Anabolic-androgenic steroids and dietary supplements among resistance trained individuals in western cities of Saudi Arabia

28 Sep 2021

Anabolic-androgenic steroids and dietary supplements among resistance trained individuals in western cities of Saudi Arabia / Ameen Mosleh Almohammadi, Anas Mohammed Edriss, Turki Talal Enani. - (BMC Sports Science, Medicine and Rehabilitation 13 (2021) 1 (28 September); p. 1-7)

  • PMID: 34583769
  • PMCID: PMC8480089
  • DOI: 10.1186/s13102-021-00345-6


Background: Anabolic-androgenic steroids (AAS) contain testosterone-like androgens and are used as supplements to improve performance, therapeutic measures, appearance, and muscular development.

Purpose: This study aimed to estimate using anabolic-androgenic steroids (AAS) and good and bad practices about dietary supplements among resistance-trained individuals. It further seeked to determine the use of common drugs and supplements containing anabolic steroids among resistance-trained individuals (who work out at the sports centre) and assess users' knowledge about its side effects.

Methods: A cross-sectional survey was conducted at the sports centres of the western cities of Saudi Arabia. A self-administered questionnaire was used to collect data from 120 male resistance-trained individuals.

Results: The majority of the participants (80%) reported that they had not used any hormonal bodybuilding supplement last year, while 20% said they had used such hormonal supplements. Approximately half (52.5%) of participants reported that they always used dietary supplements. A total of 44.2% of participants possessed inadequate knowledge of these products. The main reason behind the use of hormones and supplements was to increase muscle mass.

Conclusions: A minority of resistance-trained individuals in the studied population frequently misused AAS. However, the results cannot be generalised to the whole of Saudi Arabia. AAS consumption can be reduced by enhancing the level of awareness and knowledge of potential adverse health outcomes.

Severe Cardiac and Metabolic Pathology Induced by Steroid Abuse in a Young Individual

21 Jul 2021

Severe Cardiac and Metabolic Pathology Induced by Steroid Abuse in a Young Individual / Adrian Tirla, Cosmin Mihai Vesa, Simona Cavalu. - (Diagnostics 11 (2021) 8 (21 July); p. 1-13)

  • PMID: 34441248
  • PMCID: PMC8394374
  • DOI: 10.3390/diagnostics11081313


Androgenic-Anabolic Steroids (AAS) abuse is known to play an important role in causing the systemic inflammatory response and multiple-organ dysfunction in healthy individuals. Although many of the undesirable effects of steroid abuse have been reported, at present, little is known about the effect of anabolic supplements and the correlation between cardiac and metabolic pathology. This paper presents a case of a 25 year old patient with a complex medical history after 6 months of steroid administration. Myocardial infraction, dyslipidemia, obesity, hyperuricemia, secondary diabetes, and chronic renal disease were identified after clinical and para-clinical examinations. The particularities of this case were interpreted in the context of a literature review, highlighting the effect of multi-organ damage as a result of the uncontrolled use of anabolic steroid supplements.

An exploration of doping-related perceptions and knowledge of disabled elite athletes in the UK and Austria

29 Sep 2021

An exploration of doping-related perceptions and knowledge of disabled elite athletes in the UK and Austria / Kathrin Weber, Laurie B. Patterson, Cornelia Blank. - (Psychology of Sport and Exercise 58 (2022) 102061)




Compared to anti-doping research in Olympic sport, the issue of doping is under-researched and poorly understood in Paralympic sport. However, with the growth of the Paralympic Games and the increased number of disabled elite athletes, the number of doping controls and doping cases has also increased. Therefore, there is a need to address the dearth of evidence in disabled sport contexts and develop an understanding of disabled elite athletes' perceptions, reasons and knowledge related to doping to ensure appropriate policy and programmes are implemented.


Sixteen disabled elite athletes from Austria (n = 9) and the UK (n = 7) participated in semi-structured interviews. Data were analysed using inductive reflexive thematic analysis (Braun & Clarke, 2019a).


Four themes were generated during the analysis. The first showed that athletes perceive doping to be a well-known and wide-spread issue in Paralympic sport. The second theme illustrated that disabled elite athletes are exposed to extreme pressure (e.g., to earn money), which they state poses a risk for using prohibited methods and/or substances. Thirdly, athletes suggested that there are several ways to cheat if someone would like to find ‘loopholes’ (e.g., misuse of Therapeutic Use Exemptions) in the current anti-doping system, which they reported only works partially. Lastly, although it is not officially named as an anti-doping rule violation, athletes proposed cheating on classification as a form of doping – and the greatest threat to the integrity of disabled sport.


