Introduction and Overview of the Topic
People have been abusing anabolic-androgenic steroids for a long time since their discovery. The problem is no longer endemic to athletes. It has become a global phenomenon affecting even non-athletes, such as adolescents (Ip & Silva, 2022). Steroid abuse is gaining widespread international attention owing to increasing reports of high use among celebrity athletes in Olympic sports. WADA (World Antidoping Agency) estimates that one to two percent of the urine samples it collects from athletes test positive for some performance-enhancing substances. Also, in a survey of about 2,167 anonymous world-class athletes, nearly 43.6 percent admitted to using steroids (Perry et al., 2020). Studies estimate that more than a hundred thousand Americans abuse drugs in secret. However, their secret comes to light when they develop aggressive and homicidal behavior. Such cases have become common in the media.
Even so, it is essential to note that people, particularly athletes, have been using substances to enhance their athletic performance since the first Olympic games in Athens, Greece. Researchers have found anecdotal evidence demonstrating the use of steroids among German soldiers to enhance aggressiveness in the second world war (Pope & Kanayama, 2022). Reports of abuse among athletes began to emerge in the 50s. Athletes use drugs to increase their strength, competitiveness, and muscle mass. Shortly after, the sports management organization, including the Olympic Committee, decided to ban the use of steroids in sports as they gave athletes an undue advantage over others and were possibly harmful in the long run. In 1991, Congress made anabolic steroids a schedule III drug and mandated the DEA (Drugs Enforcement Agency) to control and monitor its use among Americans (Ip & Silva, 2022). This paper reviews the current literature on the behavioral impacts of anabolic steroids.
Anabolic Androgenic Steroids (AAS)
The world has known for years that castrating male animals results in tameness, infertility, and loss of masculine characteristics. In 1849, scientists found that the testes of humans produce hormones that change the body (Ip & Silva, 2022). However, according to Anawalt (2019), the history of anabolic steroids goes back to the 1870s when Charles Brown administered an extract of bovine testes and canine to himself. He felt a remarkable increase in vigor and energy. His experiments resulted in the high use of testicular extracts by the public. Even so, scientists first isolated one of the hormones and named it testosterone in 1935. The hormone is a compound comprised of nineteen carbon atoms and comes from the cholesterol in the body. In men, the testes mainly produce this hormone, but adrenal glands also produce it in lesser amounts. In women, the ovaries and adrenal glands are responsible for producing testosterone. Normal levels of plasma testosterone range from about 300-1,000 ng/dl. A hormone-binding protein binds most of the testosterone and is inactive. Active testosterone makes up about two to three percent of all testosterone circulating in the human body (Ip & Silva, 2022). It metabolizes into dihydrotestosterone and estradiol. The former compound is ten times more potent, while the latter has feminine effects.
When scientists discovered testosterone, they did not find it active when humans took it orally, and the liver immediately inactivated it when injected. However, experts made synthetic derivatives by altering the compound’s molecule, increasing its activity and bio-availability (Pope & Kanayama, 2022). Presently, AAS are active when a person takes them orally or through injections, based on the type and position of the biochemical changes. Some AAS have few side effects, while others are not easily detectable in antidoping evaluation and tests. Although we know AAS as a performance-enhancing substance, they have medical uses. They include treating anemia, muscle dystrophies, male hypogonadism, and wasting associated with HIV infection. Almost all human cells can detect steroids; therefore, every organ can suffer the side effects of high doses of steroids (Ip & Silva, 2022).
The Olympic committee has banned athletes and nations such as Russia for increased doping or steroid abuse cases. Several cultural factors increase steroid abuse, including concerns about image, competitiveness, and improvement in biotechnology. Young individuals, including adolescents, are now becoming victims of the doping trend due to the high competitiveness of college and high school sports (Pope & Kanayama, 2022). The improved performance they get from steroids can decide whether an athlete gets a scholarship to study at a reputable university. Despite the increasing media reports of steroid use among young and veteran athletes, no database tracks such cases. However, estimates are in thousands for known cases and could be millions for those who use them in secret (Borel Hänni et al., 2019). Studies have found that most abusers are men, particularly those involved in weightlifting and bodybuilding. There have been cases of bodybuilders killing their lovers due to the psychological impacts of steroid abuse. Women, especially those involved in bodybuilding sports, also tend to use drugs. A 2005 survey found lifetime AAS use at 1.7 percent in eighth, 2 percent in 10th, and about 2.6 percent in 12th graders (Ip & Silva, 2022).
