Human Growth Hormone (hGH)Anabolic steroids are synthetic derivatives of naturally occurring testosterone. According to surveys and media reports, androgenic anabolic steroid use is widespread. Self-image in obesity, as a consequence of media attention focusing on clinical and public health implications, leads us to comment on a number of possible explanations for the progressive increases observed. The prevalence of abuse of certain prescription medicines amongst health-club attendees has dramatically increased in the Steroids to get big and ripped. The non-therapeutic use of such medicines was previously considered to be restricted to the professional athlete or recreational bodybuilder. As a consequence of the internet revolution, steroid abuse is becoming challenged by the more expensive designer drugs, particularly growth hormone.
[Doping and urologic tumors]. - PubMed - NCBI
A total of 50 studies published between and were included in the analysis. It was evident that prior to their debut, AAS users often used other licit and illicit substances. Our classification of the various substances used by AAS users resulted in 13 main groups.
These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy.
Anabolic-androgenic steroid s AAS refer to testosterone and its synthetic derivatives mainly used nonmedically for enhancing muscle growth and strength, boosting physical activity or sports performance, and for aesthetic purposes as well as for enhancing psychological well-being [ 1 ]. Moreover, many users complement AAS use or stacking with the use of other substances. In this respect, AAS use has been found to be associated with the use of both licit and illicit substances in systematic reviews of predominantly quantitative literature [ 3 , 4 ].
A synthesis of the qualitative or descriptive literature on polypharmacy by AAS users is, both from a clinical and research perspective, important in order to increase the understanding of the polypharmacy often associated with AAS use. Such a literature review and synthesis is also valuable in terms of the development and strengthening of AAS use and harm reduction interventions as such investigation will deepen existing knowledge on the various substances used and the specific function they serve, which in some cases deviates significantly from their formal medical indications.
Furthermore, results of such investigation would complement evidence emanating from a systematic review of mostly quantitative evidence [ 3 ] in the effort to elucidate the phenomenon of polysubstance use by AAS users. However, as far as we are aware, a systematic review and synthesis of the qualitative or descriptive literature on polypharmacy by AAS users has not been published. Against this backdrop, we conducted the first systematic review and synthesis of the qualitative or descriptive studies presenting data on the use of other licit and illicit substances among AAS users.
The research questions guiding the present study were: From a total of 10, hits, 7, articles were assessed after the removal of duplicates. We also inspected references of relevant studies and searched in online databases and websites. This search yielded 15 new articles. Based on titles and abstracts, full-text papers were retrieved for screening after initial evaluation of the 7, papers. After screening of the full-text papers, 79 papers were deemed relevant for inclusion.
Thus, of the 79 papers scrutinized, 50 studies satisfied the following inclusion criteria: We again inspected the characteristics of extracted studies for similarities to curb duplicate extraction and synthesis. The literature search was completed in June The literature search strategy adhered to Shaw et al. The first author conducted the study scrutiny and selection. Analysis of the studies was conducted using Smith et al. Each full-text paper was regarded as a transcript.
The first author DS read through the full-text papers several times, gaining an overall sense of the themes in the studies through this process. These themes were then highlighted. Using a standardized data extraction form, the first author and another reviewer independently extracted the following data from the included studies: DS then independently coded the full-text papers by substance used and reason s or motive s for use.
We have presented all the studies that fall under each substance. First, SP provided a functional categorization of the substances. For substances for which motive for use was not delineated in the literature, DS grouped them based on Evans-Brown et al.
JM inspected the grouping and provided further advice. Next, DS allocated substances that at this stage could not be allocated into groups based on the three previous methods by referring to Medscape Drug Reference and Wikipedia [ 60 ]. We reached consensus on the classification through further review and discussion. A total of 50 studies were included in the metasynthesis. The year of publication of the studies ranged from [ 55 ] to [ 12 , 13 , 30 ].
Thirty studies used interviews [ 10 - 12 , 17 , 19 - 22 , 24 , 27 , 28 , 30 - 32 , 34 - 38 , 40 - 43 , 45 , 47 , 48 , 51 , 53 , 55 , 58 ], seven were case studies [ 9 , 23 , 29 , 39 , 49 , 50 , 57 ], one used interviews and focus groups [ 13 ], and twelve [ 14 - 16 , 19 , 25 , 26 , 33 , 44 , 46 , 52 , 54 , 56 ] used interviews supported by a questionnaire. For the studies that used both interviews and questionnaires, we relied on the qualitative or descriptive results generated from the interviews.
Through further analysis and dialogue agreement was reached on discrepant extractions. Before their AAS use debut, some users had experimented with or were regular users of other substances. This was presented by ten studies [ 17 , 21 , 24 , 26 - 29 , 34 , 47 , 53 ].
The most prominent of these substances were alcohol, amphetamine, cannabis, and cocaine. In Kanayama et al. Furthermore, it is important to note that our data also suggested that AAS use may precede the use of other substances for some individuals.
Respondent 8 reported using narcotics after he had started using AAS. In this case, alcohol and drug abuse cannot explain why he started doping [using AAS].
