Ischemic Stroke Related to Anabolic Abuse

1 Mar 2008

Ischemic Stroke Related to Anabolic Abuse / Rodrigo Daniel Santamarina, Ana Gabriela Besocke, Lucas Martin Romano, Pablo Leonardo Ioli, Sergio Eduardo Gonorazky. - (Clinical Neuropharmacology 31 (2008) 2 (March-April); p. 80- 85).
- PMID: 18382179.
- DOI: 10.1097/WNF.0b013e3180ed4485


Anabolic-androgenic steroid (AAS) abuse increased in recent years, and it is associated with numerous adverse effects. Few reports on ischemic stroke related to anabolic steroid abuse have been published. We report a case of a 26-year-old male amateur athlete who suffered a posterior territory ischemic stroke. No abnormalities were found in angiography and echocardiography studies, neither in hemostatic profile. His only significant risk factor was nonmedical use of stanozolol, an anabolic steroid. Anabolic steroids are capable of increasing vascular tone, arterial tension, and platelet aggregation; therefore, they are prone to produce atherothrombotic phenomena. Because of young people's widespread use of anabolic steroids, physicians should be aware of this kind of complication.

Would Relaxation of the Anti-doping Rule Lead to Red Queen Effects?

7 Jun 2020

Would Relaxation of the Anti-doping Rule Lead to Red Queen Effects? / Bengt Kayser, Adreas De Block. - (Sport, Ethics and Philosophy (2020) 7 June); p. 1-15). -


One of the claims sometimes advanced in favour of anti-doping is that allowing doping would lead to a uniform increase in performance in comparison to no doping. The idea is that if all athletes would use doping, this would just shift the playing field to a higher level without a change in ranking, but at a higher health cost. In this paper, we critique this contention. We first develop our theoretical framework, with reference to the so-called Red Queen effect. We then argue that, if doping were allowed, Red Queen effects would not be the rule. We also show that to some extent Red Queen effects would occur, but these would not necessarily be morally problematic. We end by developing an argument in favour of a more liberal approach of doping, since such would allow escaping from today’s runaway effects of anti-doping efforts.

Association Between Legal Performance-Enhancing Substances and Use of Anabolic-Androgenic Steroids in Young Adults

18 May 2020

Association Between Legal Performance-Enhancing Substances and Use of Anabolic-Androgenic Steroids in Young Adults / Jason M. Nagata, Kyle T. Ganson, Sasha Gorrell, Deborah Mitchison, Stuart B. Murray. - (JAMA Pediatrics (2020) 18 May).
- PMID: 32421175.
- PMCID: PMC7235901.
- DOI: 10.1001/jamapediatrics.2020.0883


This cohort study uses data from the National Longitudinal Study of Adolescent to Adult Health database to describe the association between anabolic-androgenic steroid use and legal performance-enhancing substances in young adults.

Adverse cardiovascular effects of anabolic steroids: pathophysiology imaging

29 Dec 2011

Adverse cardiovascular effects of anabolic steroids : pathophysiology imaging / Reza Golestani, Riemer H. J. A. Slart, Robin P. F. Dullaart,
Andor W. J. M. Glaudemans, Clark J. Zeebregts, Hendrikus H. Boersma, René A. Tio, Rudi A. J. O. Dierckx. - (European Journal of Clinical Investigation 42 (2012) 7 (July); p. 795-803).
- PMID: 22299602.
- DOI: 10.1111/j.1365-2362.2011.02642.x


Background: Anabolic-androgenic steroids (AAS) are widely abused for enhancing muscle mass, strength, growth and improving athletic performance.

Materials and methods: In recent years, many observational and interventional studies have shown important adverse cardiovascular effects of AAS abuse.

Conclusions: This review discusses established and future perspectives of novel molecular imaging techniques that may serve as potential tools for early detection of AAS-associated cardiovascular disorders.

Doping in tennis, where we are and where we should be going?

