. Plewig says. „Of course, patients have to be notified of the adverse effects on the skin and other organs, including the liver, heart, endocrine organs, and even central nervous system.” […] The most prominent cutaneous manifestations of steroid misuse include enlarged sebaceous glands (seborrhea); increased Propionibacterium acnes production; folliculitis; pyodermas; aggravated pre-existing acne; induced acne de novo; inflammatory acne; acne conglobata; acne fulminans; skin atrophy; and striae distensae. […] Dr. Plewig says dermatologists, alone, can often handle these patients successfully, and often can diagnose the misuse with a clinical exam and patient history.

• #36 Cutaneous implications of anabolic steroid misuse

  https://www.dermatologytimes.com/view/cutaneous-implications-anabolic-steroid-misuse

  Dermatologists must first understand the issue, Dr. Plewig says. […] „If a dermatologist sees a young man with a lot of muscle – much more than average – he has to be suspicious that the man is using anabolic steroids,” Dr. Plewig says. „Of course, patients have to be notified of the adverse effects on the skin and other organs, including the liver, heart, endocrine organs, and even central nervous system.” […] The most prominent cutaneous manifestations of steroid misuse include enlarged sebaceous glands (seborrhea); increased Propionibacterium acnes production; folliculitis; pyodermas; aggravated pre-existing acne; induced acne de novo; inflammatory acne; acne conglobata; acne fulminans; skin atrophy; and striae distensae. […] Dr. Plewig says dermatologists, alone, can often handle these patients successfully, and often can diagnose the misuse with a clinical exam and patient history.

• #37 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  It is rare for users of anabolic steroids to present to medical services with a primary complaint of steroid use. Most do not view themselves as drug misusers, as steroid use is seen as a positive step towards bettering themselves physically. […] The combination of muscular hypertrophy with testicular atrophy in males or virilisation in females is strongly suggestive of anabolic steroid use. […] Urine testing can confirm anabolic steroid use and be used as a measure of abstinence. […] Very few anabolic steroid users enter treatment for dependence, and research evidence is limited. Treatment recommendations can be made on the basis of the treatment of other substance misuse disorders, along the lines of abstinence, treatment of withdrawal symptoms and maintenance.

• #38 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  It is rare for users of anabolic steroids to present to medical services with a primary complaint of steroid use. Most do not view themselves as drug misusers, as steroid use is seen as a positive step towards bettering themselves physically. […] The combination of muscular hypertrophy with testicular atrophy in males or virilisation in females is strongly suggestive of anabolic steroid use. […] Urine testing can confirm anabolic steroid use and be used as a measure of abstinence. […] Very few anabolic steroid users enter treatment for dependence, and research evidence is limited. Treatment recommendations can be made on the basis of the treatment of other substance misuse disorders, along the lines of abstinence, treatment of withdrawal symptoms and maintenance.

• #39 Anabolic Steroids – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  Anabolic steroids are synthetic (man-made) versions of testosterone that are used to increase muscle size. […] Anabolic steroids can also have many side effects, including psychologic (mood swings, aggressive behavior, irritability) and physical (acne, masculinizing effects in women, breast enlargement in men). […] These substances can be detected in urine for up to 6 months. […] Treatment involves stopping use. […] Urine tests are done to check for breakdown products of anabolic steroids. These products can be detected up to 6 months after use is stopped. […] The main treatment is stopping use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders, may exist. Gynecomastia (enlarged breast tissue in men) may require surgical reduction.

• #40 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #41 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  Anabolic steroids (anabolic-androgenic steroids) are often used to enhance physical performance and promote muscle growth. When used inappropriately, chronically at high doses and without medical supervision, they can cause erratic and irrational behavior and a wide range of physical adverse effects. […] Anabolic steroids are used illicitly to increase lean muscle mass and strength; resistance training and a certain diet can enhance these effects. […] Estimates of lifetime incidence of anabolic steroid abuse range from 0.5 to 5% of the population, but subpopulations vary significantly (eg, higher rates for bodybuilders and competitive athletes). […] Although elite athletes are tested for anabolic steroid use by anti-doping agencies, there is no practical diagnostic test to evaluate for surreptitious anabolic steroid use in the general patient population.

• #42 Anabolic Steroids: Use and Misuse Nursing CE Course | NursingCE

  https://www.nursingce.com/ceu-courses/anabolic-steroids-use-and-misuse-nursing-ce-course

  AAS abuse is typically discovered based on a urine or blood sample. […] Despite this research in detecting AAS and other performance-enhancing substances, new compounds are continually being developed that are undetectable by current tests. […] Before treatment with AAS is initiated, the patient must have a documented diagnosis of hypogonadism. […] This diagnosis must be supported by low early morning testosterone levels on two separate days, as measured via serum blood draw. […] The use of AAS can also lead to the proliferation of androgen-based malignant cells. […] AAS use affects many body systems. […] AAS cannot cause users to feel high; however, these substances can be addictive, and users can become dependent on them. […] If a person abruptly stops using AAS, they can experience withdrawal effects, including fatigue, restlessness, loss of appetite, sleep problems, decreased sex drive, AAS cravings, mood swings, and depression, which can last for up to a year and lead to suicide in some cases. […] The literature highlights the need for increased research on AAS abuse and its complications.

• #43 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #44 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #45 Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

  https://www.mdpi.com/2227-9032/9/1/97

  In addition, recent studies reported that miRNAs may play a role in multiple human diseases including AAS adverse effects, suggesting a possible role of these markers in identifying serum or tissue biomarkers with anti-doping potential. However, further studies are needed in this field, given that there is no reliable test to diagnose AAS abuse. […] Given the high mortality of atherosclerotic disease and AAS-induced cardiomyopathy, as well as the risk of sudden cardiac death reported in the literature, primary and secondary prevention are crucial in AAS users in order to avoid serious consequences.

