The impact of nandrolone decanoate abuse on experimental animal model: Hormonal and biochemical assessment.

Nandrolone decanoate (ND) is one of the most commonly abused anabolic androgenic steroids compounds in the world owing to its ability to improve physical performance but its abuse is associated with several adverse effects. The current study was performed to evaluate the effect of recommended and overdose of nandrolone decanoate (ND) for short and long term on the alterations of biochemical markers related to kidney, liver, adrenal, thyroid gland functions and oxidant and antioxidant activities. Sixty male rats were randomly assigned into two major groups. The first was treated with ND for 6 weeks and the second was treated with same drug for 12 weeks. Each of these groups was further subdivided into three sub groups: 1-Control (untreated rats), 2- Rats intraperitoneally injected with ND 3 mg/kg weekly, 3- Rats intraperitoneally injected with ND 15 mg/kg weekly. Administration of high ND dose for either short or long term significantly elevated kidney function biomarkers, liver enzymes both in serum, cytosol and mitochondria, insignificantly increased thyroid function, significantly increased adrenal function while, decreased ACTH. Moreover, oxidative stress biomarkers were significantly upregulated associated with depression in antioxidants activities. Administration of high ND dose for either short or long term as well as the repeated use of recommended ND dose for long term proved to have harmful effects manifested in impairing the functions of kidneys, liver, thyroid and adrenal glands as well as oxidant antioxidant balance.

Dietary supplementation of branched-chain amino acids increases muscle net amino acid fluxes through elevating their substrate availability and intramuscular catabolism in young pigs.

Branched-chain amino acids (BCAA) have been clearly demonstrated to have anabolic effects on muscle protein synthesis. However, little is known about their roles in the regulation of net AA fluxes across skeletal muscle in vivo. This study was aimed to investigate the effect and related mechanisms of dietary supplementation of BCAA on muscle net amino acid (AA) fluxes using the hindlimb flux model. In all fourteen 4-week-old barrows were fed reduced-protein diets with or without supplemental BCAA for 28 d. Pigs were implanted with carotid arterial, femoral arterial and venous catheters, and fed once hourly with intraarterial infusion of p-amino hippurate. Arterial and venous plasma and muscle samples were obtained for the measurement of AA, branched-chain α-keto acids (BCKA) and 3-methylhistidine (3-MH). Metabolomes of venous plasma were determined by HPLC-quadrupole time-of-flight-MS. BCAA-supplemented group showed elevated muscle net fluxes of total essential AA, non-essential AA and AA. As for individual AA, muscle net fluxes of each BCAA and their metabolites (alanine, glutamate and glutamine), along with those of histidine, methionine and several functional non-essential AA (glycine, proline and serine), were increased by BCAA supplementation. The elevated muscle net AA fluxes were associated with the increase in arterial and intramuscular concentrations of BCAA and venous metabolites including BCKA and free fatty acids, and were also related to the decrease in the intramuscular concentration of 3-MH. Correlation analysis indicated that muscle net AA fluxes are highly and positively correlated with arterial BCAA concentrations and muscle net BCKA production. In conclusion, supplementing BCAA to reduced-protein diet increases the arterial concentrations and intramuscular catabolism of BCAA, both of which would contribute to an increase of muscle net AA fluxes in young pigs.

Anabolic androgen use in the management of hereditary angioedema: Not so cheap after all.

BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (HAE) is a rare, life-threatening disease that imposes a significant burden on affected patients. 17α-alkylated androgens (anabolic androgens) decrease attack frequency and severity but carry the risk of potentially serious dose-related adverse effects. Despite the emergence of targeted therapies for HAE, continued anabolic androgen use has been driven in part by their low cost. OBJECTIVE: To examine the hidden cost of anabolic androgen use related to the risk of developing non-HAE comorbidities. METHODS: Patients with HAE were identified in the Southern California Kaiser Permanente database using clinical and laboratory findings compatible with HAE. These patients were stratified into anabolic androgen exposed and nonexposed groups. Matched controls were selected from the Kaiser database who did not have HAE or anabolic androgen exposure. Using multivariate analysis, we determined the number of non-HAE comorbidities linked to anabolic androgen use. We next determined the association between dosing and increasing exposure to anabolic androgens and the likelihood of having various comorbidities. RESULTS: Patients with HAE exposed to anabolic androgens had a 28% increase (P = .04) in non-HAE comorbidities when compared with their matched (nonexposed) controls. With each gram per month increase in exposure, a 12% increase in non-HAE comorbidities is observed (P < .01). The most commonly occurring non-HAE comorbidities were psychiatric, muscle cramps, obesity, and hyperlipidemia. CONCLUSION: Our data suggest that long-term anabolic androgen use enhances the risk of developing comorbid health conditions, thus amplifying the cost of care. Our report provides additional support for the preferred use of newer, targeted therapies for the management of HAE.

Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services?

INTRODUCTION AND AIM: To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. DESIGN AND METHODS: Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. RESULTS: Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. DISCUSSION AND CONCLUSION: Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2016;35:377-382].

Additive effects of growth promoting technologies on performance of grazing steers and economics of the wheat pasture enterprise.

This research was designed to evaluate the effect of monensin (Elanco Animal Health, Greenfield, IN) supplementation via mineral or pressed protein block with or without a growth-promoting implant on performance of steers grazing wheat pasture in Arkansas over 2 yr. Preconditioned steers (n = 360, BW = 238 ± 5.1 kg) grazed 15 1.6-ha wheat pastures in the fall (n = 60 steers each fall, stocking rate of 2.5 steers/ha) or 30 0.8-ha wheat pastures in the spring (n = 120 steers each spring, stocking rate of 5 steers/ha). Steers in each pasture were given free-choice access to nonmedicated mineral (CNTRL; MoorMan's WeatherMaster Range Minerals A 646AAA; ADM Alliance Nutrition, Inc., Quincy, IL), or were supplemented with monensin (Elanco Animal Health, Greenfield, IN) via mineral containing 1.78 g monensin/kg (RMIN; MoorMan's Grower Mineral RU-1620 590AR; ADM Alliance Nutrition, Inc.), or pressed protein block containing 0.33 g monensin/kg (RBLCK; MoorMan's Mintrate Blonde Block RU; ADM Alliance Nutrition, Inc.). Additionally, one-half of the steers in each pasture were implanted (IMPL) with 40 mg trenbolone acetate and 8 mg estradiol (Component TE-G with Tylan; Elanco Animal Health). There was no interaction (P ≥ 0.71) between supplement treatment and growth-promoting implants, and ADG for RMIN and RBLCK were increased (P < 0.01) over CNTRL by 0.07 to 0.09 kg/d, respectively. Implanting steers with Component TE-G increased (P < 0.01) ADG by 0.14 kg/d. The combination of these growth-promoting technologies are a cost-effective means of increasing beef production by 22% without increasing level of supplementation or pasture acreage. Utilizing ionophores and implants together for wheat pasture stocker cattle decreased cost of gain by 26%. Utilizing both IMPL and monensin increased net return by $30 to $54/steer for RMIN or $18 to $43/steer for RBLCK compared with UNIMPL CNTRL at Low and High values of BW gain, respectively.

Effects of sequential feeding of ß-adrenergic agonists on cull cow performance, carcass characteristics, and mRNA relative abundance.

The objectives of this study were to determine the effects of supplementation with a single ß-adrenergic agonist (ß-AA) or a sequence of ß-AA on cow performance, carcass characteristics, and mRNA relative abundance of cull cows implanted and fed a concentrate diet. Sixty cull cows were implanted with Revalor-200 (200 mg of trenbolone acetate and 20 mg of estradiol) and assigned to 1 of 4 treatments (n = 15/treatment): CON = fed a concentrate diet only; RH = supplemented with ractopamine-HCl for the last 25 d before slaughter; ZH = supplemented with zilpaterol-HCl for 20 d before a 3-d withdrawal before slaughter; RH + ZH = supplemented with RH for 25 d, followed by ZH for 20 d before a 3-d withdrawal before slaughter. Ractopamine-HCl was supplemented at a dose of 200 mg·animal(-1)·d(-1), and ZH was supplemented at 8.33 mg/kg (100% DM basis) of feed. All cows were fed a concentrate diet for 74 d. Each treatment had 5 cows per pen and 3 replicate pens. Body weights were collected on d 1, 24, 51, and 72. Muscle biopsies from the LM were collected on d 24, 51, and at slaughter from a subsample of 3 cows per pen. Carcass traits were evaluated postslaughter. The 2 ZH treatments averaged 15.3 kg more BW gain, 0.20 kg greater ADG, and 7.8 cm(2) larger LM area than CON and RH treatments, and 21 kg more HCW than CON, but these differences were not significant (P > 0.10), likely due to a sample size of n = 15/treatment. The sequence of RH followed by ZH tended to optimize the combination of HCW, LM area, percent intramuscular fat, and lean color and maturity compared with the ZH treatment. Abundance of ß(2)-adrenergic receptor (AR) mRNA was not altered in the RH + ZH treatment during RH supplementation from d 24 to 51 of feeding. However, the abundance of ß(2)-AR mRNA increased (P < 0.05) the last 23 d of feeding for the RH treatment and tended (P = 0.10) to increase in ZH cows during ZH supplementation. For all cows, abundance of type IIa myosin heavy chain (MHC-IIa) mRNA decreased (P < 0.05) after 24 d of feeding. Abundance of MHC-IIx mRNA increased (P < 0.05) for ZH and RH + ZH treatments the last 23 d of feeding during ZH supplementation. Although few significant differences were observed in performance or carcass traits, mRNA quantification indicated that ß-AA supplementation elicited a cellular response in cull cows. Implanting and feeding cull cows for 74 d, regardless of ß-AA supplementation, added economic value by transitioning cows from a cull cow to what is referred to in industry as a white cow market in which cows have white fat resulting from grain feeding.

