Anabolic androgenic steroids used as performance and image enhancing drugs in professional and amateur athletes: Toxicological and psychopathological findings

Anabolic androgenic steroids used as performance and image enhancing drugs in professional and amateur athletes : Toxicological and psychopathological findings / Daria Piacentino, Gabriele Sani, Georgios D. Kotzalidis, Simone Cappelletti, Livia Longo, Salvatore Rizzato, Francesco Fabi, Paola Frati, Vittorio Fineschi, Lorenzo Leggio. - (Human Psychopharmacology (2021) 15 September; 2815)

  • PMID: 34528289
  • DOI: 10.1002/hup.2815


Objective: The use of anabolic androgenic steroids (AASs) as performance and image enhancing drugs (PIEDs), once restricted to professional athletes, now includes amateurs and regular gym visitors. AAS use is associated with psychopathology, yet this relationship is complex and not fully understood. We aimed to assess the presence of AASs and other misused substances in athletes' biological samples and link toxicological to psychopathological findings.

Methods: A multicentre, cross-sectional study in fitness centres in Italy recruited 122 professional and amateur athletes training in several sports (84 men; age range = 18-45 years). Athletes completed questionnaires, interviews, and toxicology testing for AASs, other PIEDs, illicit drugs, and non-prescribed psychotropics. Toxicology was conducted in blood, urine, and hair.

Results: Self-reported and toxicologically detected use rates of AASs and other misused substances showed slight-to-fair agreement (Fleiss' κ = 0.104-0.375). There was slight-to-moderate agreement among the three biological samples used for AAS testing (κ = 0.112-0.436). Thirty-one athletes (25.4%) tested positive for AASs. More sport hours/week, narcissistic or antisocial personality disorders, and higher nonplanning impulsiveness scores predicted AAS use (pseudo-R2 = 0.665). AAS users did not differ significantly from non-users in major psychopathology, but their Hypomania Checklist-32 score, which also predicted AAS use, was significantly higher (p < 0.001), suggesting increased odds for cyclothymic disorder or subthreshold hypomania.

Conclusions: Our results have implications for studying AAS users, as they identify a cluster of variables that may be relevant in future understanding of AAS use risks (e.g., personality disorders). Possible disagreements between AAS assessment methods should be considered when implementing harm reduction interventions, such as needle and syringe distribution, health education, and counselling, as well as surveillance programmes.


Research / Study
15 September 2021
Cappelletti, Simone
Fabi, Francesco
Fineschi, Vittorio
Frati, Paola
Kotzalidis, Georgios D.
Leggio, Lorenzo
Longo, Livia
Piacentino, Daria
Rizzato, Salvatore
Sani, Gabriele
United States of America
Other organisations
Brown University School of Public Health (Brown SPH)
Center for Statistical and Social Studies (CE3S)
Georgetown University Medical Center
Johns Hopkins University School of Medicine (JHUSOM)
National Institutes of Health (NIH)
National Instute of Drug Abuse
Sapienza Università di Roma - Sapienza University of Rome
Doping classes
S1. Anabolic Agents
Medical terms
Health effects
Substance use research
Amateur / club / recreational sport
Gym/fitness environment
Document category
Date generated
11 November 2021
Date of last modification
17 November 2021
  • Legal Source
  • Education
  • Science
  • Statistics
  • History
Country & language
  • Country
  • Language
Other filters
  • ADRV
  • Legal Terms
  • Sport/IFs
  • Other organisations
  • Laboratories
  • Analytical aspects
  • Doping classes
  • Substances
  • Medical terms
  • Various
  • Version
  • Document category
  • Document type
Publication period