• #46 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids

  When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. […] It might be useful to measure serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. […] Exogenous testosterone and anabolic steroids decrease gonadotropin levels. […] When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. […] However, if high levels of testosterone are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that chemically is nearly identical to testosterone) is measured. A testosterone:epitestosterone ratio 6:1 is suggestive of exogenous testosterone use. […] The main treatment for users of anabolic steroids is cessation of use. […] Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.

• #47 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #48 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  It is rare for users of anabolic steroids to present to medical services with a primary complaint of steroid use. Most do not view themselves as drug misusers, as steroid use is seen as a positive step towards bettering themselves physically. […] The combination of muscular hypertrophy with testicular atrophy in males or virilisation in females is strongly suggestive of anabolic steroid use. […] Urine testing can confirm anabolic steroid use and be used as a measure of abstinence. […] Very few anabolic steroid users enter treatment for dependence, and research evidence is limited. Treatment recommendations can be made on the basis of the treatment of other substance misuse disorders, along the lines of abstinence, treatment of withdrawal symptoms and maintenance.

• #49 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Laboratory findings can provide further evidence to support clinical data. Blood tests may reveal: Elevated glucose, Decreased HDL levels, Increased LDL levels, Abnormal liver function tests. […] […] If the physical exam and routine laboratory testing support the preliminary diagnosis of anabolic steroid use, a physician should test directly for the presence of anabolic steroids after discussing the rationale for the testing with the patient. At this point, the patient may admit to inappropriate use of anabolic steroids. If a patient who is a minor refuses testing and denies steroid use, the physician should speak with the minor’s parents or legal guardian before proceeding.

• #50 Diagnosing Anabolic Steroid Use | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-anabolic-steroid-use/2004-07

  Laboratory findings can provide further evidence to support clinical data. Blood tests may reveal: Elevated glucose, Decreased HDL levels, Increased LDL levels, Abnormal liver function tests. […] […] If the physical exam and routine laboratory testing support the preliminary diagnosis of anabolic steroid use, a physician should test directly for the presence of anabolic steroids after discussing the rationale for the testing with the patient. At this point, the patient may admit to inappropriate use of anabolic steroids. If a patient who is a minor refuses testing and denies steroid use, the physician should speak with the minor’s parents or legal guardian before proceeding.

• #51 Anabolic Steroid Abuse Types, Use Disorder, Pills, Side Effects

  https://www.medicinenet.com/anabolic_steroid_abuse/article.htm

  How do healthcare professionals diagnose anabolic steroid abuse and addiction? The diagnosis of anabolic steroid abuse in high school, college, and professional athletes may occur with a failed drug test, but many people who abuse these drugs are never randomly tested. Doctors often make the diagnosis when someone develops one of the side effects of steroid use. […] Once the potential diagnosis of drug abuse is considered, the healthcare provider must offer the opportunity for the patient to consider drug treatment options, just like any other addictive drug. However, the patient must take the first step in diagnosis and treatment by admitting there is a potential for abuse and their willingness to consider intervention and treatment.

• #52 Anabolic Steroid Abuse Types, Use Disorder, Pills, Side Effects

  https://www.medicinenet.com/anabolic_steroid_abuse/article.htm

  How do healthcare professionals diagnose anabolic steroid abuse and addiction? The diagnosis of anabolic steroid abuse in high school, college, and professional athletes may occur with a failed drug test, but many people who abuse these drugs are never randomly tested. Doctors often make the diagnosis when someone develops one of the side effects of steroid use. […] Once the potential diagnosis of drug abuse is considered, the healthcare provider must offer the opportunity for the patient to consider drug treatment options, just like any other addictive drug. However, the patient must take the first step in diagnosis and treatment by admitting there is a potential for abuse and their willingness to consider intervention and treatment.

• #53 Anabolic Steroid Abuse | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688832/all/Anabolic_Steroid_Abuse?q=AST%2FALT+increased

  The misuse of testosterone and closely related compounds (often in supratherapeutic dosages) to increase lean muscle mass and improve athletic performance […] There is insufficient evidence to recommend routine screening for anabolic steroid abuse. […] At-risk individuals should be counseled about negative side effects associated with AAS abuse.

• #54 Anabolic Steroid Abuse | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688832/all/Anabolic_Steroid_Abuse?q=AST%2FALT+increased

  The misuse of testosterone and closely related compounds (often in supratherapeutic dosages) to increase lean muscle mass and improve athletic performance […] There is insufficient evidence to recommend routine screening for anabolic steroid abuse. […] At-risk individuals should be counseled about negative side effects associated with AAS abuse.

• #55 Anabolic steroids | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/steroids

  Anabolic steroids are often referred to as a performance and image enhancing drug. Their use includes increasing sporting performance and outcomes. […] People who misuse anabolic steroids may include athletes, bodybuilders and people who feel they need to look muscular to feel good about themselves. […] The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. […] Anabolic steroids are also misused. People who illegally use anabolic steroids often do so to increase lean muscle mass, reduce fat and speed up recovery from injury. […] Anabolic steroids can produce many unpleasant and often permanent side effects, including damage to the gonads (testicles or ovaries), liver disease, malfunctions of the kidneys, liver or heart, 'roid rage’, which is characterised by uncontrollable outbursts of psychotic aggression, paranoia and mood swings, including deep depression. […] Withdrawal symptoms from steroids can include fatigue, weight loss due to lowered appetite, decreased strength, depression. […] Treatment options for drug dependence or addiction may include detoxification, individual counselling, group therapy.

