Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users

Abstract

Abstract. The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users’ trust in physicians and drives them into the arms of so-called “gurus.” The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.

Anabolic-androgenic steroids: Considerations for forensic psychiatry, sports psychiatry, and the law

“…In part, usage rates may be driven by sociocultural factors, technological advancements, and the widening accessibility of these substances for athletes and the general public [3, 6]. Enduring stigmatisation surrounds AAS use, which can undermine trust in physicians, impair therapeutic programmes and educational initiatives, and amplify the role of non-medical experts [7, 8]. Studies suggest that people who use AAS believe that physicians have limited understanding about these substances, with perceived knowledge levels comparable to that of internet resources and even those who illicitly sell them [8].…”

“…Interdisciplinary dialogues should incorporate endocrinologists and sports physicians, as well as primary care physicians, who often fulfil gatekeeper positions as the first point of contact for AAS-related issues [7]. Harm reduction initiatives have been emphasised for individuals who use AAS [7, 23], which could be more holistically adopted into legal and drug policy structures; from a regulatory perspective, we believe that the specific frameworks of AAS consumption in recreational sport should inform the applicability of anti-doping guidelines for amateur athletes. Generally, policymakers and legal actors need to be better attuned to these wider considerations.…”

Mental illness in elite weightlifters

“…The sport has long been stigmatised through the association with performance enhancing substances [9], with several countries including Egypt and Romania being banned from Tokyo 2021 due to alleged violations of anti-doping rules. The use of performance-enhancing substances, and specifically anabolic androgenic steroids (AAS), is known to have a significant impact on mental health, particularly given the links with chronic patterns of use and research suggesting that around 30% of these individuals become dependent [10, 11]. AAS have been linked to depression [12], cognitive impairment [13], aggression [12, 14] and psychosis [12].…”

“…Affected individuals often spend significant periods employing methods to increase muscle mass, including excessive weight training and using AAS [18], and are at risk of developing eating disorders [15, 19]. Whilst the use of these substances is not confined to the elite levels of sport [11], interventions to identify and offer support to these athletes have not been widely investigated [8].…”