PEDs have potential not only for direct medical consequences but also for exacerbating other conditions. AASs are the most commonly used PEDs, with testosterone, boldenone, and trenbolone being the most frequently detected drugs among illicit PED users in the United States (Figure 4). Although boldenone is a veterinary steroid not approved for human use, this fact has not diminished its popularity among illicit AAS users. In the small subgroup of PED users who are elite athletes, WADA most commonly detects testosterone, stanozolol, and nandrolone, and the highest prevalence of positive tests occur in bodybuilding, power lifting, weightlifting, boxing, and kickboxing. WADA’s Anti-Doping Program is based on the WADA Code, a universal document that contains comprehensive guidelines for best practices in international and national antidoping programs (17). WADA also publishes the doping violation thresholds for banned substances.

• There is a prisoners’ dilemma for athletes, with the dominant strategy being to cheat.
• Studies have linked deletion polymorphisms of uridine diphospho-glucurosyl transferase 2B17 (UGT2B17) (the major enzyme for testosterone glucuronidation) with significantly lower T/E ratios (357).
• AAS use among men continues to be a major healthcare issue that has not been adequately addressed by the medical community.

Pro 3: PEDs can be regulated and safely used.

As literature shows that screen time among adolescents during the COVID-19 pandemic increased by 52% 39, it is also important to consider that the data used in this study (Year 3 data from ABCD) overlaps with the years of the COVID-19 pandemic. We adjusted for this variable in the statistical analysis; however, the shifting of family dynamics and the social distancing restrictions leading to decreased in-person interactions and increased screen time should be noted when interpreting the results. Additionally, it should be noted that all odds ratios (ORs), though significant, are relatively small.

Strategies for Decreasing Prescription PED Use Among Adolescents

When these esters of testosterone (such as testosterone enanthate and cypionate) are administered in an oily suspension, they are released very slowly into the aqueous plasma because of their hydrophobicity.

Initial Approach to Men Using AAS Seeking Healthcare

Some physiological and psychological side effects of anabolic steroid abuse have potential to impact any user, while other side effects are gender specific. With all the information, attention, and debate over performance-enhancing drugs (or PEDs), many people want to further understand how performance-enhancing drugs affect one’s body. It’s an important area of concern for athletes and at the foundation of why USADA and other anti-doping organizations exist.

Blood Doping

However, studies have shown that Adderall and related drugs can help improve hand-eye coordination, acceleration, and strength, which athletes could benefit from in addition to improved focus and concentration. Meanwhile, in the NFL, teams vary widely in the amount of drug-related suspensions enforced by the team. By comparison, only 3 games have been missed by Pittsburgh Steelers players due to suspension, while the Indianapolis Colts dwarf that number with 54 games missed. Suspensions related to substance abuse saw a sharp uptick in the NFL beginning in 2012, jumping to 82 suspensions in 2012 from 21 suspensions in 2011. Note that, in the map below, ‘third strikes’ are calculated as 16-game bans.

This hormone, made infamous by Lance Armstrong, is produced naturally by the kidneys to stimulate red-blood-cell production. But injecting the synthetic version can inflate that count, enhancing your body’s ability to transport oxygen to working muscles and skyrocketing your aerobic capacity and endurance. If you suffer from anemia caused by kidney disease, such injections prescribed by a doctor can be lifesaving. Thomas O’Connor owns and operates a private practice internal medicine clinic based out of Essex, CT, and has written a book on the adverse effects of AAS misuse. Initial assessment should include screening for hypertension, hemoglobin a1c, assessment of cardiovascular risk factors, and ensuring patients are up to date with age-appropriate cancer screenings. A review of the risks of these agents, particularly the danger of combining with nitrate compounds, should be discussed.

The Legal Aspect of PEDs Usage

These results have led to the hypothesis that AAS use may constitute a risk factor for disinhibitory behavior, partly by affecting the serotonergic system. An additional study on dominant behavior assessed pair-housed male rats for dominance status based on their behavior and alterations in body weights (228). Throughout the study, the rats had limited social interactions on a daily basis. After 1 week, rats received nandrolone or placebo, and their behavior was observed over 2 months.

• And I remember the first time I ever did it, the blood was pulled out in Spain, outside of Valencia, Spain, and it was put back into me three weeks later in the middle of the Tour de France.
• By definition, outperforming others is a goal of competitive athletics and thus, PED use may be perceived as rational behavior in a competitive athlete’s mind.
• A harm reduction approach, with a strong emphasis on reducing cardiovascular risk, should be taken with men actively using AAS who decline current cessation.
• The annual female adolescent prevalence is 0.3% in 8th-graders, 0.5% in 10th-graders, and 0.3% for 12th-graders.

Physiological Health Risks

The expert panel reviewed and synthesized evidence in their areas of expertise and prepared the Scientific Statement. The SSTF, the Advocacy and Public Outreach Core Committee, and the what is alcoholism Council of The Endocrine Society reviewed the Scientific Statement. In 2005, androstenedione was classified as a schedule III controlled substance. Unfortunately, the Dietary Supplement Health and Education Act of 1994 allows many steroid precursors to be sold over the counter with minimal regulation. The Anabolic Steroid Control Act of 1990 made AAS a schedule III controlled substance.

Stanozolol is a 17α-alkylated androgen that can be taken orally or by injection. Other substitutions in the steroid A ring may alter the susceptibility of the steroid molecule to aromatization. A number of nonsteroidal SARMs, which display tissue-specific activation of androgen signaling, are in development (8, 13). Food and Drug Administration has not approved these novel nonsteroidal SARMs for clinical use, some of them are already being sold illicitly on the Internet. Recent studies increasingly suggest that the use of AASs and other PEDs often occurs in conjunction with use of multiple classical drugs of abuse (77, 78).

The combination of easily procurable AAS/PEDs via internet sources and increased societal emphasis on idealistic muscular physiques across social media-fueled this health crisis. As with any substance use disorder, it is our duty as clinicians to provide empathetic, ethical, and supportive care to minimize self-harm until successful cessation is achieved. Limited formal undergraduate ped usage and graduate medical education on AAS use, distrust of clinicians among men using AAS,19 and lack of evidence-based harm reduction approaches to this population have resulted in suboptimal care.