Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern?
BACKGROUND
The problem of anabolic-androgenic steroid (AAS) abuse has recently generated widespread public and media attention. Most AAS abusers, however, are not elite athletes like those portrayed in the media, and many are not competitive athletes at all. This larger but less visible population of ordinary AAS users began to emerge in about 1980. The senior members of this population are now entering middle age; they represent the leading wave of a new type of aging former substance abusers, with specific medical and psychiatric risks.


METHODS
We reviewed the evolving literature on long-term psychiatric and medical consequences of AAS abuse.


RESULTS
Long-term use of supraphysiologic doses of AAS may cause irreversible cardiovascular toxicity, especially atherosclerotic effects and cardiomyopathy. In other organ systems, evidence of persistent toxicity is more modest, and interestingly, there is little evidence for an increased risk of prostate cancer. High concentrations of AAS, comparable to those likely sustained by many AAS abusers, produce apoptotic effects on various cell types, including neuronal cells--raising the specter of possibly irreversible neuropsychiatric toxicity. Finally, AAS abuse appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood syndromes, and progression to other forms of substance abuse. However, the prevalence and severity of these various effects remains poorly understood.


CONCLUSIONS
As the first large wave of former AAS users now moves into middle age, it will be important to obtain more systematic data on the long-term psychiatric and medical consequences of this form of substance abuse.
Kanayama
Gen
G
Biological Psychiatry Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States.
Hudson
James I
JI
Pope
Harrison G
HG
D045930:Anabolic Agents / Q000008:administration & dosage / Q000633:toxicity*; D050197:Atherosclerosis / Q000139:chemically induced* / Q000175:diagnosis; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004300:Doping in Sports / Q000517:prevention & control / Q000523:psychology; D004347:Drug Interactions; D006801:Humans; D007006:Hypogonadism / Q000139:chemically induced* / Q000175:diagnosis; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D013287:Illicit Drugs / Q000009:adverse effects; D007248:Infertility, Male / Q000139:chemically induced* / Q000175:diagnosis; D008134:Long-Term Care; D008297:Male; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology*; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis
D045930:Anabolic Agents; D013287:Illicit Drugs