• #56 Steroid Addiction | Causes, Symptoms and Diagnosis

  https://www.uk-rehab.com/prescription-drug-addiction/stimulants/steroid/

  Anabolic steroids are a constant source of controversy, especially in the world of sports and fitness. […] While anabolic steroid use is widespread across the UK and the world, there are many people who are unaware of the real and serious dangers they are exposing themselves to. […] Steroid abuse usually refers to the misuse of anabolic steroids. […] Many individuals misuse anabolic steroids to build muscle mass, reduce body fat and achieve a more muscular and toned physique. […] Athletes in various sports may abuse steroids to gain a competitive edge. […] Some individuals, particularly those suffering from body dysmorphic disorders, may turn to steroids in an attempt to alter their body image to align with their ideal physique. […] Steroid addiction refers to a physical and psychological dependence on anabolic steroids, characterised by the compulsive use of the drugs despite negative consequences.

• #57 Anabolic steroids | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/steroids

  Anabolic steroids are often referred to as a performance and image enhancing drug. Their use includes increasing sporting performance and outcomes. […] People who misuse anabolic steroids may include athletes, bodybuilders and people who feel they need to look muscular to feel good about themselves. […] The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. […] Anabolic steroids are also misused. People who illegally use anabolic steroids often do so to increase lean muscle mass, reduce fat and speed up recovery from injury. […] Anabolic steroids can produce many unpleasant and often permanent side effects, including damage to the gonads (testicles or ovaries), liver disease, malfunctions of the kidneys, liver or heart, 'roid rage’, which is characterised by uncontrollable outbursts of psychotic aggression, paranoia and mood swings, including deep depression. […] Withdrawal symptoms from steroids can include fatigue, weight loss due to lowered appetite, decreased strength, depression. […] Treatment options for drug dependence or addiction may include detoxification, individual counselling, group therapy.

• #58 Steroid Addiction | Causes, Symptoms and Diagnosis

  https://www.uk-rehab.com/prescription-drug-addiction/stimulants/steroid/

  Anabolic steroids are a constant source of controversy, especially in the world of sports and fitness. […] While anabolic steroid use is widespread across the UK and the world, there are many people who are unaware of the real and serious dangers they are exposing themselves to. […] Steroid abuse usually refers to the misuse of anabolic steroids. […] Many individuals misuse anabolic steroids to build muscle mass, reduce body fat and achieve a more muscular and toned physique. […] Athletes in various sports may abuse steroids to gain a competitive edge. […] Some individuals, particularly those suffering from body dysmorphic disorders, may turn to steroids in an attempt to alter their body image to align with their ideal physique. […] Steroid addiction refers to a physical and psychological dependence on anabolic steroids, characterised by the compulsive use of the drugs despite negative consequences.

• #59 Concurrent Alcohol and Steroid Use | Signs and Effects

  https://drugabuse.com/taking-drugs-alcohol/steroid/

  Furthermore, steroid use may be linked to long-term psychiatric problems. […] Concurrent anabolic steroid and alcohol use can lead to a number of harmful effects on the mind and body, including the following: […] Chronic anabolic steroid users will experience various withdrawal symptoms when they stop using the substance. […] Depression is the most dangerous withdrawal symptom, as it can lead to suicide attempts—an alarming risk among those in steroid withdrawal. […] Anabolic steroid treatment sometimes involves treating the unpleasant withdrawal symptoms associated with cessation of use. […] There are a number of recovery programs available that will treat concurrent alcohol and steroid addiction. […] Research has revealed that teen boys who use steroids are more likely to have depression, low self-esteem, parents who worry about weight, inconsistent eating habits, and co-occurring substance abuse.

• #60 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  Anabolic steroids have been associated with a range of psychiatric symptoms, although the limited research literature in this area does not yet prove a causal link. […] Empirical studies in both animals and humans have shown an increase in aggression in both males and females exposed to anabolic steroids, and self-reported aggression may be the only sign of steroid misuse. […] Moderately high doses of testosterone cypionate have been shown to increase aggressive responding in individuals who have not used steroids before, and increasing doses of methyltestosterone have been correlated with increasing irritability, mood swings, violent feelings and hostility. […] Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of non-use.

• #61 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  Anabolic steroids have been associated with a range of psychiatric symptoms, although the limited research literature in this area does not yet prove a causal link. […] Empirical studies in both animals and humans have shown an increase in aggression in both males and females exposed to anabolic steroids, and self-reported aggression may be the only sign of steroid misuse. […] Moderately high doses of testosterone cypionate have been shown to increase aggressive responding in individuals who have not used steroids before, and increasing doses of methyltestosterone have been correlated with increasing irritability, mood swings, violent feelings and hostility. […] Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of non-use.

• #62 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  Anabolic steroids have been associated with a range of psychiatric symptoms, although the limited research literature in this area does not yet prove a causal link. […] Empirical studies in both animals and humans have shown an increase in aggression in both males and females exposed to anabolic steroids, and self-reported aggression may be the only sign of steroid misuse. […] Moderately high doses of testosterone cypionate have been shown to increase aggressive responding in individuals who have not used steroids before, and increasing doses of methyltestosterone have been correlated with increasing irritability, mood swings, violent feelings and hostility. […] Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of non-use.

• #63 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  Anabolic steroids have been associated with a range of psychiatric symptoms, although the limited research literature in this area does not yet prove a causal link. […] Empirical studies in both animals and humans have shown an increase in aggression in both males and females exposed to anabolic steroids, and self-reported aggression may be the only sign of steroid misuse. […] Moderately high doses of testosterone cypionate have been shown to increase aggressive responding in individuals who have not used steroids before, and increasing doses of methyltestosterone have been correlated with increasing irritability, mood swings, violent feelings and hostility. […] Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of non-use.