For the first time, the current study shows that doping in the context of disabled elite sport likely stems from only a few main factors; a perception of pressure and faults in the anti-doping system. To address these risks, prize money could be distributed more broadly, the TUE process and classification system should be more closely scrutinised, and targeted anti-doping education that addresses the main risk factors in disabled elite sport should be provided for all athletes and their support team worldwide.

KeywordsParalympicsDopingAnti-Doping systemReasonsEducationThematic analysis

Anabolic-Androgenic Steroid Use in Sports, Health, and Society

1 Aug 2021

Anabolic-Androgenic Steroid Use in Sports, Health, and Society / Shalender Bhasin, Disa L. Hatfield, Jay R. Hoffman, William J. Kraemer, Michele Labotz, Stuart M. Phillips, Nicholas A. Ratamess. - (Medicine & Science in Sports & Exercise 50 (2021) 8 (August); p. 1778-1794)

  • PMID: 34261998
  • DOI: 10.1249/MSS.0000000000002670


This consensus statement is an update of the 1987 American College of Sports Medicine (ACSM) position stand on the use of anabolic-androgenic steroids (AAS). Substantial data have been collected since the previous position stand, and AAS use patterns have changed significantly. The ACSM acknowledges that lawful and ethical therapeutic use of AAS is now an accepted mainstream treatment for several clinical disorders; however, there is increased recognition that AAS are commonly used illicitly to enhance performance and appearance in several segments of the population, including competitive athletes. The illicit use of AAS by competitive athletes is contrary to the rules and ethics of many sport governing bodies. Thus, the ACSM deplores the illicit use of AAS for athletic and recreational purposes. This consensus statement provides a brief history of AAS use, an update on the science of how we now understand AAS to be working metabolically/biochemically, potential side effects, the prevalence of use among athletes, and the use of AAS in clinical scenarios.

Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trial

4 Nov 2008

Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trial / Ralf Nass, Suzan S. Pezzoli, Mary Clancy Oliveri, James T. Patrie, Frank E. Harrell Jr, Jody L. Clasey, Steven B. Heymsfield, Mark A. Bach, Mary Lee Vance, Michael O. Thorner. - (Annals of Internal Medicine 149 (2008) 9 (4 November); p. 601-611)

  • PMID: 18981485
  • PMCID: PMC2757071
  • DOI: 10.7326/0003-4819-149-9-200811040-00003


Background: Growth hormone secretion and muscle mass decline from midpuberty throughout life, culminating in sarcopenia, frailty, decreased function, and loss of independence. The decline of growth hormone in the development of sarcopenia is one of many factors, and its etiologic role needs to be demonstrated.

Objective: To determine whether MK-677, an oral ghrelin mimetic, increases growth hormone secretion into the young-adult range without serious adverse effects, prevents the decline of fat-free mass, and decreases abdominal visceral fat in healthy older adults.

Design: 2-year, double-blind, randomized, placebo-controlled, modified-crossover clinical trial.

Setting: General clinical research center study performed at a university hospital.

Participants: 65 healthy adults (men, women receiving hormone replacement therapy, and women not receiving hormone replacement therapy) ranging from 60 to 81 years of age.

Intervention: Oral administration of MK-677, 25 mg, or placebo once daily.

Measurements: Growth hormone and insulin-like growth factor I levels. Fat-free mass and abdominal visceral fat were the primary end points after 1 year of treatment. Other end points were body weight, fat mass, insulin sensitivity, lipid and cortisol levels, bone mineral density, limb lean and fat mass, isokinetic strength, function, and quality of life. All end points were assessed at baseline and every 6 months.

