Women's Health Care PhysiciansThe use of anabolic-androgenic steroids AAS by young athletes has been a primary concern of sports governing bodies because of the implications for unfair advantage in performance and the potential for adverse side effects. However, recent studies have questioned the presumption aghletes participation in organised sport is anabolic steroids female athletes primary risk factor for AAS use in adolescents as well as the extant estimates of the magnitude of the problem. Increasing evidence indicates that AAS use is associated with non-athletes and is linked to a broader syndrome of problem behaviours rather than anabolicc to achieve sporting success, and that sports participation anavar for dogs be protective against AAS anabolic steroids female athletes. Moreover, employing lifetime prevalence to gauge AAS use limits accurate evaluation of the personal and public health risk as the majority of respondents are not habitual users. Previous studies may steroiss also inflated prevalence values through ambiguously worded survey questions and other design flaws, and few data are available on actual dosages.
Anabolic steroid use in female athletes and the implications for FTMs | 4thWaveNow
Anabolic steroids are composed of testosterone and other substances related to testosterone that promote growth of skeletal muscle, increase hemoglobin concentration, and mediate secondary sexual characteristics. These substances have been in use since the s to promote muscle growth, improve athletic performance, and enhance cosmetic appearance. Although anabolic steroids are controlled substances, only to be prescribed by a physician, it is currently possible to obtain anabolic steroids illegally without a prescription.
There are significant negative physical and psychologic effects of anabolic steroid use, which in women can cause significant cosmetic and reproductive changes. Anabolic steroid use can be addictive and, therefore, difficult to stop.
Treatment for anabolic steroid abuse generally involves education, counseling, and management of withdrawal symptoms. Health care providers are encouraged to address the use of these substances, encourage cessation, and refer patients to substance abuse treatment centers to prevent the long-term irreversible consequences of anabolic steroid use.
Anabolic steroids were first discovered to promote muscle growth and enhance athletic performance in the s. Since the s, these substances have been used by body builders, athletes, and others to improve performance and enhance cosmetic appearance. In , the International Olympic Committee first banned the use of anabolic steroids. Now most athletic organizations prohibit the use of these substances, and drug testing has become routine in professional sports 1.
A growing awareness of steroid abuse also has led to federal regulation of these substances. Anabolic steroids were first classified as schedule III controlled substances in , and in , a new law expanded the definition of anabolic steroids to include substances that could be converted to testosterone, such as androstenedione 2. Current clinical uses of these substances in women include libido disorders, cachexia related to chronic disease such as human immunodeficiency virus HIV , and anemia.
Clinical use requires a prescription from a licensed physician and close observation 3. Although the exact prevalence of anabolic steroid use is not known, data from the National Household Survey on Drug Abuse estimates that approximately 1 million individuals in the United States are current or former anabolic steroid users, and that more than , individuals use these substances annually 4.
The Youth Risk Behavior Surveillance Study evaluated more than 16, high-school adolescents and reported a lifetime prevalence of use of 2. Pressure to perform well is pervasive throughout amateur and professional athletics and can lead some individuals to pursue unsafe and illegal means to enhance performance. Anabolic steroids have been shown to improve athletic performance by increasing muscle strength and aggressiveness 1. Another motivation to take anabolic steroids is to improve physical appearance because these substances increase muscle size and reduce body fat.
Factors that predict anabolic steroid use in teenagers include perceived social pressure to increase muscularity, depression, and a negative body image. In addition, steroid users are more likely to have participated in high-school sports, used other illicit substances, and engaged in other risky behaviors. Individuals are likely to begin steroid use in their late teenaged years and 20s. Boldenone undecylenate Methenolone enanthate Nandrolone decanoate Nandrolone phenpropionate Testosterone cypionate Testosterone enanthate Testosterone propionate Trenbolone acetate.
Supraphysiologic doses of testosterone, which result in serum testosterone levels 10— times the normal level, are required to have the desired cosmetic and athletic effect 6, 7. Because oral and injectable testosterone is inactive, testosterone esters and ethers have been developed to enhance bioavailability when administered intramuscularly, transdermally, and orally Box 1. Polypharmacy and drug cycling starting and stopping and use of new preparations with very short half-lives are common among steroid abusers to evade detection of these substances during drug testing.
Some dietary and body building supplements sold over the Internet are mislabeled and can contain anabolic steroids. Alternatively, these substances are imported and sold illegally. Other substances, not considered anabolic steroids, are also inappropriately used for cosmetic and athletic enhancement purposes.
