Original research
Somatic effects of AAS abuse: A 30-years follow-up study of male former power sports athletes

https://doi.org/10.1016/j.jsams.2017.03.008Get rights and content

Abstract

Objectives

The aim of the present study was to investigate the association between somatic health and former abuse of AAS in former elite male athletes 30 years after the end of their active sports career.

Design

Retrospective follow-up study.

Methods

N = 996 former elite male athletes were sent a questionnaire concerning sociodemographic variables, previous and past sport activity and lifetime prevalence of seeking professional help for health problems. N = 683 (68.6%) answered the questionnaire. The lifetime prevalence of AAS-abuse was 21% (n = 143), while 79% (n = 540) did not admit having ever used AAS.

Results

Former AAS-abuse was associated with tendon ruptures (p = 0.01), depression (p = 0.001), anxiety (p = 0.01) and lower prevalence of prostate hypertrophy (p = 0.01) and decreased libido (p = 0.01). Former advanced AAS-abusers had higher anxiety (p = 0.004) compared to the former less advanced AAS-abusers. Moreover, former advanced AAS-abusers, compared to AAS-naïves, reported more psychiatric problems (p = 0.002), depression (p = 0.003) and anxiety (p = 0.00).

Conclusions

A former AAS-abuse seems to be associated with some somatic and mental health problem, although a former less advanced AAS-abuse is related to lower incidence of prostate hypertrophy. The results raise the question whether some of these associations might be dose- and frequency dependent. These findings should however be seen as hypothesis generating and further studies are needed.

Introduction

Whether AAS-abuse induces long-term somatic complications in humans is poorly investigated, probably since it is difficult to conduct well-controlled studies due to the highly individual variation of AAS abuse patterns (e.g. type of AAS compound, dosage and frequency of administration) and individual vulnerability.

Case reports and clinical studies have reported that human AAS-administration may cause several kinds of physical side effects.1, 2, 3, 4 Abuse of AAS may lead to hypercholesterolemia, platelet aggregation5, 6 and increased blood pressure,7 all of which constitute risk factors for heart diseases. Cases of myocardial infarction8 and pulmonary embolization9 have been reported among young abusers. Moreover, AAS-abuse has been shown to cause gynecomastia10 and atrophy of the testes leading to gonadal dysfunction11 including decreased production of both testosterone and sperm cells.12, 13

It is fairly undisputed that AAS-administration causes short-term somatic side effects,1, 2, 14 however, the evidence for persistent toxicity of AAS in other organ systems is limited. Supraphysiological doses of AAS seem to cause long-term cardiovascular effects like atherosclerosis and cardiomyopathy15 and strength athletes displayed a left ventricular hypertrophy some years after discontinuation of the AAS-abuse.16

The aim of the present study was to investigate the association between somatic health and former abuse of AAS in former elite male athletes 30 years after the end of their active sports career. The specific research aims were to explore;

  • 1.

    If a former AAS-abuse is associated with higher self-reported lifetime prevalence of somatic problems compared to non-AAS-abusers?

  • 2.

    If former AAS-abusers with a more advanced AAS-abuse report higher self-reported lifetime prevalence of somatic problems compared to former AAS users with a lesser advanced AAS-abuse?

Section snippets

Methods

The subjects included in this study were Swedish male elite power sport athletes, on the top 10 national ranking lists, in any of the years 1960–1979 in four power sports; wrestling, Olympic lifting, power lifting and the throwing events in track and field (hammer, discus, javelin and shot put) (n = 1199). The athletes’ present contact data were identified through the Swedish Tax Agency by using the athletes’ Swedish National Registration Number (NRN). Of the 1199 former elite athletes, 66

Results

‘Former AAS-abusers’, compared to ‘AAS-naïves’, had higher self-reported lifetime prevalence of seeking professional expertise for tendon ruptures (44.8% vs 33.4%; p = 0.01), depression (13.3% vs 5.0%; p = 0.001) and anxiety (13.3% vs 6.3%; p = 0.01). ‘Former AAS-abusers’, compared to ‘AAS-naïves’, had lower prevalence of prostate hypertrophy (4.9% vs 12.4%; p = 0.01) and decreased libido (2.8% vs 9.3%; p = 0.01).

‘Former advanced AAS-abusers’, compared to ‘Former less advanced AAS-abusers’, had higher

Discussion

The literature concerning long-term somatic effect of previous AAS-abuse is sparse.15, 16 The aim of the present study was therefore to investigate the relationship between lifetime prevalence of seeking professional expertise for somatic problems and former AAS-abuse, and furthermore if these somatic problems were correlated to the extent of AAS-abuse. In this 30-years follow-up study of former male elite power sport athletes, 21% (n = 143) of the sample reported having used AAS during their

Conclusion

A former AAS-abuse does seem to have a strong association with psychiatric problem, such as depression and anxiety. This association seems to be even stronger if the abuse of AAS was advanced (AAS-cycles ≥2 years). This result raises the question whether these somatic and mental health effects of AAS-abuse are dose- and frequency dependent. However, no large differences were seen in somatic health except an association between former AAS-abuse and tendon rupture, which has been noted in

Practical implications

  • The association between former AAS-abuse and depression and anxiety might be dose- and frequency dependent, which strengthens the importance of asking patients, not only active body builders, about current and former AAS-abuse in cases of depression and anxiety, since treatment may also require consultation of an endocrinologist in addition to conventional psychiatric care.

  • Tendon rupture seems to be more common in elite athletes who have used AAS compared to AAS-naïve athletes, which is

Acknowledgments

This work was financially supported by grants from the Swedish National Centre for Research in Sports (Nos. 32/08 and 35/09).

The skilful assistance of Inger Setterberg, Ingrid Höglund Karlsson, Erik Andersson and Erika Rosén are gratefully acknowledged.

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