• #64 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  There have been several case reports of what users call roid rage, frenzied violent behaviour during the high-dose cycles of steroid use. […] In earlier research, 12.2% of individuals who used anabolic steroids had psychotic symptoms and 10% had sub-threshold psychotic symptoms while taking steroids: none had these symptoms when not taking them. […] Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. […] Affective disorders have long been recognised as a complication of anabolic steroid use. […] The above-mentioned study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSMIIIR criteria. […] Anabolic steroid use has increased in prevalence in many high-income countries over the past decade, and it can lead to aggression, depression, mania and psychosis, in addition to a range of physical complications.

• #65 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  There have been several case reports of what users call roid rage, frenzied violent behaviour during the high-dose cycles of steroid use. […] In earlier research, 12.2% of individuals who used anabolic steroids had psychotic symptoms and 10% had sub-threshold psychotic symptoms while taking steroids: none had these symptoms when not taking them. […] Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. […] Affective disorders have long been recognised as a complication of anabolic steroid use. […] The above-mentioned study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSMIIIR criteria. […] Anabolic steroid use has increased in prevalence in many high-income countries over the past decade, and it can lead to aggression, depression, mania and psychosis, in addition to a range of physical complications.

• #66 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  There have been several case reports of what users call roid rage, frenzied violent behaviour during the high-dose cycles of steroid use. […] In earlier research, 12.2% of individuals who used anabolic steroids had psychotic symptoms and 10% had sub-threshold psychotic symptoms while taking steroids: none had these symptoms when not taking them. […] Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. […] Affective disorders have long been recognised as a complication of anabolic steroid use. […] The above-mentioned study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSMIIIR criteria. […] Anabolic steroid use has increased in prevalence in many high-income countries over the past decade, and it can lead to aggression, depression, mania and psychosis, in addition to a range of physical complications.

• #67 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  There have been several case reports of what users call roid rage, frenzied violent behaviour during the high-dose cycles of steroid use. […] In earlier research, 12.2% of individuals who used anabolic steroids had psychotic symptoms and 10% had sub-threshold psychotic symptoms while taking steroids: none had these symptoms when not taking them. […] Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. […] Affective disorders have long been recognised as a complication of anabolic steroid use. […] The above-mentioned study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSMIIIR criteria. […] Anabolic steroid use has increased in prevalence in many high-income countries over the past decade, and it can lead to aggression, depression, mania and psychosis, in addition to a range of physical complications.

• #68 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  There have been several case reports of what users call roid rage, frenzied violent behaviour during the high-dose cycles of steroid use. […] In earlier research, 12.2% of individuals who used anabolic steroids had psychotic symptoms and 10% had sub-threshold psychotic symptoms while taking steroids: none had these symptoms when not taking them. […] Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. […] Affective disorders have long been recognised as a complication of anabolic steroid use. […] The above-mentioned study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSMIIIR criteria. […] Anabolic steroid use has increased in prevalence in many high-income countries over the past decade, and it can lead to aggression, depression, mania and psychosis, in addition to a range of physical complications.

• #69 The Endocrine Society

  https://www.healio.com/news/endocrinology/20240603/mental-health-sexual-function-worsen-for-men-in-first-year-of-quitting-steroids

  BOSTON In the first year after stopping anabolic steroid misuse, men had worse sexual function than those who continued using or never used the agents as well as more depression and anxiety, according to a presenter at ENDO 2024. […] Many men [about 65%] will restart using anabolic steroids within the first year, often due to difficult withdrawal symptoms, Grant told Healio. […] Recent steroid cessation was associated with higher depression scores (BDI-II = 7; 95% CI, 4-11) compared with no past steroid use (BDI-II = 3; 95% CI, 1-6; P = .0079). […] Quitting steroids exacerbated existing poor mental health. Depression scores were tripled for recent quitters with vs. without a psychiatric diagnosis (OR = 3.04; 95% CI, 1.72-5.38; P .001), whereas a psychiatric diagnosis was associated with doubled depression scores for current steroid users (OR = 2.04; 95% CI, 1.34-3.09; P = .001).

• #70 The Endocrine Society

  https://www.healio.com/news/endocrinology/20240603/mental-health-sexual-function-worsen-for-men-in-first-year-of-quitting-steroids

  BOSTON In the first year after stopping anabolic steroid misuse, men had worse sexual function than those who continued using or never used the agents as well as more depression and anxiety, according to a presenter at ENDO 2024. […] Many men [about 65%] will restart using anabolic steroids within the first year, often due to difficult withdrawal symptoms, Grant told Healio. […] Recent steroid cessation was associated with higher depression scores (BDI-II = 7; 95% CI, 4-11) compared with no past steroid use (BDI-II = 3; 95% CI, 1-6; P = .0079). […] Quitting steroids exacerbated existing poor mental health. Depression scores were tripled for recent quitters with vs. without a psychiatric diagnosis (OR = 3.04; 95% CI, 1.72-5.38; P .001), whereas a psychiatric diagnosis was associated with doubled depression scores for current steroid users (OR = 2.04; 95% CI, 1.34-3.09; P = .001).

• #71 The Endocrine Society

  https://www.healio.com/news/endocrinology/20240603/mental-health-sexual-function-worsen-for-men-in-first-year-of-quitting-steroids

  Men who quit steroids in the past year also had higher anxiety scores (GAD-7 = 2; 95% CI, 1-3) compared with those who had never used steroids (GAD-7 = 1; 95% CI, 0-2; P = .035). […] We dont actually know how long [men who stop using steroids] experience symptoms of depression and sexual function, Grant told Healio. More studies need to be done, but ultimately support [for men quitting steroids] is going to look like something that addresses the hormone loss, but a big part is going to be whats addressed in the psychiatric aspects, so its probably going to be a joint treatment between physicians and psychiatrists.