Anabolic androgenic steroids--use and correlates among gym users--an assessment study using questionnaires and observations at gyms in the Stockholm region.

The purpose of this study was to estimate the prevalence of anabolic androgenic steroid (AAS) use and offers to use among gym users in Stockholm County (Sweden), and to conduct a comparison of concordance in estimates of AAS and supplements at gyms between two data collection methods. A questionnaire was distributed to members at 36 training facilities and 1,752 gym users participated in the study. An observation study was conducted as covert participant observations at 64 gyms. According to the questionnaire, 3.9% of men reported life time use of AAS, 1.4% use during the past 12 months and 0.4% AAS use during past 30 days. Not only were there similar patterns found in the two methods, i.e., similar age and gender distributions for AAS use, but analyses of concordance showed that gyms with a higher prevalence of self-reported AAS-use and supplement use (questionnaire) showed a significantly higher proportion of observer-assessed AAS users. Analyses of individual predictors showed that AAS users were almost always young men, regular weight trainers and more often users of drugs and nutritional supplements. The higher prevalence of AAS use among gym users than in the general population makes the former an appropriate target group for AAS prevention. The connection between supplements, drugs and AAS use suggests that effective AAS prevention need to focus on several risk factors for AAS use. The clear resemblance in estimates between the observation and questionnaire data strengthen the credibility of the two methods.

Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the Internet.

Internet websites offering androgenic anabolic steroids (AAS) were identified and available products were examined. Keywords for the website search were: "anabolic steroids," "anabolic steroids buy," "anabolic steroid purchase." The first 10 websites offering AAS in the first 10 pages of results were considered. At least two AAS-containing products per website were selected. Thirty AAS-selling websites were identified, mainly located in the United States (46.7%) and Europe (30%). Most websites sold other anabolic/ergogenic products (clenbuterol, 76.7%; GH/IGF, 60.0%; thyroid hormones, 46.7%; erythropoietin, 30.0%; insulin, 20.0%) or products for AAS-related adverse effects (mainly: estrogen antagonists, 63.3%; products for erectile dysfunction, 56.7%; 5α-reductase inhibitors, 33.3%; anti-acne products, 33.3%). AAS were sold as medicines (69.6%) or as dietary supplements (30.4%). AAS in medicines were mainly: nandronole (20.4%), methandrostenolone (18.4%), and testosterone (12.2%). Dietary supplements contained mainly DHEA and included several fake compounds. Manufacturers were declared for 97.9% of medicines and 66.7% of dietary supplements; however, several manufacturers were not found on the Internet. Described benefits were usually few adverse effects and no estrogenicity. Toxicity was seldom reported and presented as mild. Recommended doses were two-fourfold higher than current medical recommendations. In conclusion, misleading information and deceiving practices were common findings on AAS-selling websites, indicating their deleterious potential for public health.

[Body cult and use of anabolic steroids by bodybuilders]. / Culto ao corpo e uso de anabolizantes entre praticantes de musculação.