However, AAS use seems to have led him into drug use and criminality in order to finance his extensive AAS use and investment in elite powerlifting.
This respondent became aggressive and violent when he combined AAS and alcohol. Due to these side effects he changed from alcohol to cocaine as his primary social drug when he was on AAS p.
Indeed, in a study [ 46 ] of AAS users: We also investigated lifetime use of other substances by AAS users. The most popular substances declared in multiple studies were: Our classification of the various substances used by AAS users resulted in 13 main groups: These groups of substances are briefly discussed below.
There may be overlap between classes e. CNS depressants may be used for promoting sleep and for analgesic properties. Some of the drugs do not have well documented efficacy for their alleged motives for use. This group of drugs was used for relieving inflammation, pain, and fever emanating from exercise, sports participation or the recreational and occupational activities of AAS users. Anti-oestrogens include aminogluthimide, clomiphene, and tamoxifen. These drugs were used for reducing the oestrogen-like side effects of AAS use such as preventing gynecomastia.
They were also used for endurance, improved testosterone production, and burning body fat. These drugs such as captopril, carvedilol, and digoxin were used for improved functioning of the cardiovascular system such as lowering blood pressure and reducing the risk of myocardial infarction, as well as burning body fat. Examples of depressants are buprenorphine, hydrocodone, and oxycodone.
The purposes for which these drugs were used were improved sleep, relaxation, and elevation of mood. Cosmetic or aesthetic drugs such as esiclene, melanotan II, and thiomucase were used in order to deal with acne, and for: These supplements such as calcium, glutamine, and potassium were consumed to provide essential nutrients to supplement the diet and combat the risk of illness.
Diuretics such as furosemide, hydrochlorothiazide, and spironolactone were used for combating side effects of AAS use such as water retention, together with masking the use of AAS and other doping agents. These drugs include 2,4-dinitrophenol DNP , conjugated linoleic acid, and teroxin T3 and were used for suppression of appetite, increased metabolism, and reduced absorption of body fat as a means to burning body fat and losing weight.
These drugs such as phosphodiesterase-5 inhibitors PDE5i , melanotan II, and sildenafil were used for dealing with testicular atrophy, improved sexual desire or arousal as well as erectile functioning. In sum, the above groups of substances were used to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. It is important to note that there is overlap between some of the groups.
For instance, some central nervous system depressants may be misused for promoting sleep as well as their analgesic properties. Additionally, some of the substances are used for multiple purposes. For instance, melanotan II is used for tanning the skin and also as self—treatment for erectile dysfunction resulting from long-term AAS use. Others may use melanotan II to self-treat specific conditions such as rosacea or fibromyalgia and others may use melanotan for the self-reported weight loss effects due to appetite suppression.
It is also important to note that some of the alleged properties or uses are not scientifically well documented such as the use of insulin for burning body fat [ 54 ].
Furthermore, the quality, safety, and efficacy of substances obtained from the illicit market cannot be known, with adulteration usually commonplace [ 2 , 63 ]. The present study has highlighted various licit and illicit substances used by AAS users. Evidence abounds that some of the substances identified in our study, especially dietary and nutritional supplements, may be contaminated with AAS and other pharmacological elements thus, potentially, playing a role in the decision to initiate AAS use [ 2 , 64 - 67 ].
Preventive efforts should therefore highlight the potential role licit and illicit substance use, especially dietary and nutritional supplement use, may play in the initiation of AAS use as well as the role AAS use may potentially play in the use of other substances, together with the potential negative consequences individuals who engage in such behavior may encounter.
AAS-associated polypharmacy is dangerous for several reasons. First, it has been associated with violent and criminal behavior as well as various forms of pathology and mortality [ 68 - 70 ].
Second, chemical interactions from AAS-related polypharmacy may have adverse psychophysical effects on individuals engaged in such behavior. Thus, the main and combined effects of the use of these substances must attract the attention of clinicians, policymakers and public health officials. Indeed, physicians may inadvertently administer medication to AAS-using polydrug users thereby triggering unintended adverse chemical interactions that may be harmful to AAS-using patients.
Additionally, most AAS users obtain the substances identified in the present study from the illicit market [ 1 , 2 ]. Stakeholders must take our findings into consideration in the development of preventive and therapeutic interventions for AAS users.
There is also the need for the strengthening of harm reduction interventions to combat the harmful consequences of AAS-related polydrug use. There is the need for further investigations to elucidate better the pathway to AAS-associated polysubstance use. Further studies are also necessary to examine the main and complementary enervating consequences of the use of different dosages of these varied substances, plus their addictive potential and trajectories.
Moreover, there is a dearth of knowledge regarding the spread of these substances due to the fact that most of these substances are relatively new. So far most focus has been directed toward AAS in particular. Thus, the use of ancillary and associated substances has mainly escaped the attention of clinicians, public health officials, policymakers, and researchers [ 2 ].
There is therefore the need for studies examining the emergence of these substances in the pharmacopoeia of substance users as well as their diffusion into other substance-using populations. There is the need for the collection and analysis or testing of these substances, to ascertain their content and potential contaminants.
Additionally, apart from the Iranian study [ 10 ], all studies were conducted in Western countries.