Some of these substances include danazol, dehydroepiandrosterone sulfate, growth hormone, human chorionic gonadotropin, insulin, and levothyroxine. These medications are more easily obtained because they are not considered controlled substances. Some medications, such as dehydroepiandrosterone sulfate, are considered dietary supplements and can be purchased over the counter. These preparations can have serious risks when used for nonmedical purposes, some of which may be similar to those of anabolic steroids.
As previously noted, many dietary supplements actually contain anabolic steroids even though the labeling does not reflect this. It is important to recognize and inform patients that dietary supplements do not require close government regulation 8. More information on anabolic steroids is available at http: There are significant negative physical and psychologic effects of anabolic steroid use.
Anabolic steroid use in women can cause significant cosmetic and reproductive changes see Box 2. In addition, these substances can have a negative effect on serum lipid parameters, liver function particularly with methylated steroids , glucose tolerance, and they can significantly increase the risk of cardiovascular disease and thrombotic events, including venous thromboembolism, stroke, and myocardial infarction 9.
Anabolic steroid use during pregnancy may cause virilization of a female fetus. Psychologic effects include irritability, hostility, mood changes, personality changes, and psychosis 2. Changes in the biomechanics of limb movements caused by use of anabolic steroids also can lead to tendon injuries.
Use of unsanitary needles and sharing needles puts users at risk of infections such as hepatitis, HIV, and intramuscular abscesses Some of these health risks are irreversible. Data show that anabolic steroid use in women is accompanied by extreme dissatisfaction with body image and a body dysmorphic syndrome similar to anorexia.
Such women engage in rigid eating and exercise schedules that can impair social and occupational functioning Although most anabolic steroids can be detected with urine testing kits available commercially, testing for naturally occurring and novel compounds may be difficult.
Urine screening for drug use in adolescents without the adolescent's prior informed consent is not recommended Individuals suspected of abusing anabolic steroids should be referred to physicians with experience in this area or to drug treatment centers.
Treatment centers may be located through the National Institute on Drug Abuse at http: No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Requests for authorization to make photocopies should be directed to: Performance enhancing anabolic steroid abuse in women. American College of Obstetricians and Gynecologists. Women's Health Care Physicians. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
History Anabolic steroids were first discovered to promote muscle growth and enhance athletic performance in the s. Prevalence Although the exact prevalence of anabolic steroid use is not known, data from the National Household Survey on Drug Abuse estimates that approximately 1 million individuals in the United States are current or former anabolic steroid users, and that more than , individuals use these substances annually 4.
Risk Factors of Abuse Pressure to perform well is pervasive throughout amateur and professional athletics and can lead some individuals to pursue unsafe and illegal means to enhance performance. Types of Steroid Preparations to Enhance Bioavailability Oral Preparations Fluoxymesterone Mesterolone Methandienone Methyltestosterone Mibolerone Oxandrolone Oxymetholone Stanozolol Dihydrotestosterone Androstenedione Intramuscular Preparations Boldenone undecylenate Methenolone enanthate Nandrolone decanoate Nandrolone phenpropionate Testosterone cypionate Testosterone enanthate Testosterone propionate Trenbolone acetate Types of Substances Anabolic steroids are composed of testosterone and other substances related to testosterone that promote growth of skeletal muscle, increase hemoglobin concentration, and mediate secondary sexual characteristics.
Other Drugs of Abuse Other substances, not considered anabolic steroids, are also inappropriately used for cosmetic and athletic enhancement purposes. Signs of Anabolic Steroid Abuse in Women Acne Hirsutism Deepening of the voice Male pattern balding Clitoromegaly Breast atrophy Irregular menstrual cycles Infertility Significant muscle growth Depression Mood instability Adverse Effects There are significant negative physical and psychologic effects of anabolic steroid use.
Drug Testing Although most anabolic steroids can be detected with urine testing kits available commercially, testing for naturally occurring and novel compounds may be difficult.
Treatment Treatment for anabolic steroid abuse generally involves education, counseling, and management of withdrawal symptoms. Recommendations Have information about the risks and deleterious effects of abusing anabolic steroids available to patients, especially teenagers and athletes. Address the use of these substances, encourage cessation, and refer patients to substance abuse treatment centers to prevent the long-term irreversible consequences of anabolic steroid use. Hormonal doping and androgenization of athletes: Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: Drug Alcohol Depend ; Anabolic-androgenic steroid therapy in the treatment of chronic diseases.
J Clin Endocrinol Metab ; Anabolic-androgenic steroid use in the United States. Youth risk behavior surveillance — United States, A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men.