title: Anabolic-androgenic steroid dependence: an emerging disorder.
abstract: OBJECTIVE
  Anabolic-androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects.
  
  
  METHODS
  We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database.
  
  
  RESULTS
  About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be adapted slightly for cumulatively acting drugs such as AAS.
  
  
  CONCLUSIONS
  AAS dependence is a valid diagnostic entity, and probably a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies.
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Gen
authors.initials: G
authors.lastname: Kanayama
authors.forename: Kirk J
authors.initials: KJ
authors.lastname: Brower
authors.forename: Ruth I
authors.initials: RI
authors.lastname: Wood
authors.forename: James I
authors.initials: JI
authors.lastname: Hudson
authors.forename: Harrison G
authors.initials: HG
authors.lastname: Pope
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects / Q000494:pharmacology*; D000818:Animals; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000523:psychology; D006224:Cricetinae; D004300:Doping in Sports; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced*; D018482:Muscle, Skeletal / Q000187:drug effects*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence
chemical_list: D045930:Anabolic Agents