Muscle dysmorphia: a critical review of the proposed criteria

1 Nov 2001

Muscle dysmorphia : a critical review of the proposed criteria / Bryan Chung. - (Perspectives in Biology and Medicine 44 (2001) 4 (Autumn); p. 565-574)

  • PMID: 11600802
  • DOI: 10.1353/pbm.2001.0062


While body-image related disorders such as anorexia nervosa have focused on thinness, only recently have clinical criteria for a disorder that centers around muscularity--muscle dysmorphia--been proposed. An individual affected by muscle dysmorphia is overly concerned with his or her degree of muscularity. This preoccupation is manifested in the individual's behavior (excessive weight lifting, excessive attention to diet, social impairment). This article examines the historical aspects and proposed criteria for muscle dysmorphia and contrasts them with those of anorexia nervosa. While the authors of the proposed criteria have suggested that muscle dysmorphia be classified as a subcategory of body dysmorphic disorder, both the historical and clinical aspects of this syndrome are more consistent with its classification as an obsessive-compulsive disorder.

A case of anabolic steroid abuse

1 Dec 1998

A case of anabolic steroid abuse / John H. Porcerelli, Bruce A. Sandler. - (Psychiatric Clinics of North America 21 (1998) 4 (1 December); p. 829-833)


This case report is of a young man who developed significant psychiatric symptomatology, which warranted brief hospitalization, as a result of anabolic-androgenic steroid abuse. His symptoms included hostility, agitation, and homicidal and paranoid thinking. The initiation of steroid use was motivated by efforts to master an adult trauma (being shot with a shotgun). Individual (outpatient) psychotherapy helped the patient to understand his fears and to discover and work through the meanings that the shooting and injuries had for him. Cessation of steroid use eliminated his presenting symptoms. However, the major depressive symptoms, indicative of steroid dependence, developed and were treated successfully on an outpatient basis with antidepressant medication.

Use of anabolic-androgenic steroids in adolescence: winning, looking good or being bad?

1 Nov 2020

Use of anabolic-androgenic steroids in adolescence : winning, looking good or being bad? / Lars Wichstrøm, Willy Pedersen. - (Journal of Studies on Alcohol, 62 (2001) 1 (January); p. 5-13)

  • PMID: 11271964
  • DOI: 10.15288/jsa.2001.62.5


Objective: To investigate the prevalence of anabolic-androgenic steroid (AAS) use among Norwegian adolescents and to contrast three perspectives on AAS use: performance enhancement in sports competition, body image and eating concerns, and AAS-use as belonging to a cluster of problem behaviors.

Method: A nationally representative sample of 8,877 (53.8% female) Norwegian youths (15-22 years of age) were surveyed (response rate 78%). Sports participation included measures of participation in strength sports, participation in competitive sports, strength training and perceived athletic competence. Body image and eating concerns included measures of disordered eating, perceived physical appearance and satisfaction with body parts. Problem behavior was measured by three dimensions of conduct problems (overt destruction, overt nondestruction and covert destruction), illicit drug use and sexual involvement.

Results: Information about AAS was obtained from 8,508 subjects. Lifetime AAS use was 0.8% (1.2% male and 0.6% female), 12-month prevalence was 0.3% and 5.1% had been offered AAS. AAS use did not vary according to sports involvement and demographics. Logistic regression analyses showed that AAS use was associated with such problem behavior as marijuana (cannabis) involvement and overt nondestruction (e.g., aggressive-type conduct problems) and, to some extent, with involvement in power sports and disordered eating. AAS users differed little from those who had been offered but refrained from using AAS, except that they were more likely to be current marijuana users.

Conclusions: Adolescent AAS use seems primarily to be another type of problem behavior and only secondarily is it associated with strength-sport participation and disordered eating.

Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100 men

10 Oct 2020

Positive and negative side effects of androgen abuse. The HAARLEM study : A one-year prospective cohort study in 100 men / Diederik L. Smit, Madelon M. Buijs, Olivier de Hon, Martin den Heijer, Willem de Ronde. - (Scandinavian Journal of Medicine & Science in Sports (2020) 10 October); p. 1-12).