This study focused on the reasons for practicing bodybuilding and the use of anabolic steroids, as well as the social representations and uses of the body among bodybuilding steroid users. This ethnographic study involved participant observation in middle and lower-class bodybuilding gyms in Salvador, Bahia State, Brazil, and 43 in-depth interviews with steroid users. Aesthetic reasons are the main motivation for bodybuilding and steroid use in both middle and lower-class users. Dissatisfaction with one's real body as compared to the ideal standard flaunted by the mass media, fear of being devalued or shunned by one's peer groups, the symbolic capital associated with a 'pumped-up' body, and the sense of immediacy in obtaining results all contributed to steroid use. Preventive campaigns are needed, targeting young people and combining a critical view and deconstruction of the values assigned to the body by consumer society, counteracted by high-quality information on the health risks associated with anabolic steroid use.

Culto ao corpo e uso de anabolizantes entre praticantes de musculação / Body cult and use of anabolic steroids by bodybuilders

O objetivo do estudo foi investigar as motivações para a prática da musculação e uso de anabolizantes, assim como as representações e usos sociais do corpo entre usuários de anabolizantes praticantes de musculação. Foi realizado um estudo etnográfico com observação participante em academias de musculação de bairros de classe média e classes populares de Salvador, Bahia, Brasil, e realização de 43 entrevistas em profundidade com usuários de anabolizantes. A prática da musculação e o uso de anabolizantes, tanto entre usuários de classe média quanto populares, são motivados sobretudo por razões estéticas. A insatisfação com corpo real em comparação ao padrão ideal disseminado pela mídia, o receio de ser desvalorizado ou excluído do grupo de pares, o capital simbólico associado ao corpo "trabalhado" e o imediatismo na obtenção dos resultados favorecem o uso de anabolizantes. Faz-se necessária a realização de campanhas de prevenção voltadas para os jovens que aliem a visão crítica na desconstrução dos valores associados ao corpo na sociedade de consumo à veiculação de informação de qualidade sobre os riscos à saúde no consumo de anabolizantes.

This study focused on the reasons for practicing bodybuilding and the use of anabolic steroids, as well as the social representations and uses of the body among bodybuilding steroid users. This ethnographic study involved participant observation in middle and lower-class bodybuilding gyms in Salvador, Bahia State, Brazil, and 43 in-depth interviews with steroid users. Aesthetic reasons are the main motivation for bodybuilding and steroid use in both middle and lower-class users. Dissatisfaction with one's real body as compared to the ideal standard flaunted by the mass media, fear of being devalued or shunned by one's peer groups, the symbolic capital associated with a "pumped-up" body, and the sense of immediacy in obtaining results all contributed to steroid use. Preventive campaigns are needed, targeting young people and combining a critical view and deconstruction of the values assigned to the body by consumer society, counteracted by high-quality information on the health risks associated with anabolic steroid use.

Growth-promotant implants: managing the tools.

Great contemplation, conversation, and controversy have surrounded the use of growth-promotant implants since their inception in the 1950s. Since the very beginning, the purpose of growth promotants has been to enhance production efficiency, reduce the cost of production, and improve profitability. Changes in our understanding of the physiologic mechanisms involved in growth promotion have not altered this fundamental purpose. With enhanced knowledge of the impact of various compounds and doses on different classes of animals, and with the introduction of numerous products providing those compounds and doses, planning implant programs has become difficult. However, the net return from a well-designed implant program may mean the difference between profit and loss on a given set of cattle.

Growth performance and shedding of some pathogenic bacteria in feedlot cattle treated with different growth-promoting agents.

Eighty steers with a mean body weight of 319 kg were used in a study to evaluate the effect of a growth-promoting implant (trenbolone acetate plus estradiol benzoate), monensin, and oxytetracycline on the steer performance and shedding of some foodborne pathogens. The steers were allotted to one of eight treatment combinations according to a randomized complete block design with 16 pens of five animals. Rectal fecal samples were collected before treatment commenced and over a period of more than 24 weeks to study the influence of treatments on the intestinal microbiology of the animals. Results supported the beneficial effect of the hormonal implant on the performance of feedlot steers (average daily gain, feed efficiency, and fat thickness), on carcass characteristics (hot carcass weight, lean yield), and economic value of the carcasses (P < 0.01). The levels of Escherichia coli in feces were not affected by treatments but remained high throughout the study period. Antibiotic-resistant isolates of E. coli were more frequently found as the study progressed but were not associated with any specific treatment. Also independently of treatment, we observed a reduction over time in the shedding of Campylobacter and Yersinia during the feeding period, whereas the shedding of Enterococcus was increased. The results of this study confirmed the beneficial economic effect of growth-promoting agents in beef production and showed that the agents tested did not specifically affect the overall microbial evolution of the animal gut. However, the study also showed, independently of the growth promoter used, the shedding of Campylobacter, Yersinia, and antibiotic-resistant E. coli in the feedlot environment. These bacteria also may be found in the colonic tissue of steers at slaughter and might be a source of carcasses contamination.

