Treatment of Anabolic-Androgenic Steroid Related Disorders

Abstract

The family of anabolic-androgenic steroids (AAS) comprises the male hormone testosterone and its many synthetic relatives. Although elite athletes have used AAS for muscle and performance gains since the 1950s, widespread AAS use did not emerge into the general population until the 1980s. Thus, AAS abuse is the youngest of the world’s major forms of substance abuse, with most AAS users still below age 50. There are now some tens of millions of AAS users worldwide, primarily male and primarily in Western societies. Contrary to common belief, most AAS users do not engage in competitive athletics, but simply want to become leaner and more muscular. AAS users may occasionally experience serious psychiatric effects, including hypomania or mania during AAS exposure and depression during AAS withdrawal. Long-term medical effects include especially cardiomyopathy, atherosclerotic disease, and prolonged suppression of the hypothalamic-pituitary-gonadal axis. About 30 % of AAS users develop dependence syndromes, likely caused by a confluence of psychosocial factors (e.g., using AAS to “self-treat” muscle dysmorphia), neuroendocrine factors (e.g., repeatedly resuming AAS use to self-treat hypogonadism during AAS withdrawal), and hedonic effects. A hedonic component is supported by evidence that male hamsters will self-administer testosterone to the point of death. Treatment of AAS dependence remains largely empirical, in part because most AAS abusers are still too young to have developed adverse effects. Thus, few have desired or sought treatment. This situation may change in future decades, however, as growing numbers of aging AAS users enter the age of risk for long-term adverse effects.