  • PMID: 33038020
  • DOI: 10.1111/sms.13843


An estimated 4-6% of fitness center visitors uses anabolic-androgenic steroids (AAS). Reliable data about adverse reactions of AAS are scarce. The HAARLEM study aimed to provide insight into the positive and negative effects of AAS use. One hundred men (≥18 years) who intended to start an AAS cycle on short notice were included for follow-up. Clinic visits took place before (T0 ), at the end (T1 ), and three months after the end of the AAS cycle (T2 ), and one year after the start of the cycle (T3 ), and comprised a medical history, physical examination, laboratory analysis, and psychological questionnaires. During the follow-up period, four subjects reported a serious adverse event, that is, congestive heart failure, acute pancreatitis, suicidal ideation, and exacerbation of ulcerative colitis. All subjects reported positive side effects during AAS use, mainly increased strength (100%), and every subject reported at least one negative health effect. Most common were fluid retention (56%) and agitation (36%) during the cycle, and decreased libido (58%) after the cycle. Acne and gynecomastia were observed in 28% and 19%. Mean alanine transaminase (ALT) and creatinine increased 18.7 U/l and 4.7 µmol/L, respectively. AAS dose and cycle duration were not associated with the type and severity of side effects. After one-year follow-up (T3 ), the prevalence of observed effects had returned to baseline. There was no significant change in total scores of questionnaires investigating wellbeing, quality of life, and depression. In conclusion, all subjects experienced positive effects during AAS use. Four subjects experienced a serious adverse event. Other side effects were mostly anticipated, mild, and transient.

Suspected reactivation of extrapulmonary tuberculosis focus after non-medical abuse of anabolic androgenic steroids: a case report

25 Dec 2019

Suspected reactivation of extrapulmonary tuberculosis focus after non-medical abuse of anabolic androgenic steroids : a case report / Vikramjit Singh, Angelika Batta. -

  • PMID: 31874100
  • DOI: 10.1515/jbcpp-2019-0167



Youth population has a common tendency to use androgenic steroids. The reasons for such abuse vary from performance enhancement to muscle building in order to enhance physical appearance. Such rampant abuse, aided by fitness centers and gym trainers, has a huge risk of side effects such as hepatic dysfunctions and increased risk of infections.

Case presentation

We report a case of 21-year-old man who started with anabolic steroids, namely testosterone enanthate, nandrolone decanoate and boldenone undecylenate injections, for the purpose of muscle building and strength training at his fitness center. He presented to his family physician after 2 months with upper neck swelling on right side 5 × 4 cm for 15–20 days. He was started on Augmentin 625 mg tablet three times a day for 7 days. On seventh day, swelling persisted, and fine needle aspiration cytology (FNAC) was performed, which was suggestive of granulomatous lesion likely to be tuberculosis. The patient was started with anti-tubercular therapy (ATT) under category A, but swelling did not improve and repeated FNAC was advised. The ATT was withheld and Augmentin tablet was restarted for another 3 days. A revised diagnosis of acute suppurative lymphadenitis was made, and an incision and drainage of the abscess was performed. The patient was started on Amikacin 500 intramuscular injection for 5 days along with faropenem and cefuroxime axetil tablets for 14 days. He initially started recovering but returned with pustular discharge from the incision mark. It was decided to reinitiate the ATT-intensive phase medication for another 2 months. The patient finally recovered with complete healing of the wound. The frequent change of treating physician and misuse of antimicrobials made the diagnosis tougher, contributing to delay in the optimum therapy.


This case highlights the abuse of multiple steroids together in the form of stacking by a young adult, which leads to a rare serious adverse effect such as suspected tubercular reactivation.