31 Jan 2020

Doping in tennis, where we are and where we should be going? / Thomas Zandonaia, Darias Holgado. - (Performance Enhancement & Health 7 (2020) 100157 (31 January); p. 1-2).
- DOI: 10.1016/j.peh.2020.100157


- The lack of studies concerning doping in tennis is evident.
- Doping rumours give rise to easy simplistic speculation around tennis players.
- Projects to fight against doping in tennis are needed.

Recreational Anabolic-Androgenic Steroid Use Associated With Liver Injuries Among Brazilian Young Men

11 Oct 2010

Anabolic-androgenic Steroids : A Possible New Risk Factor of Toxicant-Associated Fatty Liver Disease / Paulo Adriano Schwingel, Helma Pinchemel Cotrim, Bernardo Rios Salles, Carlos Eduardo Almeida, Crimério Ribeiro dos Santos Jr, Bruno Nachef, Antonio Ricardo Andrade, Cláudio Cesar Zoppi. - (Liver International 31 (2011) 3 (March); p. 348-353).
- PMID: 21040407.
- DOI: 10.1111/j.1478-3231.2010.02346.x


Background: Industrial toxin and drugs have been associated with non-alcoholic fatty liver disease (NAFLD); in these cases, the disease has been termed toxicant-associated steatohepatitis (TASH).

Aim: This study hypothesizes that the use of anabolic-androgenic steroids (AAS) could also be a risk factor to TASH or better toxicant-associated fatty liver disease (TAFLD) development.

Methodology: Case-control study including 180 non-competitive recreational male bodybuilders from August/2007 to March/2009. Ninety-five had a history of intramuscular AAS use (cases; G1) and 85 were non-users (controls; G2). They underwent a clinical evaluation and abdominal ultrasound, and their blood levels of aminotransferases, creatine phosphokinase (CPK), lipids, glucose and insulin were measured. TAFLD criteria: history of AAS use >2 years; presence of hepatic steatosis on ultrasound and/or aminotransferase alterations with normal CPK levels; exclusion of ethanol intake ≥20 g/day or use of other drugs; and exclusion of obesity, dyslipidaemia, diabetes and other liver diseases. Homeostasis model assessment for insulin resistance ≥3 was considered insulin resistant. Independent t-test, odds ratio (OR) and 95% confidence intervals (95% CI) were calculated.

Results: All cases were asymptomatic. Clinical and laboratorial data were similar in G1 and G2 (P>0.05). TAFLD criteria were observed in 12.6% of the G1 cases and 2.4% of controls had criteria compliant with non-alcoholic fatty liver related to metabolic conditions. OR was 6.0 (95% CI: 1.3-27.6).

Conclusions: These results suggest that AAS could be a possible new risk factor for TAFLD. In this type of fatty liver disease, the individuals had a low body fat mass and they did not present insulin resistance.

The Influence of Concomitant Use of Alcohol, Tobacco, Cocaine and Anabolic Steroids on Lipid Profiles of Brazilian Recreational Bodybuilders

1 Jun 2020

The Influence of Concomitant Use of Alcohol, Tobacco, Cocaine and Anabolic Steroids on Lipid Profiles of Brazilian Recreational
Bodybuilders / Paulo Adriano Schwingel, Cláudio Cesar Zoppi, Helma Pinchemel Cotrim. - (Substance Use & Misues 49 (2014) 9 (July); p. 1115-1125).
- PMID: 24766402.
- DOI: 10.3109/10826084.2014.903753


Anabolic-androgenic steroids (AAS) are used to enhance physical performance and/or appearance. The aim of this study was to evaluate the influence of the concomitant use of alcohol, tobacco, cocaine, and AAS on blood lipid profiles of 145 asymptomatic male bodybuilders from the Northeast region of Brazil. Interviews, clinical exams, and serological evaluations were performed on all participants between 2007 and 2009. All subjects' self-reported use of testosterone or its derivatives, 118 individuals reported alcohol intake, 27-reported cigarette smoking, and 33 confirmed cocaine use. Four subjects were users of all drugs at the same time. Higher levels of total cholesterol and LDL-cholesterol were observed among concomitant users of alcohol, tobacco, cocaine, and AAS.