• #72 The Endocrine Society

  https://www.healio.com/news/endocrinology/20240603/mental-health-sexual-function-worsen-for-men-in-first-year-of-quitting-steroids

  BOSTON In the first year after stopping anabolic steroid misuse, men had worse sexual function than those who continued using or never used the agents as well as more depression and anxiety, according to a presenter at ENDO 2024. […] Many men [about 65%] will restart using anabolic steroids within the first year, often due to difficult withdrawal symptoms, Grant told Healio. […] Recent steroid cessation was associated with higher depression scores (BDI-II = 7; 95% CI, 4-11) compared with no past steroid use (BDI-II = 3; 95% CI, 1-6; P = .0079). […] Quitting steroids exacerbated existing poor mental health. Depression scores were tripled for recent quitters with vs. without a psychiatric diagnosis (OR = 3.04; 95% CI, 1.72-5.38; P .001), whereas a psychiatric diagnosis was associated with doubled depression scores for current steroid users (OR = 2.04; 95% CI, 1.34-3.09; P = .001).

• #73 The Endocrine Society

  https://www.healio.com/news/endocrinology/20240603/mental-health-sexual-function-worsen-for-men-in-first-year-of-quitting-steroids

  Men who quit steroids in the past year also had higher anxiety scores (GAD-7 = 2; 95% CI, 1-3) compared with those who had never used steroids (GAD-7 = 1; 95% CI, 0-2; P = .035). […] We dont actually know how long [men who stop using steroids] experience symptoms of depression and sexual function, Grant told Healio. More studies need to be done, but ultimately support [for men quitting steroids] is going to look like something that addresses the hormone loss, but a big part is going to be whats addressed in the psychiatric aspects, so its probably going to be a joint treatment between physicians and psychiatrists.

• #74 Anabolic steroid use disorder – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/987

  Anabolic-androgenic steroid (AAS; also known as anabolic steroid) use is the illicit use of testosterone derivatives to improve athletic performance and/or to increase lean body mass and muscle size. […] Users take other drugs to minimize the unwanted effects of AASs, or to mask their use. […] Focus of treatment is supporting AAS discontinuation and managing complications associated with chronic AAS use. […] Cardiac complications are the major cause of sudden and premature death. […] Anabolic-androgenic steroid (AAS) use refers to the use of testosterone (or its derivatives, or other drugs that increase endogenous testosterone production) for nonmedical purposes to enhance athletic performance, or to create a more muscular physical appearance. […] AASs are used at doses 10 to 100 times higher than those required to treat medical conditions.

• #75 Anabolic steroid use disorder – Symptoms, Causes, Images, and Treatment Options

  https://www.epocrates.com/online/diseases/987/anabolic-steroid-use-disorder

  Anabolic-androgenic steroid (AAS; also known as anabolic steroid) use is the illicit use of testosterone derivatives to improve athletic performance and/or to increase lean body mass and muscle size. […] Users take other drugs to minimize the unwanted effects of AASs, or to mask their use. […] Focus of treatment is supporting AAS discontinuation and managing complications associated with chronic AAS use. […] Cardiac complications are the major cause of sudden and premature death. […] Clinical assessment and urine testing for anabolic-androgenic steroid abuse and dependence. […] Anabolic steroid-induced hepatotoxicity: is it overstated? […] Androgen abuse in athletes: detection and consequences. […] Treatments for people who use anabolic androgenic steroids: a scoping review. […] Body image disorders and anabolic steroid withdrawal hypogonadism in men.

• #76 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #77 Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

  https://www.mdpi.com/2227-9032/9/1/97

  In addition, recent studies reported that miRNAs may play a role in multiple human diseases including AAS adverse effects, suggesting a possible role of these markers in identifying serum or tissue biomarkers with anti-doping potential. However, further studies are needed in this field, given that there is no reliable test to diagnose AAS abuse. […] Given the high mortality of atherosclerotic disease and AAS-induced cardiomyopathy, as well as the risk of sudden cardiac death reported in the literature, primary and secondary prevention are crucial in AAS users in order to avoid serious consequences.

• #78 Managing The Ocular Effects of Steroid Overdose – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/managing-the-ocular-effects-of-steroid-overdose

  AAS abuse can also lead to a hypercoagulable state by increasing the production of thromboxane A2 and platelet thromboxane A2 receptor density, which causes aggregation and a decrease in the production of prostaglandins. […] Our case demonstrates a vascular occlusion secondary to AAS. To our knowledge, there are no prior reports of AAS leading to retinal damage or adverse effects on vision. […] It is essential to maintain a high index of suspicion for AAS-related ocular adverse events and advise affected patients to discontinue the use of such substances immediately.

• #79 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #80 Cutaneous implications of anabolic steroid misuse

  https://www.dermatologytimes.com/view/cutaneous-implications-anabolic-steroid-misuse

  „If the patient has bad acne in the wake of the anabolic steroids, step one is get the patient off the steroids. It will take several weeks until the acne calms to a quieter state,” Dr. Plewig says. „Dermatologists, in addition, would use standard topical or systemic treatments to treat the acne.” […] Before prescribing antibiotics or isotretinoin, dermatologists should first rule out liver toxicity from taking the anabolic androgenic steroids. […] By treating the skin conditions and helping patients to stop steroid use, dermatologists can save patients from the often devastating effects of the drugs, including severe mood swings, stroke, organ toxicity and even death, Dr. Plewig says.