Searching for new long-term urinary metabolites of metenolone and drostanolone using gas chromatography-mass spectrometry with a focus on non-hydrolysed sulfates

9 May 2020

Searching for new long-term urinary metabolites of metenolone and drostanolone using gas chromatography-mass spectrometry with a focus on non-hydrolysed sulfates / Aðalheiður Dóra Albertsdóttir, Wim Van Gansbeke, Gilles Coppieters, Kyzylkul Balgimbekova, Peter Van Eenoo, Michael Polet. - (Drug Testing and Analysis 12 (2020) 8 (August); p. 1041-1053)

  • PMID: 32386339
  • DOI: 10.1002/dta.2818


Sulfated metabolites have been shown to have potential as long‐term markers of anabolic–androgenic steroid (AAS) abuse. In 2019, the compatibility of gas chromatography–mass spectrometry (GC–MS) with non‐hydrolysed sulfated steroids was demonstrated, and this approach allowed the incorporation of these compounds in a broad GC–MS initial testing procedure at a later stage. However, research is needed to identify which are beneficial.

In this study, a search for new long‐term metabolites of two popular AAS, metenolone and drostanolone, was undertaken through two excretion studies each. The excretion samples were analysed using GC–chemical ionization–triple quadrupole MS (GC–CI–MS/MS) after the application of three separate sample preparation methodologies (i.e. hydrolysis with Escherichia coli–derived β‐glucuronidase, Helix pomatia–derived β‐glucuronidase/arylsulfatase and non‐hydrolysed sulfated steroids).

For metenolone, a non‐hydrolysed sulfated metabolite, 1β‐methyl‐5α‐androstan‐17‐one‐3ζ‐sulfate, was documented for the first time to provide the longest detection time of up to 17 days. This metabolite increased the detection time by nearly a factor of 2 in comparison with the currently monitored markers for metenolone in a routine doping control initial testing procedure. In the second excretion study, it prolonged the detection window by 25%.

In the case of drostanolone, the non‐hydrolysed sulfated metabolite with the longest detection time was the sulfated analogue of the main drostanolone metabolite (3α‐hydroxy‐2α‐methyl‐5α‐androstan‐17‐one) with a detection time of up to 24 days. However, the currently monitored main drostanolone metabolite in routine doping control, after hydrolysis of the glucuronide with E.coli, remained superior in detection time (i.e. up to 29 days).

Hospital morbidity due to anabolic-androgenic steroids (AAS) consumption in Brazil

1 Apr 2013

Hospital morbidity due to anabolic-androgenic steroids (AAS) consumption in Brazil / Sérgio Henrique Almeida da Silva Junior. - (Revista Brasileira de Medicina do Esporte 19 (2013|) 2 (March/April); p. 108-111)

  • DOI: 10.1590/S1517-86922013000200007


INTRODUCTION: Anabolic androgenic steroids (AAS) are male sex hormones, developers and maintainers of sexual characteristics associated with masculinity and the anabolic status of somatic tissues. The physical and mental effects of AAS abuse are rare and it is almost impossible to say with certainty what adverse effects may become evident after their self-administration; however, they constitute risk of death for the individuals.

OBJECTIVE: The aim of this study was to describe the main characteristics of morbidity by AAS ingestion in Brazil in the 2000/2010 period.

METHODS: Information on hospitalizations was obtained from computerized databases of the Ministry of Health. In the analysis of AAS consumption as primary or secondary diagnosis for hospital admission, the E28.1 (androgen excess), E34.5 (androgen insensitivity syndrome), T38.7 (adverse effect of and underdosing of androgens and anabolic congeners) and Y42.7 (adverse effects in the therapeutic use of androgens and anabolic congeners) codes of the ICD-10 were used.

RESULTS: Hospitalizations by AAS were responsible for 0.001% of total admissions in the country. 1,319 admissions (mean = 119.9, SD = 99.01) were accounted. The Androgen insensitivity syndrome was the primary cause, corresponding to 55.8% of total admissions. Of of all hospitalizations, 1% of patients died and the maximum stay was of 47 days (mean = 3.8, SD = 4.7). Minas Gerais, Maranhão and Espírito Santo presented the highest rates of hospital admissions per 1,000,000 inhabitants from 2002 to 2007. Women and people aged 15-29 presented the highest hospitalization rate 82.5% and 37.7%, respectively.