An Overview on Performance and Image Enhancing Drugs (PIEDs) Confiscated in Italy in the Period 2017-2019

1 Jun 2020

An Overview on Performance and Image Enhancing Drugs (PIEDs) Confiscated in Italy in the Period 2017-2019 / Sara Odoardi, Serena Mestria, Giulia Biosa, Valeria Valentini, Sofia Federici, Sabina Strano Rossi. - (Clinical Toxicology (2020) 1 June; p. 1-6).
- PMID: 32475176
- DOI: 10.1080/15563650.2020.1770277


Context: The illegal market of counterfeit and falsified medicines and supplements containing unlabeled pharmaceuticals is expanding worldwide. They are usually referred to by the term "performance and image enhancing drugs" (PIEDs) and are mainly steroids, stimulants, hormones, and drugs for erectile dysfunction. PIEDs are easily accessible through the online or black markets. We analyzed over 400 such medicines confiscated in Italy in the period 2017-2019, to determine their composition.

Methods: Confiscated products were analyzed by gas chromatography/mass spectrometry and liquid chromatography/high-resolution mass spectrometry, in order to ascertain their composition and to evaluate the correspondence between what was declared on the label and the actual content, or to identify unknown products.

Results: The most commonly found substance was anabolic steroids, found in 64% of products, with 11% containing hormone modulators, 6% stimulants, 6% sexual enhancers (mainly sildenafil) and other drugs, including thyroid hormones, melanin stimulators, and vitamins. These substances were often in mixtures. The products were often mislabeled, containing contaminants in addition to the drug declared, or consisted of a drug completely different from the one reported on the label. Fifteen percent of products had a qualitative composition completely different from that declared, while 10% of products showed cross-contamination with other drugs, mainly testosterone esters, probably due to the presence of residues of other drugs in the production line. In addition, 11% of products were not labeled, so their purported composition was unknown.

Discussion: PIEDs pose a threat to public health. The main risks are related to the intrinsic toxicity of the substances found, especially when taken without a therapeutic indication. Another issue is related to the mislabeling of the fake medicines, and the poor-quality standard of counterfeit product preparation, with additional risks of the presence of other toxic ingredients or microbial contamination.

Conclusions: The use of counterfeit products is a public health concern, as it constitutes a high risk for consumer health. It is mainly caused by the uncontrolled use of steroids, stimulants, sexual enhancers, and other medicaments, without medical indication or supervision, with variable and unknown compositions and doses, as well as other contaminants as a result of the absence of good manufacturing practices.

Enhancement Drugs and the Athlete

11 Dec 2008

Enhancement Drugs and the Athlete / Francesco Botrè, Antonio Pavan. - (Physical Medicine and Rehabilitation Clinics of North America 20 (2009) 1 (February); p. 133-148).
- PMID: 19084767.
- DOI: 10.1016/j.pmr.2008.10.010


This article considers the health risks associated with the abuse of performance-enhancing drugs (PEDs) in sport. After an overview on the evolution of doping substances and methods and on the current international organization of the antidoping tests, the potential risks correlated with abuse of PEDs are presented. Specific problems of drug associations, designer steroids, and nutritional supplements also are discussed. Data from randomized clinical trials may not be sufficient to identify the complete range of adverse effects possible with abuse of PEDs; more specific studies are necessary to assess their actual toxic potential.

Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis

15 Mar 2015

Polypharmacy among anabolic-androgenic steroid users : a descriptive metasynthesis / Dominic Sagoe, Jim McVeigh, Astrid Bjørnebekk, Marie-Stella Essilfie, Cecilie Schou Andreassen, Ståle Pallesen. - (Substance Abuse Treatment, Prevention, and Policy 10 (2015) 12 (15 March); p. 1-19).
- PMID: 25888931.
- PMCID: PMC4377045.
- DOI: 10.1186/s13011-015-0006-5


Background: As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published.

Method: We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users' polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council's qualitative research synthesis manual and the PRISMA guidelines.

Results: A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n=22), followed by Sweden (n=7), England only (n=5), and the United Kingdom (n=4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. 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.

Conclusions: 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.

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