• #81 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #82 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml

  Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.

• #83 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml

  Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.

• #84 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml

  Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.

• #85 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml

  Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.

• #86 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml

  Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.

• #87 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml

  In summary, psychological disturbances affect many former AAS abusers, but long-term symptoms are mild in most cases. Evidence to indicate a specific timeframe for recovery and the predictors of recovery is lacking. Further studies that can quantify and take into account the bidirectional relationship between the psychopathology of AAS abuse and the effect of AAS abuse on psychopathology are needed. […] Taken together, testosterone recovery is expected but likely to be incomplete despite months or years of AAS cessation.

• #88 Managing The Ocular Effects of Steroid Overdose – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/managing-the-ocular-effects-of-steroid-overdose

  AAS abuse can also lead to a hypercoagulable state by increasing the production of thromboxane A2 and platelet thromboxane A2 receptor density, which causes aggregation and a decrease in the production of prostaglandins. […] Our case demonstrates a vascular occlusion secondary to AAS. To our knowledge, there are no prior reports of AAS leading to retinal damage or adverse effects on vision. […] It is essential to maintain a high index of suspicion for AAS-related ocular adverse events and advise affected patients to discontinue the use of such substances immediately.

• #89 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538174/

  A comprehensive history and physical examination are needed to diagnose AAS abuse. […] Exogenous administration of androgens should be suspected in a patient who is in a competitive sport or activity, who demonstrates behavioral changes such as aggression, depression, or irritability, or with blood work changes such as deficient luteinizing hormone (LH) concentration, high hematocrit, and low sex hormone-binding globulin (SHBG). […] According to the current evidence, the most effective treatment for AAS is the discontinuation of AAS use, treatment of withdrawal symptoms, a combination of behavioral therapy, and symptomatic treatments. […] Timely identification of the anabolic steroid abuse and appropriate referral for treatment is highly warranted. […] Clinicians should target treating depression, body-image, and dysmorphia and associated detrimental behavioral patterns in groups at risk of anabolic-androgenic steroid misuse.

• #90 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538174/

  A comprehensive history and physical examination are needed to diagnose AAS abuse. […] Exogenous administration of androgens should be suspected in a patient who is in a competitive sport or activity, who demonstrates behavioral changes such as aggression, depression, or irritability, or with blood work changes such as deficient luteinizing hormone (LH) concentration, high hematocrit, and low sex hormone-binding globulin (SHBG). […] According to the current evidence, the most effective treatment for AAS is the discontinuation of AAS use, treatment of withdrawal symptoms, a combination of behavioral therapy, and symptomatic treatments. […] Timely identification of the anabolic steroid abuse and appropriate referral for treatment is highly warranted. […] Clinicians should target treating depression, body-image, and dysmorphia and associated detrimental behavioral patterns in groups at risk of anabolic-androgenic steroid misuse.

• #91 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538174/

  A comprehensive history and physical examination are needed to diagnose AAS abuse. […] Exogenous administration of androgens should be suspected in a patient who is in a competitive sport or activity, who demonstrates behavioral changes such as aggression, depression, or irritability, or with blood work changes such as deficient luteinizing hormone (LH) concentration, high hematocrit, and low sex hormone-binding globulin (SHBG). […] According to the current evidence, the most effective treatment for AAS is the discontinuation of AAS use, treatment of withdrawal symptoms, a combination of behavioral therapy, and symptomatic treatments. […] Timely identification of the anabolic steroid abuse and appropriate referral for treatment is highly warranted. […] Clinicians should target treating depression, body-image, and dysmorphia and associated detrimental behavioral patterns in groups at risk of anabolic-androgenic steroid misuse.

• #92 Treatments for people who use anabolic androgenic steroids: a scoping review | Harm Reduction Journal | Full Text

  https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0343-1

  It is argued that while there are differences between AAS and psychoactive drugs dependence, such as that AAS are typically used over a period of weeks and months to increase muscularity rather than to achieve a high in the short-term, these criteria are still highly applicable to AAS dependence. […] A number of hypotheses to explain AAS dependence have been put forward and recommendations for treating what has been described as steroid abuse or dependence have long been proposed. […] Recent recommendations to treat steroid dependence include a staged discontinuation, managing withdrawal symptoms, maintaining abstinence and attenuating complications of chronic use. […] Supporting discontinuation may require a multidisciplinary approach with input from health professionals such as a GP, addiction specialist, psychiatrist and endocrinologist.

• #93 Treatments for people who use anabolic androgenic steroids: a scoping review | Harm Reduction Journal | Full Text

  https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0343-1

  Swedish guidelines for diagnosing and treating AAS abuse include advice around psychosocial treatments, such as cognitive behavioural therapy, counselling group therapy and motivational interviewing. […] It may be necessary to identify and address such disorders through counselling or psychotherapies as part of AAS treatment to reduce likelihood of re-initiation. […] There remains scant evidence in relation to effective policy and practice within the topic. […] While we have a greater understanding of the environmental influences and risk factors for use, there are few robust findings to support the effective prevention of AAS use. […] Policy guidance regarding the delivery of harm reduction services for AAS users, centred around NSP provision, is in place in the United Kingdom, with its importance recognised in National Drug Strategy and Treatment guidelines. […] While these guidelines are based on well-established principles of treatment engagement and harm reduction, there is an urgent need to identify where we have evidence to support specific interventions and where the evidence gaps remain.