CONCLUSION: The results of this study showed that the hospitalization rate was relatively low for AAS intake; women and individuals aged 15-29 years possessed the highest rates in the period studied.

Anabolic Steroid Use and Aortic Dissection in Athletes: A Case Series

30 Sep 2020

Anabolic Steroid Use and Aortic Dissection in Athletes : A Case Series / Aghigh Heydari, Atefeh Asadmobini, Feridoun Sabzi. - (Oman Medical Journal 35 (2020) 5 (30 September); p. 514-517)

  • PMID: 33083037
  • PMCID: PMC7568822
  • DOI: 10.5001/omj.2020.120


The use of anabolic steroids in supraphysiologic doses has grown in the last decade as doping drugs in athletes. The high dose of anabolic-androgenic steroids (AAS) causes cardiomyopathy, hypertension, thrombosis, myocardial infarction (MI), weakness of connective tissue, and its sequelae such as tendon injury and aortic dissection. Dissection of the ascending aorta is an uncommon injury that has been recognized with increasing frequency in bodybuilders in recent years. It has been proposed that such cases commonly accompany the weakening of connective tissue and must be actively evaluated in the presence of anabolic steroid usage. We present a case series of isolated ascending aorta dissection in athletes who were bodybuilders. All cases were evaluated by transthoracic echocardiography (TTE) and laboratory exams. These cases also served as a reminder of the risks of ascending aorta dissection with AAS, especially in strength athletes who place high demands on their musculoskeletal structures. The results of the current study suggested that anabolic steroid abuse may be associated with detrimental effects on the myocardium represented as cardiomyopathy or atherosclerotic changes in the coronary artery as MI. These findings also strongly suggest that anabolic steroid treatment predisposes the individual to aortic dissection, especially when the patients are exercised.

Severe Persistent Jaundice after the Abuse of an Anabolic Androgenic Steroid Analogue

25 Sep 2020

Severe Persistent Jaundice after the Abuse of an Anabolic Androgenic Steroid Analogue / Hyun Gil Goh, Yoo Jin Lee, Tae Hyung Kim. - (Korean Journal of Gastroenterology 76 (2020) 3 (25 September); p. 167-170)

  • PMID: 32969366
  • DOI: 10.4166/kjg.2020.76.3.167


Hepatic disorders with prominent cholestasis can be caused by a range of conditions, and anabolic androgenic steroids have been considered a cause of protracted cholestasis. A 29-year-old man who had taken an anabolic androgenic steroid analogue for 2 months visited the hospital complaining of jaundice and indigestion. After stopping the medication, the hyperbilirubinemia tended to decrease, but a transiently elevated aminotransferase level was observed. The endogenous testosterone level also decreased initially but recovered soon after. The liver function profiles were normalized after 2 months of conservative management. This case emphasizes that close drug history taking, including anabolic steroids, is important for identifying the cause of unexplained persistent jaundice.

Keywords: Anabolic agents; Chemical and drug induced liver injury; Jaundice; Steroids; Substance abuse; oral.

Anabolic-androgenic steroid abuse and psychopathology

1 Dec 1998

Anabolic-androgenic steroid abuse and psychopathology / John H. Porcerelli, Bruce A. Sandler. - (Psychiatric Clinics of North America 21 (1998) 4 (1 December); p. 829-833)

  • PMID: 9890124
  • DOI: 10.1016/s0193-953x(05)70043-5


Anabolic steroid abuse is a significant public health problem. There is evidence from both case reports and empirical studies that abuse of these drugs causes significant psychiatric and medical effects. There appears to be a relationship between increased dosages and severity of psychiatric symptomatology. Research is needed on the role of pathologic personality traits in the initiation and maintenance of anabolic steroid abuse.

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