title: Mad men, women and steroid cocktails: a review of the impact of sex and other factors on anabolic androgenic steroids effects on affective behaviors.
abstract: BACKGROUND
  For several decades, elite athletes and a growing number of recreational consumers have used anabolic androgenic steroids (AAS) as performance enhancing drugs. Despite mounting evidence that illicit use of these synthetic steroids has detrimental effects on affective states, information available on sex-specific actions of these drugs is lacking.
  
  
  OBJECTIVE
  The focus of this review is to assess information to date on the importance of sex and its interaction with other environmental factors on affective behaviors, with an emphasis on data derived from non-human studies.
  
  
  METHODS
  The PubMed database was searched for relevant studies in both sexes.
  
  
  RESULTS
  Studies examining AAS use in females are limited, reflecting the lower prevalence of use in this sex. Data, however, indicate significant sex-specific differences in AAS effects on anxiety-like and aggressive behaviors, interactions with other drugs of abuse, and the interplay of AAS with other environmental factors such as diet and exercise.
  
  
  CONCLUSIONS
  Current methods for assessing AAS use have limitations that suggest biases of both under- and over-reporting, which may be amplified for females who are poorly represented in self-report studies of human subjects and are rarely used in animal studies. Data from animal literature suggest that there are significant sex-specific differences in the impact of AAS on aggression, anxiety, and concomitant use of other abused substances. These results have relevance for human females who take these drugs as performance-enhancing substances and for transgender XX individuals who may illicitly self-administer AAS as they transition to a male gender identity.
authors.affiliation: Cherokee Nation Technology Solutions Contractor to: The National Intrepid Center of Excellence (NICoE) Network Research Program, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda, MD, 20889, USA. marie.m.onakomaiya.gr@dartmouth.edu.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Onakomaiya
authors.affiliation: Department of Physiology and Neurobiology, Geisel School of Medicine at Dartmouth, HB 7701, Hanover, NH, 03755, USA.
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Henderson
mesh_terms: D000374:Aggression / Q000187:drug effects / Q000523:psychology; D045930:Anabolic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000728:Androgens / Q000008:administration & dosage / Q000009:adverse effects*; D000818:Animals; D001007:Anxiety / Q000139:chemically induced / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000139:chemically induced* / Q000523:psychology*; D012646:Self Administration; D012727:Sex Characteristics; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D013256:Steroids
keywords: Aggression; Alcohol; Anabolic androgenic steroids (AAS); Anxiety; Corticotropin-releasing factor/hormone (CRF/CRH); Diet; Exercise; GABAA receptors; Serotonin (5-hydroxytryptamine; 5-HT); Sex differences