• #94 Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires | Substance Abuse Treatment, Prevention, and Policy | Full Text

  https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-019-0206-5

  Anabolic-androgenic steroids (AAS) are used to increase muscle strength and improve appearance, but users also carry the risk of developing physical and mental health problems. […] This study describes health problems, motivations for AAS cessation, and treatment desires among AAS users. […] Of the 232 AAS users, 179 (77.2%) desired treatment after completing the information session and 53 (22.9%) were unsure or did not want treatment. […] Although 181 (78.0%) reported co-occuring physical and mental health problems, mental health problems were the most common motivation for AAS cessation (n=108, 47.8%), followed by a combination of mental and physical health problems (52, 23.0%). […] Healthcare professionals who encounter users of AAS should have knowledge about AAS use and adverse effects.

• #95 Treatments for people who use anabolic androgenic steroids: a scoping review | Harm Reduction Journal | Full Text

  https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0343-1

  A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. […] Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. […] This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. […] Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. […] While AAS are not explicitly recognised in the Diagnostic and statistical manual of mental disorders (DSM 5) as one of nine classes of drugs, they may be considered under the tenth other (or unknown) substance class.

• #96 Cutaneous implications of anabolic steroid misuse

  https://www.dermatologytimes.com/view/cutaneous-implications-anabolic-steroid-misuse

  „If the patient has bad acne in the wake of the anabolic steroids, step one is get the patient off the steroids. It will take several weeks until the acne calms to a quieter state,” Dr. Plewig says. „Dermatologists, in addition, would use standard topical or systemic treatments to treat the acne.” […] Before prescribing antibiotics or isotretinoin, dermatologists should first rule out liver toxicity from taking the anabolic androgenic steroids. […] By treating the skin conditions and helping patients to stop steroid use, dermatologists can save patients from the often devastating effects of the drugs, including severe mood swings, stroke, organ toxicity and even death, Dr. Plewig says.

• #97 Cutaneous implications of anabolic steroid misuse

  https://www.dermatologytimes.com/view/cutaneous-implications-anabolic-steroid-misuse

  „If the patient has bad acne in the wake of the anabolic steroids, step one is get the patient off the steroids. It will take several weeks until the acne calms to a quieter state,” Dr. Plewig says. „Dermatologists, in addition, would use standard topical or systemic treatments to treat the acne.” […] Before prescribing antibiotics or isotretinoin, dermatologists should first rule out liver toxicity from taking the anabolic androgenic steroids. […] By treating the skin conditions and helping patients to stop steroid use, dermatologists can save patients from the often devastating effects of the drugs, including severe mood swings, stroke, organ toxicity and even death, Dr. Plewig says.

• #98 Survey of endocrinologists managing recovery from anabolic androgenic steroid induced hypogonadism in: Reproduction and Fertility Volume 4 Issue 1 (2023)

  https://raf.bioscientifica.com/view/journals/raf/4/1/RAF-22-0097.xml

  Most (84%) responding clinicians advised men with AAS-induced hypogonadism to wait until symptoms resolved without any other treatment. The remaining 13 (16%) respondents provided hormonal treatment for symptoms. […] It is also unsurprising that few endocrinologists were confident about treating AAS-induced hypogonadism, partly explained by the perception that their knowledge about AAS is inferior to fitness coaches, bodybuilding websites, and other AAS users. […] We suggest further studies aim to define AAS-induced hypogonadism as a separate entity. This would support the development of evidence-based treatments and clinical guidance to optimise reproductive recovery in men motivated to stop AAS.

• #99 Survey of endocrinologists managing recovery from anabolic androgenic steroid induced hypogonadism in: Reproduction and Fertility Volume 4 Issue 1 (2023)

  https://raf.bioscientifica.com/view/journals/raf/4/1/RAF-22-0097.xml

  Most (84%) responding clinicians advised men with AAS-induced hypogonadism to wait until symptoms resolved without any other treatment. The remaining 13 (16%) respondents provided hormonal treatment for symptoms. […] It is also unsurprising that few endocrinologists were confident about treating AAS-induced hypogonadism, partly explained by the perception that their knowledge about AAS is inferior to fitness coaches, bodybuilding websites, and other AAS users. […] We suggest further studies aim to define AAS-induced hypogonadism as a separate entity. This would support the development of evidence-based treatments and clinical guidance to optimise reproductive recovery in men motivated to stop AAS.

• #100 Survey of endocrinologists managing recovery from anabolic androgenic steroid induced hypogonadism in: Reproduction and Fertility Volume 4 Issue 1 (2023)

  https://raf.bioscientifica.com/view/journals/raf/4/1/RAF-22-0097.xml

  Most (84%) responding clinicians advised men with AAS-induced hypogonadism to wait until symptoms resolved without any other treatment. The remaining 13 (16%) respondents provided hormonal treatment for symptoms. […] It is also unsurprising that few endocrinologists were confident about treating AAS-induced hypogonadism, partly explained by the perception that their knowledge about AAS is inferior to fitness coaches, bodybuilding websites, and other AAS users. […] We suggest further studies aim to define AAS-induced hypogonadism as a separate entity. This would support the development of evidence-based treatments and clinical guidance to optimise reproductive recovery in men motivated to stop AAS.

• #101 Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

  https://www.mdpi.com/2227-9032/9/1/97

  In addition, diagnostically reliable tests for AAS abuse should be standardized. […] In this regard, to prevent the use of AASs, public health measures in all settings are crucial. These measures consist of improved knowledge among healthcare workers, proper doping screening tests, educational interventions, and updated legislation. […] This review suggests that AAS misuse and abuse lead to adverse effects in all body tissues and organs. Oxidative stress, apoptosis, and protein synthesis alteration are common mechanisms involved in AAS-related damage in the whole body. This review shows that long-term administration of high doses of AASs may lead to serious consequences, such as hypogonadism, cardiac impairment, neurodegeneration, coronary artery disease and sudden cardiac death. […] Clinicians and family doctors should be aware of AAS adverse effects, in order to investigate AAS use in high risk patients, especially in young athletes.