Studies have also tried establishing the risk factors for AAS, but there is limited data. However, some of these factors include conduct disorders, poor relationships with parents, particularly the father, perception of bad body image, and substance abuse. Education levels, race, and income are not potential risk factors (National Institute on Drug Abuse, 2020). Among young people, make are highly likely to abuse AAS compared to females. Participation in sports and knowing people who abuse AAS also increase the likelihood that a person will use the substance in the future. Analysts estimated the market for anabolic steroids to be about 400 million dollars. Thirty years later, the market has grown tremendously. Data Bridge Market Research estimated that the market value for anabolic steroids was 56.45 billion dollars in 2021 (Data Bridge Market Research, 2022). The researchers expect it to rise to about 131.98 billion dollars by 2029 with an 11.20 percent CAGR. This statistic shows that more people are using steroids daily despite increasing awareness of their dangerous side effects. A steroid cycle lasts between 6 and 14 weeks and costs hundreds, if not thousands, of dollars (Data Bridge Market Research, 2022). A single cycle comprises daily oral dosage plus monthly or weekly intramuscular injections.
Sources of Steroids
Since most physicians cannot prescribe performance-enhancement drugs, many steroid users depend on illegitimate sources. It seems easy to acquire steroids in the United States since there are a high number of abusers (Drug Enforcement Agency, n.d). Many websites promise to provide anabolic steroids and ship them to any part of the world. Most users go to the internet to retrieve steroids. According to the DEA, most illicit anabolic steroids in the U.S. come from abroad. Some sellers also illegally divert steroids from legitimate sources (inappropriate prescribing or theft). Some gyms also sell steroids to their customers. Other sources include schools, coaches, trainers, teammates, and even bodybuilding competitions.
Common street names for steroids include roids, juice, weight gainers, stackers, Arnolds, and pumpers. There is a booming market for steroids in America. According to reports, about 500,000 young Americans, mostly males, spend more than 400 million dollars yearly on anabolic steroids. Most steroids come from Mexico and Europe, where people can buy them from pharmacies. Upon arriving in the country, they sell on the streets from one to ten dollars per pill (Drug Enforcement Agency, n.d). Bodybuilders and other athletes stack them, taking multiple doses that cost up to 1,000 dollars or more every month. Once a person becomes addicted, they can spend thousands of their income on these drugs.
Effects of Steroids on the Brain and Behavior
Brain Impacts
AAS act as androgen receptors influencing gene expression and cellular functioning. They regulate pathways involved in male characteristics development and activate androgen receptors, which increase calcium levels within the heart, brain cells, and skeletal muscle (Pope & Kanayama, 2022). Calcium is essential in neural signaling. Studies involving human cells show that AAS interacts with GABAA receptors responsible for mediating the high anxiety levels steroid users report. Also, animal studies have demonstrated that steroids increase serotonin levels in the human brain, affecting moods and dopamine levels. Chronic abuse of steroids causes abnormalities in reward-related pathways of mice. Specifically, rats that received daily injections of nandrolones for about four weeks demonstrated a loss of preference for sweet things, which is a sign of brain dysfunction (Pope & Kanayama, 2022). Reduced levels of serotonin, noradrenaline and dopamine (reward hormones) in their nucleus accumbens also accompanied this loss.
Aggression
Mice studies show that high dosages and duration of steroid use correlates with aggressive behavior. In one experiment, the female mice ended up killing their offspring. Researchers have also conducted extensive studies to understand the impacts of steroids on human aggression (Chegeni et al., 2021). To determine their effects, a study compared aggression measures in fifty users of anabolic steroids with forty nonusers. It found that users had little control over their aggressive feelings. However, although sixty percent had high irritability levels and bad tempers, the research did not find any significant differences in the tendency to engage in violence (Hauger et al., 2021). However, researchers have found cases where steroids induced crime. Many studies show high verbal aggression among steroid users.
Despite contradicting results, most researchers agree that high steroid use increases aggression and irritability. Anabolic steroid users report experiencing episodes of anger. However, personality traits in users, such as antisocial and borderline disorder, may confound the findings of most of these studies (National Institute on Drug Abuse, 2020). People who abuse steroids engage in more fights, physical violence, and verbal aggression than nonusers. Those who agree that steroids increase aggression test their theory by giving high doses of steroids for weeks to subjects and examining their behavior. Several studies found that using steroids for more than six weeks increased aggression. High doses also increased feelings of aggression and irritability than placebo, although the impacts were variable across subjects. A possible explanation is that not all steroid users develop aggressive behavior or irritability (National Institute on Drug Abuse, 2020). Other underlying factors, such as stress levels, may increase the likelihood that individuals will be aggressive after taking steroids for months or even weeks.
