Anabolic Androgenic Steroid Use Associated With Psychiatric Disorders

A significant association was observed between anabolic androgenic steroids and the use of antipsychotics, anxiolytics, antidepressants, and psychostimulants.

Anabolic androgenic steroid (AAS) use among men is significantly associated with psychopharmacological treatment of psychiatric disorders, according to study results published in Depression & Anxiety.

Researchers conducted a retrospectively matched cohort study that included 545 men who tested positive for anabolic steroids in Danish fitness centers from January 2006 until March 2018. Study participants were matched with 5450 men who were randomly selected as controls. Participants were followed from 10 years prior to doping sanction/baseline until mid-May 2018. The primary endpoint was prescription of psychopharmacological treatment.

Average age at doping sanction was 26.2±6.3 years with an average follow-up of 17.0±3.9 years in the AAS group and 16.6±4.1 years in the control group. Those in the control group tended to have a higher education level and a higher rate of employment.

Researchers found a significant increase in the incidence of antipsychotics (hazard ratio [HR] 2.69; 95% CI, 1.99-3.63), anxiolytics (HR 2.34; 95% CI, 1.62-3.38), and psychostimulants (use topped 2 years after doping sanction; HR 2.29; 95% CI, 1.47-3.57) vs control group in the years following doping sanction. Antidepressant prevalence, which was noticeably high several years prior to doping sanction, also showed increased incidence in the years following sanction (HR 1.65; 95% CI, 1.28-2.13). Associations persisted after controlling for socioeconomic factors.

AAS use is strongly associated with psychopharmacological treatment, especially in the years following doping sanction, indicating treatment of psychiatric disorders.

Chronic psychopharmacological treatment with anxiolytics and antipsychotics was significantly more common among AAS users. Antidepressant association was only significant in an unadjusted model. Psychoactive substance use causing mental and behavioral disorders seemed to be strongly associated with AAS use.

Limitations of the study include unaccounted for adverse mental health effects and stigma of sanction or lack of exercise, unaccounted for lifestyle of AAS users, nongeneralizability to individuals in other countries, a lack of random testing, and missing data for amount and duration of exposure.

Study authors conclude, “AAS use is strongly associated with psychopharmacological treatment, especially in the years following doping sanction, indicating treatment of psychiatric disorders. […] These findings could not alone be attributed to socioeconomic factors, and this study seems to corroborate the current knowledge of AAS and mental health and might implicate acute withdrawal of AAS as a possible mechanism.”

References:

Windfeld-Mathiasen J, Christoffersen T, Strand NAW, Dalhoff K, Andersen JT, Horwitz H. Psychiatric morbidity among men using anabolic steroids. Depress Anxiety. Published online October 25, 2022. doi:10.1002/da.23287