The use of testosterone derivatives to improve athletic performance and/or to increase lean body mass and muscle size.
Athletes sometimes use elaborate schemes to avoid detection. Due to the intricate nature of medication routines, many users have a coach who helps coordinate the drugs given and the schedule.
Users take other drugs to minimise unwanted effects or mask their use.
Focus of treatment is the management of complications associated with chronic use and preventing further abuse.
Cardiac complications are the major cause of sudden and premature death.
Androgenic anabolic steroid (AAS) abuse refers to the use of testosterone derivatives to improve athletic performance and/or to increase lean body mass and muscle size. Abuse differs from that of other drugs, such as heroin or cocaine, as the desire to use them does not generally come from effects of the drug, but rather from wanting to change appearance or improve athletic performance. They are used at doses 10 to 100 times higher than those required to treat medical conditions. Anabolic steroids are often just referred to as steroids.
History and exam
Key diagnostic factors
- consumption of nutritional supplements
- use of other drugs to counteract adverse effects of steroids
- increased weight gain and muscular build
- increased appetite
- aggression and mood swings
- voice pitch alterations
- clitoral hypertrophy
- disproportionate muscular development of upper torso
- testicular atrophy
Other diagnostic factors
- acne and/or oily skin
- temporal hairline recession/male pattern baldness
- striae or keloids
- menstrual irregularities
- changes in libido
- scrotal pain
- premature masculinisation/feminisation (adolescents)
- cognitive impairment
- GI upset
- short stature (adolescents)
- needle marks
- enlarged prostate
- narcissistic personality
- male sex
- participation in sports and athletics or bodybuilding
- hx of muscle dysmorphia or other body image disorder
- employment as nightclub bouncer, professional male dancer, professional wrestler, or law enforcement officer
- hx of childhood physical or sexual abuse
1st investigations to order
- urine toxicology testing
- testosterone to epitestosterone ratio
- serum LH and FSH
- serum glucose
- serum electrolytes
- lipid panel
- hepatitis serology
- HIV serology
- nuclear medicine cardiovascular imaging
acute GI toxicity
refusal to cease taking steroids
Marcel J. Casavant, MD, FACEP, FACMT, FAACT
Division of Toxicology
Nationwide Children's Hospital
The Ohio State University
Colleges of Medicine and Pharmacy
MJC declares that he has no competing interests.
Jill R. K. Griffith, BS, Pharm D
Clinical Assistant Professor
The Ohio State University
College of Pharmacy
Mount Carmel Medical Center West
JRKG declares that she has no competing interests.
Fred Hartgens, MD, PhD
Department of Epidemiology
Maastricht University Medical Centre
Department of Surgery
Outpatient Clinic Sports Medicine
FH is an author of a reference cited in this monograph.
Harrison G. Pope Jr, MD, MPH
Professor of Psychiatry
Biological Psychiatry Laboratory
HGP is an author of a number of references cited in this monograph.
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