title: Heavy Testosterone Use Among Bodybuilders: An Uncommon Cohort of Illicit Substance Users.
abstract: OBJECTIVE
  To identify and characterize patterns of use among a contemporary cohort of current anabolic-androgenic steroid (AAS) users.
  
  
  METHODS
  An anonymous, self-administered, 49-item questionnaire was posted on message boards of Internet websites popular among AAS users and administered via SurveyMonkey from February 1, 2015, to June 1, 2015. Thirty-seven questions were analyzed for this study.
  
  
  RESULTS
  A total of 231 male respondents met the inclusion criteria. Most were white, were older than 25 years, were employed with above average income, and had received a formal education beyond high school. Ninety-three percent began using AAS after the age of 18 years, and 81% reported using 400 mg or more of testosterone per week. Factors associated with longer duration of use (>5 years) included higher incomes (≥$75,000, P=.003), increased testosterone dosages (>600 mg per week, P=.007), older age (≥35 years, P<.001), being married (P<.001), and being self-employed (P<.001). The Internet was the most common source of testosterone (53%). Ninety-three percent used at least one additional performance-enhancing drug. Seventy-seven percent had routine laboratory tests performed, and 38% reported laboratory abnormalities at some point. Nearly all experienced subjective adverse effects while using and not using testosterone. Fifty-three percent reported use of other illegal substances, most commonly (90%) beginning before AAS initiation. Ten percent had a criminal conviction, 91% of which preceded AAS use. Fifty percent were felonies.
  
  
  CONCLUSIONS
  The population of AAS users is disparate from that of other drugs of abuse. Laboratory test abnormalities and adverse effects are common and should be taken into account when counseling patients who may be using AASs.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Westerman
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Charchenko
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ziegelmann
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: George C
authors.initials: GC
authors.lastname: Bailey
authors.affiliation: Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Todd B
authors.initials: TB
authors.lastname: Nippoldt
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: Trost.Landon@mayo.edu.
authors.forename: Landon
authors.initials: L
authors.lastname: Trost
mesh_terms: D000328:Adult; D017668:Age of Onset; D045930:Anabolic Agents / Q000494:pharmacology*; D000728:Androgens / Q000494:pharmacology; D003415:Crime / Q000706:statistics & numerical data; D006801:Humans; D013287:Illicit Drugs; D020407:Internet; D008297:Male; D058573:Performance-Enhancing Substances / Q000494:pharmacology*; D000067029:Physical Appearance, Body / Q000187:drug effects*; D012923:Social Class; D013008:Somatotypes / Q000502:physiology / Q000523:psychology; D015813:Substance Abuse Detection / Q000379:methods / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000494:pharmacology*
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D013287:Illicit Drugs; D058573:Performance-Enhancing Substances; D013739:Testosterone