Studies have not documented enhanced aggression in those who use physiologic doses. Many researchers have sought to understand the impact of Andriol, which appears mainly in fertility studies but rarely in cases of steroid abuse (Chegeni et al., 2021). They found no aggressive behavior among its users. Physiologic doses such as cypionate 100 milligrams or supraphysiological doses do not increase aggression in patients. Therefore, they are safe to use for treating conditions such as hypogonadism. However, other researchers have found contradicting evidence. Pany et al. (2019) conducted a cross-sectional study investigating the impact of supraphysiologic doses among bodybuilders. They found that supraphysiologic doses negatively impact the users’ health, and their prolonged use causes hormone changes.
Similarly, high levels of serum testosterone correlate with highly aggressive behavior. Some studies have investigated the impact of AAS on children. A study that gave doses of testosterone to children with delayed adolescence found that both genders demonstrated increased aggressive impulses and behavior than other children (Hauger et al., 2021). The researchers showed that testosterone causes aggression in children the same way it does in adults.
According to recent studies, human and animal subjects who have stopped taking AAS still show signs of anxiety and aggression (National Institute on Drug Abuse, 2020). They suggest that this could be due to the extended hormonal glands suppression in the users’ bodies during their abuse period. During sustained use of AAS, the body minimizes its testosterone output to balance the levels of hormones. Due to the high doses involved in AAS use, the body experiences hormonal imbalance despite its attempts to attain balance. In most cases, even after ceasing steroids, the hormonal glands hardly return to normal functioning, resulting in reduced testosterone levels that cause increased anxiety (National Institute on Drug Abuse, 2020).
Addiction and other Disorders
Steroid users are highly likely to report cases of anxiety. High to moderate use can also cause major depressive disorders, hypomania, and mania. However, manic symptoms are not usually similar across individuals. Most show no psychological changes, while a few portray significant impacts (Hauger et al., 2021). Also, an irresolute percentage of users develop steroid-related disorders. Drug and substance use disorders occur as a result of addiction. A person continues to use the drug or substance despite experiencing adverse effects. For steroids, adverse effects include psychological and physical problems like sexual dysfunction, breast growth for men, high blood fat, mood swings, heart diseases, and other behavioral effects. Anabolic steroid abusers may also give up crucial activities for fear of missing workouts or violating their dietary limitations. Steroids also result in other health problems, such as cardiovascular diseases (Perry et al., 2020). The users spend vast amounts of money and time obtaining steroids (Borel Hänni et al., 2019). Some try to quit using or reduce their intake with no success, most likely due to anxiety about changes to their body, depression, and other adverse withdrawal effects.
Steroid withdrawal occurs when a person is addicted to a substance. A systematic review of the literature on steroid addiction suggests that more than thirty-two percent of individuals who misuse AAS develop dependency (Hauger et al., 2021). Addition symptoms may include high tolerance. With time, users need more drugs to achieve the effects they used to feel when they began abusing steroids. Another sign of dependence on steroids is severe withdrawal symptoms when a person stops. They include reduced appetite, restlessness, insomnia, low sex drive, steroid cravings, and fatigue (National Institute on Drug Abuse, 2020). However, depression is the most serious of these symptoms because it can easily lead to suicidal tendencies or ideation.
Researchers have also found that steroid users are likely to abuse other drugs. One study found that weightlifters who used steroids to increase their muscle mass also tried illegal substances (Nelson et al., 2022). Elite athletes who do not use steroids tend to avoid other drugs, such as alcohol and cigarettes, to optimize their performance and physique. However, when they begin using steroids, their behavior changes. Adolescents who use steroids are at an increased risk of using other illegal drugs than their adult counterparts. The use of steroids among teenagers is highly concerning because of its dangers. These teenagers tend to experiment with various other drugs, including opiates, which are highly addictive. Gymnastics who abuse steroids also tend to easily fall prey to opiates as they often use them to relieve pain from injuries they suffer during training. Unfortunately, substance and drug abuse centers often tend to ignore steroid abuse among teenagers (Nelson et al., 2022). Despite becoming common, physicians rarely notice steroid abuse in young people, and therefore there is a need to increase awareness of this problem among clinicians.
Conclusion
The above review presents essential information about anabolic steroids and their impact on the brain and behavior. As seen, there are many side effects of abusing steroids. They present through changes in a person’s outward appearance and behavior. Some of the long-term impacts of using steroids are hard to observe. Even though steroids do not cause the same immediate or intense reaction in the human brain as drugs such as cocaine, it creates long-lasting changes. The change affects neurotransmitter production and distribution, leading to a change in the behavior and mood of a person. Most people develop aggressive behavior, such as a tendency to engage in physical and verbal fights. Others may develop mood, anxiety, and even depressive disorders. However, researchers have not established why some abuse other drugs, such as opiates. There are many studies explaining how adults develop behavioral problems after using steroids. However, few study how steroids affect behavior among children and adolescents. There is speculation that the abuse of drugs among young people could affect their academic achievements. We need to conduct more research to understand this problem.
References
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