AUSTIN, Texas — Contrary to public perception, most androgen abusers are not elite athletes seeking to enhance performance, but instead are nonathletes pursuing a leaner and more muscular appearance, according to a speaker at the American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress.
“Initially, [anabolic steroid abuse] came to the forefront because there were elite athletes who wanted to gain competitive advantage, but now what we see are normal people who are not trying to win a competition, they just want to look good,” Sandeep Dhindsa, MD, associate professor of medicine and director of the division of endocrinology and metabolism at St. Louis University, Missouri, said during a presentation.
The typical anabolic steroid abuser is a nonathlete weightlifter who began using these agents in his early 20s, according to Dhindsa.
“Most of them are not using testosterone. They’re using a steroid that is approved for veterinary use — boldenone [Equipoise] — and some of the others,” Dhindsa said.
It is estimated that approximately 6% of U.S. men have abused anabolic steroids at some point during their lifetime, Dhindsa said. About 30% of these men become long-term users, who may have developed a steroid dependency. In perhaps half of those, dependency is due to muscle dysmorphia, a psychiatric disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, as “an insatiable desire for continuous body shaping towards, but never reaching, a desired goal.”
“Then, there are a large number of people who are not really trying to take anabolic steroids, but are turning to supplements to get their muscles and, unknown to them, many of these supplements contain anabolic steroids,” Dhindsa said.
These men may seek medical care for side effects of steroid misuse, such as erectile dysfunction or infertility, or because they’ve been found to have a high hemoglobin level. History and physical exam may reveal anabolic steroid abuse among patients who do not disclose this information.
“You’re [likely] to have someone who has symptoms of both androgen excess and androgen deficiency,” Dhindsa said. Indicators of androgen excess may include a muscular appearance, high hemoglobin level, low HDL, male-pattern baldness and truncal acne. Signs of androgen deficiency may include testicular atrophy, infertility, low sperm count and perhaps gynecomastia depending on the agent used.
“One thing that we worry about [in these patients] is sudden deaths,” Dhindsa said. Although there are few long-term studies, some anabolic steroid users have been found to have cardiac hypertrophy on autopsy. In one study, compared with nonusers, steroid users had lower ejection fraction and systolic and diastolic dysfunction.
Less easily quantified, aggression has also been associated with steroid abuse, Dhindsa said.
Infertility appears to be less of a risk with anabolic steroid use, at least in the short term.
“There seems to be quick reversal as long as they stop anabolic steroids around 3 or 4 months,” Dhindsa said. “Recovery may take sometimes up to 2 years, but there is no evidence that it causes permanent damage to spermatogenesis.” – by Jill Rollet
Dhindsa S. Androgen therapy use and abuse. Presented at: Presented at: AACE Annual Scientific and Clinical Congress; May 3-7, 2017; Austin, Texas.
Disclosure: Dhindsa reports serving on the speaker’s bureau for AbbVie.