Results: Daily administration of MK-677 significantly increased growth hormone and insulin-like growth factor I levels to those of healthy young adults without serious adverse effects. Mean fat-free mass decreased in the placebo group but increased in the MK-677 group (change, -0.5 kg [95% CI, -1.1 to 0.2 kg] vs. 1.1 kg [CI, 0.7 to 1.5 kg], respectively; P < 0.001), as did body cell mass, as reflected by intracellular water (change, -1.0 kg [CI, -2.1 to 0.2 kg] vs. 0.8 kg [CI, -0.1 to 1.6 kg], respectively; P = 0.021). No significant differences were observed in abdominal visceral fat or total fat mass; however, the average increase in limb fat was greater in the MK-677 group than the placebo group (1.1 kg vs. 0.24 kg; P = 0.001). Body weight increased 0.8 kg (CI, -0.3 to 1.8 kg) in the placebo group and 2.7 kg (CI, 2.0 to 3.5 kg) in the MK-677 group (P = 0.003). Fasting blood glucose level increased an average of 0.3 mmol/L (5 mg/dL) in the MK-677 group (P = 0.015), and insulin sensitivity decreased. The most frequent side effects were an increase in appetite that subsided in a few months and transient, mild lower-extremity edema and muscle pain. Low-density lipoprotein cholesterol levels decreased in the MK-677 group relative to baseline values (change, -0.14 mmol/L [CI, -0.27 to -0.01 mmol/L]; -5.4 mg/dL [CI, -10.4 to -0.4 mg/dL]; P = 0.026); no differences between groups were observed in total or high-density lipoprotein cholesterol levels. Cortisol levels increased 47 nmol/L (CI, 28 to 71 nmol/L (1.7 microg/dL [CI, 1.0 to 2.6 microg/dL]) in MK-677 recipients (P = 0.020). Changes in bone mineral density consistent with increased bone remodeling occurred in MK-677 recipients. Increased fat-free mass did not result in changes in strength or function. Two-year exploratory analyses confirmed the 1-year results.

Limitation: Study power (duration and participant number) was insufficient to evaluate functional end points in healthy elderly persons.

Conclusion: Over 12 months, the ghrelin mimetic MK-677 enhanced pulsatile growth hormone secretion, significantly increased fat-free mass, and was generally well tolerated. Long-term functional and, ultimately, pharmacoeconomic, studies in elderly persons are indicated.

Value of measuring muscle performance to assess changes in lean mass with testosterone and growth hormone supplementation

12 Jul 2011

Value of measuring muscle performance to assess changes in lean mass with testosterone and growth hormone supplementation / E. Todd Schroeder, Jiaxiu He, Kevin E. Yarasheski, Ellen F. Binder, Carmen Castaneda-Sceppa, Shalender Bhasin, Christina M Dieli-Conwright, Miwa Kawakubo, Ronenn Roubenoff, Stanley P. Azen, Fred R. Sattler. - (European Journal of Applied Physiology 112 (2012) 3 (March); p. 1123-1131)

  • PMID: 21748366
  • PMCID: PMC3448487
  • DOI: 10.1007/s00421-011-2077-y


We hypothesized that treatment with testosterone (T) and recombinant human growth hormone (rhGH) would increase lean mass (LM) and muscle strength proportionally and an in a linear manner over 16 weeks. This was a multicenter, randomized, controlled, double-masked investigation of T and rhGH supplementation in older (71 ± 4 years) community-dwelling men. Participants received transdermal T at either 5 or 10 g/day as well as rhGH at 0, 3.0 or 5.0 μg/kg/day for 16 weeks. Body composition was determined by dual-energy X-ray absorptiometry (DEXA) and muscle performance by composite one-repetition maximum (1-RM) strength and strength per unit of lean mass (muscle quality, MQ) for five major muscle groups (upper and lower body) at baseline, week 8 and 17. The average change in total LM at study week 8 compared with baseline was 1.50 ± 1.54 kg (P < 0.0001) in the T only group and 2.64 ± 1.7 (P < 0.0001) in the T + rhGH group and at week 17 was 1.46 ± 1.48 kg (P < 0.0001) in the T only group and 2.14 ± 1.96 kg (P < 0.0001) in the T + rhGH group. 1-RM strength improved modestly in both groups combined (12.0 ± 23.9%, P < 0.0001) at week 8 but at week 17 these changes were twofold greater (24.7 ± 31.0%, P < 0.0001). MQ did not significantly change from baseline to week 8 but increased for the entire cohort, T only, and T + rhGH groups by week 17 (P < 0.001). Despite sizeable increases in LM measurements at week 8, tests of muscle performance did not show substantive improvements at this time point.

Cardiometabolic risks during anabolic hormone supplementation in older men

18 Oct 2012

Cardiometabolic risks during anabolic hormone supplementation in older men / J. He, S. Bhasin, E.F. Binder, K.E. Yarasheski, C. Castaneda-Sceppa, E.T. Schroeder, R. Roubenoff, C-P. Chou, S.P. Azen, F.R. Sattler. - (Obesity 21 (2013) 5 (May); p. 968-975)

  • PMID: 23784898
  • PMCID: PMC3930448
  • DOI: 10.1002/oby.20081


Objective: To determine the cardiometabolic risks of testosterone and growth hormone (GH) replacement therapy to youthful levels during aging.