• #102 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538174/

  A comprehensive history and physical examination are needed to diagnose AAS abuse. […] Exogenous administration of androgens should be suspected in a patient who is in a competitive sport or activity, who demonstrates behavioral changes such as aggression, depression, or irritability, or with blood work changes such as deficient luteinizing hormone (LH) concentration, high hematocrit, and low sex hormone-binding globulin (SHBG). […] According to the current evidence, the most effective treatment for AAS is the discontinuation of AAS use, treatment of withdrawal symptoms, a combination of behavioral therapy, and symptomatic treatments. […] Timely identification of the anabolic steroid abuse and appropriate referral for treatment is highly warranted. […] Clinicians should target treating depression, body-image, and dysmorphia and associated detrimental behavioral patterns in groups at risk of anabolic-androgenic steroid misuse.

• #103 Anabolic steroid misuse

  https://www.nhs.uk/conditions/anabolic-steroid-misuse/

  Anabolic steroids are prescription-only medicines that are sometimes taken without medical advice to increase muscle mass and improve athletic performance. […] If used in this way, they can cause serious side effects and addiction. […] Anabolic steroids are addictive. This means you can crave the drug, require more to get the same effect, and have withdrawal symptoms if you suddenly stop taking it. […] A person who is addicted to anabolic steroids will want to keep using them despite experiencing unpleasant physical side effects. […] You should see a GP if you think you’re addicted to anabolic steroids. Treatment for an addiction to anabolic steroids will be similar to that of other types of addiction.

• #104 Anabolic Steroids: Mental Health Effects, Use, and Misuse

  https://www.verywellmind.com/steroids-abuse-faq-69354

  Many people who misuse steroids spend large amounts of time and money to obtain the drugs they use. […] When they stop taking steroids, people can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids. […] One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to a suicide attempt. […] Treatment options recommended by the National Institute on Drug Abuse for anabolic steroid misuse are based more on case studies and physician experience rather than controlled studies. […] Treatment for anabolic steroid withdrawal often involves supportive care to manage physical symptoms, psychoeducation to help people understand the effects of steroid use, and evaluation for depression and suicidal thoughts. […] Because the dangers of anabolic steroid misuse are so great and because there does exist a potential for some people to develop addictive-like behavior related to steroid use, efforts should be concentrated on preventing the use in the first place, especially among young student-athletes.

• #105 Treatments for people who use anabolic androgenic steroids: a scoping review | Harm Reduction Journal | Full Text

  https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0343-1

  It is argued that while there are differences between AAS and psychoactive drugs dependence, such as that AAS are typically used over a period of weeks and months to increase muscularity rather than to achieve a high in the short-term, these criteria are still highly applicable to AAS dependence. […] A number of hypotheses to explain AAS dependence have been put forward and recommendations for treating what has been described as steroid abuse or dependence have long been proposed. […] Recent recommendations to treat steroid dependence include a staged discontinuation, managing withdrawal symptoms, maintaining abstinence and attenuating complications of chronic use. […] Supporting discontinuation may require a multidisciplinary approach with input from health professionals such as a GP, addiction specialist, psychiatrist and endocrinologist.

• #106 Treatments for people who use anabolic androgenic steroids: a scoping review | Harm Reduction Journal | Full Text

  https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0343-1

  A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. […] Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. […] This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. […] Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. […] While AAS are not explicitly recognised in the Diagnostic and statistical manual of mental disorders (DSM 5) as one of nine classes of drugs, they may be considered under the tenth other (or unknown) substance class.

• #107 Diagnosis and Management of Anabolic Androgenic Steroid Use – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30753550/

  Context: The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. […] Results: The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete’s baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. […] Conclusions: Men who use AASs 1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use 1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.

• #108 Anabolic androgenic steroids: what the psychiatrist needs to know | Advances in Psychiatric Treatment | Cambridge Core

  https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/anabolic-androgenic-steroids-what-the-psychiatrist-needs-to-know/38A5531F66EE651A75DFB4EB5FB8962F

  It is rare for users of anabolic steroids to present to medical services with a primary complaint of steroid use. Most do not view themselves as drug misusers, as steroid use is seen as a positive step towards bettering themselves physically. […] The combination of muscular hypertrophy with testicular atrophy in males or virilisation in females is strongly suggestive of anabolic steroid use. […] Urine testing can confirm anabolic steroid use and be used as a measure of abstinence. […] Very few anabolic steroid users enter treatment for dependence, and research evidence is limited. Treatment recommendations can be made on the basis of the treatment of other substance misuse disorders, along the lines of abstinence, treatment of withdrawal symptoms and maintenance.

• #109 Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

  https://www.mdpi.com/2227-9032/9/1/97

  In addition, diagnostically reliable tests for AAS abuse should be standardized. […] In this regard, to prevent the use of AASs, public health measures in all settings are crucial. These measures consist of improved knowledge among healthcare workers, proper doping screening tests, educational interventions, and updated legislation. […] This review suggests that AAS misuse and abuse lead to adverse effects in all body tissues and organs. Oxidative stress, apoptosis, and protein synthesis alteration are common mechanisms involved in AAS-related damage in the whole body. This review shows that long-term administration of high doses of AASs may lead to serious consequences, such as hypogonadism, cardiac impairment, neurodegeneration, coronary artery disease and sudden cardiac death. […] Clinicians and family doctors should be aware of AAS adverse effects, in order to investigate AAS use in high risk patients, especially in young athletes.

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