title: Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse.
abstract: OBJECTIVE
  The objective of our study was to evaluate the psychological consequences of real-world AAS use in athletes abusing such agents, in comparison with a placebo and control group of comparable athletes, while correlating the severity of abuse with the side effects observed. The hypothesis tested by the study was that the use of AAS induces a wide range of psychological side effects whose impact and emergence is dependent upon the severity of the abuse.
  
  
  METHODS
  The study includes a substantial group of AAS abusing athletes and two more groups demographically similar to the first, one composed of athletes not using any substance and a placebo group. All athletes were stratified according to the severity of AAS abuse. Psychometric instruments were applied to all athletes in specific time intervals, dependent to the AAS abusers' regimens, providing us with a final psychological profile that was to be compared to the pre-study profile. All results were comparable (within and between groups) for statistically significant differences and correlated to the severity of the abuse. Homogeneity of all groups was safeguarded by random doping controls, monitoring of drug levels and analysis of all self obtained drugs by method of liquid chromatography/mass spectrometry. All athletes were provided with a common exercise and dietary regime, so common training and nutritional conditions were achieved.
  
  
  METHODS
  We studied a cohort of 320 body-building, amateur and recreational athletes, of whom 160 were active users of AAS (group C), 80 users administering placebo drugs (group B) and 80 not abusing any substance (Group A). Group C athletes were stratified according to AAS abuse parameters, thus providing us with three subgroups of "light, medium and heavy abuse". Athletes of groups A and B were included in a "no abuse" subgroup. The psychometric instruments used were the Symptoms Check List-90 (SCL-90) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The psychometric evaluations took place within a time interval of 13 months. Statistical analysis was performed by using the Mann-Whitney/Wilcoxon two-sample non-parametric test (Kruskal-Wallis test for two groups) for data that were not normally distributed and Linear regression analysis was used to ascertain the correlation between severity of use and escalation of side effects.
  
  
  RESULTS
  The study showed a statistically significant increase in all psychometric subscales recorded in group C, and no statistically significant difference in group C and A. There was a significant increase in the scorings of group C for all subscales of SCL-90 and HDHQ. Correlation of abuse severity and side effects showed that there was a statistical significant increase in Delta values of all SCL-90 and HDHQ subscales that escalated from light abuse to medium and heavy abuse/consumption patterns.
  
  
  CONCLUSIONS
  The results of the study suggest that the wide range of psychiatric side effects induced by the use of AAS is correlated to the severity of abuse and the force of these side effects intensifies as the abuse escalates.
authors.affiliation: Department of Psychiatry, University Hospital, Thessaly University Medical School, Larissa, Greece. tpsportmed@th.forthnet.gr
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Pagonis
authors.forename: Nikiforos V
authors.initials: NV
authors.lastname: Angelopoulos
authors.forename: George N
authors.initials: GN
authors.lastname: Koukoulis
authors.forename: Christos S
authors.initials: CS
authors.lastname: Hadjichristodoulou
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D004300:Doping in Sports / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D005260:Female; D006167:Guilt; D006791:Hostility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000523:psychology*; D010258:Paranoid Behavior / Q000139:chemically induced / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods; D012016:Reference Values; D012649:Self Concept; D012720:Severity of Illness Index; D013177:Sports; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D045930:Anabolic Agents; D013256:Steroids