Design and methods: A double-masked, partially placebo controlled study in 112 men 65-90 years-old was conducted. Transdermal testosterone (5 g vs. 10 g/day) using a Leydig Cell Clamp and subcutaneous recombinant GH (rhGH) (0 vs. 3 vs. 5 μg/kg/day) were administered for 16-weeks. Measurements included testosterone and IGF-1 levels, body composition by DEXA, and cardiometabolic risk factors (upper body fat, blood pressure, insulin sensitivity, fasting triglycerides, HDL-cholesterol, and serum adiponectin) at baseline and after 16 weeks of treatment.

Results: Some cardiometabolic factors improved (total and trunk fat, triglycerides, HDL-cholesterol) and others worsened (systolic blood pressure, insulin sensitivity index [QUICKI], adiponectin). Cardiometabolic risk composite scores (CRCSs) improved (-0.69 ± 1.55, P < 0.001). In multivariate analyses, QUICKI, triglycerides, and HDL-cholesterol contributed 33%, 16%, and 14% of the variance in CRCS, respectively. Pathway analyses indicated that changes in fat and lean mass were related to individual cardiometabolic variables and CRCS in a complex manner. Changes in BMI, reflecting composite effects of changes in fat and lean mass, were more robustly associated with cardiometabolic risks than changes in fat mass or LBM individually.

Conclusions: Testosterone and rhGH administration was associated with diverse changes in individual cardiometabolic risk factors, but in aggregate appeared not to worsen cardiometabolic risk in healthy older men after 4-months. The long-term effects of these and similar anabolic therapies on cardiovascular events should be investigated in populations with greater functional limitations along with important health disabilities including upper body obesity and other cardiometabolic risks.

Recreational drug use and sport: Time for a WADA rethink?

9 May 2013

Recreational drug use and sport : Time for a WADA rethink? / Ivan Waddington, Ask Vest Christiansen, John Gleaves, John Hoberman, Verner Møller. - (Performance Enhancement & Health 2 (2013) 2 (June); p. 41-47)

  • DOI: 10.1016/j.peh.2013.04.003

Part of special issue:

Anti-Doping and Non-Performance Enhancing Drugs: The Debate


This paper examines current policies towards drug use in sport to evaluate their appropriateness. The focus is on the World Anti-Doping Agency's (WADA's) attitudes and policies towards athletes’ use of recreational drugs. Since recreational drugs such as marijuana are not performance-enhancing, one of the most frequently used arguments to justify doping controls – that those involved in drug use derive an unfair advantage over other competitors – cannot be used to justify controls on the use of such drugs. Given this, it is suggested that the attempt to control the use of marijuana within a sporting context is best understood in terms of the growing concern about drug ‘abuse’ within the wider society. The paper further suggests that the WADA has used the ‘spirit of sport’ argument to reach beyond traditionally accepted sporting concerns. In this regard, WADA is using anti-doping regulations to police personal lifestyle and social activities that are unrelated to sporting performance. On this basis, it is concluded that WADA's focus and resources should return to enforcing sporting values related to doping rather than policing athletes’ lifestyles, and it is therefore suggested that the ban on marijuana and similar recreational drugs should be lifted.

Flawed reasoning for testing for recreational drugs in anti-doping

13 Aug 2013

Flawed reasoning for testing for recreational drugs in anti-doping / Bengt Kayser, Patrick O’Hare. - (Performance Enhancement & Health 2 (2013) 2 (June); p. 68-69)

  • DOI: 10.1016/j.peh.2013.08.008

Part of special issue:

Anti-Doping and Non-Performance Enhancing Drugs: The Debate

Comment on Henne, Koh and McDermott

14 Aug 2013

Comment on Henne, Koh and McDermott / Ivan Waddington, Ask Vest Christiansen, John Gleaves, John Hoberman, Verner Møller. - (Performance Enhancement & Health 2 (2013) 2 (June); p. 56-57)

  • DOI: 10.1016/j.peh.2013.08.002

Commentary on:

Coherence of drug policy in sports : Illicit inclusions and
illegal inconsistencies / Kathryn Henne, Benjamin Koh, Vanessa McDermott. - (Performance Enhancement & Health 2 (2013) 2 (June); p. 48-55)

  • DOI: 10.1016/j.peh.2013.05.003
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