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

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

[Faster, higher, stronger: knowledge about old and new doping substances]. / Sneller, hoger, sterker: kennis over oude en nieuwe dopingmiddelen.

Physicians should possess specific diagnostic and pharmacotherapeutic skills in order to recognize symptoms associated with doping use. It is important to be on the alert in athletes and fitness enthusiasts for physical and psychological changes due to use of anabolic steroids such as acne, stretch marks, gynecomastia, signs of acromegaly, irascibility and lethargy. Stimulants such as amphetamines, ephedrine and cocaine lead to fat loss and increased alertness; their main side effects are cardiac problems, behavioural changes and addiction. In addition to anabolic steroids and stimulants, erythropoietin, growth hormone, diuretics and glucocorticoids are regularly used to improve sport performance. In cycling, a biological passport will be used in an attempt to detect doping use. In future, the Olympic motto 'citius, altius, fortius' (faster, higher, stronger) will have ground-breaking consequences for the performance and health of top athletes.