Stacking anabolic androgenic steroids (AAS) during puberty in rats: a neuroendocrine and behavioral assessment.

Anabolic androgenic steroid (AAS) abuse is increasing in teenagers. We examined the effects of stacked AAS in adolescent male rats. Stacking, in which multiple AAS are taken simultaneously, is commonly employed by humans. Beginning at puberty gonadally intact male rats received testosterone, nandrolone, or stanozolol. Additional groups received stacked AAS: testosterone + stanozolol, nandrolone + stanozolol, or nandrolone + testosterone. Injections continued during tests for sexual behavior, vocalizations, scent marking, partner preference, aggression and fertility. Body and reproductive tissue weights were taken. Sexual and aggressive behaviors were increased by testosterone yet inhibited by stanozolol; nandrolone had no effect. Stacking testosterone with stanozolol prevented the inhibitory effects of stanozolol. Body weight was decreased by testosterone and all stacked AAS. Cell nuclear androgen receptor binding in brain was significantly increased in nandrolone males and decreased in stanozolol males; testosterone males were slightly higher than controls. Androgen receptors in stacked groups were intermediate between individual AAS suggesting that stanozolol competed with other AAS for androgen receptors despite its low affinity. The results indicate that stacking AAS influences the effects of individual AAS on behavioral and endocrine measures, and levels of androgen receptor occupation are not directly correlated with AAS effects on behavior.

[Postmenopausal osteoporosis]. / Osteoporosis a postmenopausában.

Due to its incidence and clinical consequences osteoporosis followed by vertebral, hip, and forearm fractures represents an outstanding problem of nowadays' health care. Because of its high mortality rate hip fractures are of special interest. The number of fractures caused by postmenopausal osteoporosis increases with age. Costs of examinations and treatment of women with postmenopausal osteoporosis and fractures are also increasing and represent a significant amount all over the world. Organization of Osteoporosis Centres in Hungary was founded in 1995 and has been since functioning, however, only the one-sixth of osteoporotic patients are treated. Several risk factors are known in the pathogenesis of osteoporosis, first of all the lack of sufficient calcium and vitamin D intake, age, genetic factors, and circumstances known to predispose falling. Estrogen deficiency is the most likely cause of postmenopausal osteoporosis. Osteodensitometry by DEXA is the most important method to evaluate osteoporosis, since decrease in bone mineral density strongly correlates with fracture incidence. Physical, radiologic, and laboratory examination are also required at the first visit and during follow-up. The quantity of bone can hardly be influenced after the 35th year of age, thus prevention of osteoporosis has special significance: appropriate calcium and vitamin D supplementation, weight-bearing sports and physical activity can prevent fractures. According to the results from studies fulfilling the criteria of evidence-based medicine, first choice treatment of osteoporosis involves hormone replacement therapy, bisphosphonates, the tissue specific tibolone, raloxifen and calcitonin. Calcium and vitamin D supplementation are always necessary to be added to any antiporotic treatment. Other combinations of different antiporotic drugs are useless and make the treatment more expensive. Other treatments like massage, physiotherapy, hip-protecting pants, etc. as well as rehabilitation have special clinical significance.

Metabonomic assessment of physiological disruptions using 1H-13C HMBC-NMR spectroscopy combined with pattern recognition procedures performed on filtered variables.

