Side effects and experiences of doping with anabolic androgenic steroids in men and women

Sammanfattning: Anabolic androgenic steroids (AAS) are mainly used in non-medical conditions for aesthetic and performance- enhancing purposes. The use of AAS is a growing public health problem and a concern in society due to side effects. Men and women use AAS despite their known negative effects and unknown long-term risks. The research in this thesis aimed to study somatic and psychiatric side effects, describe patterns of use, compare self-reported doping agent use with urine test results and to describe AAS usersʼ lived experiences. The approaches in this thesis have been both quantitative (Studies I-IV) and qualitative (Studies V-VI) and were focused on use of AAS outside the field of sports. Study I was an experimental study and included eleven healthy male volunteers administered with a single dose of nandrolone. The aim was to study endocrine and cardiovascular effects. The results showed that luteinising hormone, follicle stimulating hormone and testosterone were suppressed for 14 days after administration. Cholesterol and an enzyme involved in the cholesterol synthesis were increased and hence AAS may be a risk factor for cardiovascular diseases even in low doses. Studies II and III were descriptive studies with eight women and fifty-six men who contacted healthcare (Anti-Doping Hot-Line) on their own initiative. The aim was to identify the pattern of doping agent use in women and compare with similar data reported in men. We also aimed to identify psychiatric and personality disorders and to measure anxiety and depression in men using Structured Clinical Interviews Diagnosis -I and -II, the Brief Scale for Anxiety and the Montgomery Asberg Depression Rating Scale. The participants were interviewed about demographics, details of their AAS use and other co-used substances. They were also asked about motives, side effects they experienced and family background. Both men and women expressed a concern for side effects but there were very few who wanted professional help to terminate their AAS use. Classical side effects of AAS were reported and women contacted healthcare at an earlier stage of use. Women were introduced to AAS by a man in a close relationship. Male individuals diagnosed with a personality disorder showed a significantly increased risk of reporting aggressive feelings/behaviour, suicidal thoughts/attempts and criminality. It was more common that men used injections, higher doses of AAS and several different AAS substances per cycle compared with women. Study IV was an experimental and descriptive study with thirty men and six women who self-reported use of AAS and other performance-enhancing substances within the past year. Our aim was to identify which doping agents could be detected in doping test. The results showed that as many as 50% and 100 % respectively of current male and female testosterone users may escape a doping test. This indicates that AAS users outside the field of sports using only testosterone as a doping agent may not be identified by the routine tests currently used. In men, luteinising hormone and follicle stimulating hormone were normalised within 6-12 months. Haematocrit and haemoglobin values were shown to be high in male current users compared with previous users whereas all women displayed normal values. Thus, cessation of AAS use may reduce the risk of cardiovascular diseases relatively fast. Studies V and VI were qualitative studies with twelve women and twelve men using AAS. The studies applied a phenomenological approach aimed to describe AAS usersʼ lived experiences of using AAS. Our aim was to deepen the understanding about womenʼs and menʼs use of AAS. The results showed that it is an existential challenge to achieve the perfect body. Body dissatisfaction were mastered by hard training, strict diet and the use of AAS. Low self-esteem is compensated for by self-control, discipline and performance. For women it is an arduous endeavour to balance the substances’ side effects with desired femininity. For men the new self-identity stimulates respect by being impressive, prominent and dominant. The use of AAS means living with lies and the fear of being discovered, which may lead to consequences and feelings of not being genuine. The built-up body is fragile from both an existential and a biological perspective, self-esteem can quickly be destroyed in the absence of confirmation and acceptance from others or the substances may damage the body in the form of side effects. Conclusions and reflection: Our studies show that AAS use is associated with many somatic and psychiatric side effects. However, regardless of the perceived side effects, many choose to continue with their AAS use. The fact that the use of AAS is illegal does not prevent those who want to from achieving their goals. A non-judgemental attitude would facilitate the meeting between AAS users and healthcare as it could lead to users experiencing trust and security and would encourage open and honest communication.