Metabonomic characterization of long-lasting although weak physiological events such as anabolic disruptions remains poorly investigated. We have validated 1H-13C HMBC-NMR as a suitable generator of instrumental variables that are strongly linked to the concentration of endogenous metabolites in biological fluids. This method is interfaced to multivariate pattern recognition procedures. Fingerprints established from urine sample collected on cattle treated with anabolic steroids were used to validate this method. Four main results arise from this study. (i) 2D NMR is as informative as 1D NMR. (ii) 2D NMR variable clustering highlights successfully a contingent redundancy of variables, although a relevant hierarchical model of statistical correlations covering from structural relationships to physiologic links can also be evidenced. (iii) To enhance pattern recognition performances, we have validated a variable selection algorithm for accurate prediction of unknown individuals belonging to predetermined groups achieved by linear discriminant analysis (LDA). This algorithm synthesizes the whole information contained in the data set by selecting preferentially nonredundant variables. Parameters generating variable subsets are validated by predicted variance efficiency obtained when minimizing error rates calculated by cross-validation methods. (iv) Provided variables are correctly filtered, LDA fairly competes with partial least-squares methods for both classification of individuals and statistical interpretation of metabolic responses obtained in such a physiological disruption context.

Steroid use among adolescents: findings from Project EAT.

PURPOSE: To explore the prevalence and correlates of using steroids for the purpose of gaining muscle among adolescent males and females. More specifically, the study objectives were to: (a) assess the prevalence of anabolic steroid use in a large population-based sample of adolescent males and females; and (b) identify personal, socio-environmental, and behavioral factors related to the health of adolescents that use anabolic steroids. METHODS: The study population included 4746 middle and high school students from St. Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of a population-based study of eating patterns and weight concerns among teenagers (Project EAT: Eating Among Teens). Steroid use and a range of socio-environmental, personal, and behavioral factors hypothesized to be correlates of steroid use were assessed. Associations were examined separately among males and females through comparisons of means (unadjusted and adjusted for grade-level and race) for continuous variables, and percentages, and odds ratios for dichotomized variables. RESULTS: Steroid use was more common in males (5.4%, vs. 2.9% of females), non-Caucasians (especially Hmong, a subset of the Asian-American population), and in middle school students (as compared to high school). In males, steroid use was associated with poorer self-esteem and higher rates of depressed mood and attempted suicide, poorer knowledge and attitudes about health, greater participation in sports that emphasize weight and shape, greater parental concern about weight, and higher rates of disordered eating and substance use. Among females, steroid use was less consistent in its associations with other variables, although overall, a similar pattern of results emerged. CONCLUSIONS: Anabolic steroid use in adolescence is associated with poorer health-related attitudes and behaviors and exposure to socio-environmental influences encouraging weight preoccupation. Attention needs to be directed toward youth who may be at increased risk for steroid use within clinical and community-based settings

Androgen-androgenic steroids, the athlete, and mortality.

Use of performance-enhancing substances is widespread among men and women athletes and body builders, professional or amateur, adolescent or adult. Many of these substances are illegal or have adverse effects. This article describes the action and effects of androgenic and growth hormones, their legality, their potential for abuse, and their impact on mortality.

Anabolic-androgenic steroids: medical assessment of present, past and potential users.

OBJECTIVE: To document adverse effects of anabolic-androgenic steroid (AAS) use in community-based users attending a medical clinic. DESIGN AND SETTING: Prospective recruitment, questionnaire-based interview, physical examination and investigations, with follow-up, of people who attended, anonymously, an inner-city hospital clinic established specifically to examine AAS use. PARTICIPANTS: 58 men, comprising 27 past AAS users, 14 present users and 17 potential users (who formed the control group). MAIN OUTCOME MEASURE: Clinical adverse effects and abnormal laboratory findings. RESULTS: Cyclical use of oral and intramuscular, human and veterinary AASs were reported. The most commonly reported source of AASs was friends (59%), gymnasiums (25%) and doctors (14%). The most common reported adverse effects were alterations in libido (61%), changes in mood (48%), reduced testis volume (46%) and acne (43%). Although mean systolic and diastolic blood pressure was not significantly different between groups, five present (29%), 10 past (37%) and one potential user (8%) were hypertensive. Gynaecomastia was found in 10 past users (37%; P<0.01 v. potential users), two present users (12%) and no potential users. Mean testis volume was significantly smaller in present users (18 mL; P<0.02) than in the other groups. Twenty past users (83%), eight present users (62%) and five potential users (71%) had abnormal liver function test results (P=0.5). After discussion of test results, only 11 participants (19%) reported they would not use AASs in the future. CONCLUSIONS: Adverse effects were reported by or detected in most of the AAS users who attended the clinic. Despite awareness of adverse consequences, most participants planned future use of AASs.