Anabolic steroids are associated with a range of adverse side-effects. Some of the adverse symptoms linked with AS are classified as psychological, or psychiatric. From the mid-1980s onwards the popular press has been reporting the incidence of rages induced by AS, termed ‘roid rages’ (Lubell, 1989). There has been a significant level of controversy regarding the influence that AS may have upon the judgement of the individual user. Anabolic steroids have been associated with a number of violent crimes (Lubell, 1989; Lenehan et al., 1996); however, there has been speculation regarding the amount of influence these drugs exerted upon the offender’s behaviour. It is interesting to note that
although AS are now associated with adverse psychological symptoms, they were used between the 1930s and the mid-1980s, with varying levels of success, in the treatment of psychological disorders, such as depression (Taylor, 1991).
Research into the psychological effects of illicit AS use is difficult because it is more or less impossible to replicate the conditions under which AS are used illicitly. However, Su et al. (1993) conducted research into the effects of high doses of AS. They found that men taking a high dose of AS were likely to experience effects that included increased irritability, increased violent tendencies, increased mood swings and an increase in anger. This study was controlled and double blind, the subjects were also screened for previous substance misuse and psychological problems before taking part in the study. Other studies have shown similar relationships between use of AS and changes in mood and behaviour (Pope and Katz, 1988; Kouri et al., 1995; Corrigan, 1996; Lenehan et al., 1996; Borowsky et al., 1997).
It has also been suggested that some users of AS have a predisposition towards personality disorders. Cooper et al. (1996) conducted a study that showed that one in three of the AS-using individuals in their research satisfied the diagnostic criteria for at least one of the personality disorders before they started to use AS. These included paranoid, schizotypal, antisocial, borderline, histrionic, narcissistic, and passive–aggressive personality trait disorders. Their results also suggested that significant disturbances in personality profile are associated with, and possibly a direct result of, AS use. A study by Porcerelli and Sandler (1995) outlined a positive relationship between narcissistic personality traits and use of AS. Their study compared two groups made up of weightlifters and body-builders, one group consisting of AS users, the other of non-AS users. The AS-using group had significantly lower levels of empathy but significantly higher levels of narcissism than the non-AS-using group. The only difficulty involved in the interpretation of these results stems from the fact that personality traits prior to onset of AS use were not recorded, therefore it is impossible to conclude whether a predisposition to such traits is related to the initiation of AS use.
It is interesting that in a study of general practitioners from the Liverpool, Birmingham and Berkshire areas of the UK, the largest number of adverse effects observed by the doctors were psychological/psychiatric in nature. This result was common to all three areas surveyed (Lenehan et al., unpublished).
The potential societal implications of these adverse psychological effects have been documented in a number of reports. Murder (Dalby, 1992; Corrigan, 1996), armed robbery (Dalby, 1992), domestic violence (Schulte et al., 1993; Choi and Pope, 1994; Stanley and Ward, 1994) and child abuse (Schulte et al., 1993) are examples of crimes that have been associated with abuse of AS. The effects of AS and testosterone derivatives upon road aggression are also subject to research. Ellingrod et al. (1997) conducted a study using the Iowa driving simulator to discover the effects of physiologic and supraphysiologic doses of testosterone cypionate. They used weekly doses of 100 mg, 250 mg and 500 mg, and then tested the driving behaviour of the subjects. The study did not provide conclusive evidence of a relationship between AS and aggressive driving behaviour, but it was suggested that greater doses of testosterone cypionate, i.e. over 500 mg per week, may be responsible for alterations in driving behaviour. Further research is required to determine the prevalence of AS-related incidents of driving aggression.
A report by Lubell (1989) documented two murder cases that were associated with AS use, namely the trials of Horace Williams and Glenn Wollstrum. In both cases the men that committed the murders were stated to have been psychologically normal before they started to use AS. At each of the trials the defendants pleaded not guilty because AS use had caused insanity; however, these pleas were rejected by the respective juries and a guilty verdict was passed on both occasions. Although it has been established that use of AS may render certain individuals more prone to aggressive behaviour (Su et al., 1993), there is no conclusive evidence to support the theory that AS can be the direct cause of violence (Lubell, 1989; Pope and Katz, 1990; Kouri et al., 1995).
Research by Choi and Pope (1994) has suggested there is a link between male aggression towards women and AS use. Their study involved AS-using and non-AS-using athletes. The results showed that, while using AS, the user group reported significantly greater levels of aggression towards their female partners. The levels of aggression of the control group of non- AS-using athletes and the AS-using group during their off-drug cycle were not significantly different.
Other research has been carried out to discover the relationship between AS use and sexual aggression. Yates et al. (1999) performed a study of the psychosexual effects of testosterone cycling in men. The doses used in this study were 100 mg, 250 mg and 500 mg of testosterone cypionate administered in weekly intramuscular injections. Their work showed that doses of testosterone up to five times the physiologic replacement dose do not present a significant risk of adverse psychosexual effects in most normal men. The study also revealed that at doses starting from 500 mg of testosterone cypionate per week, a small proportion of men are more likely to experience adverse psychosexual effects. This result is particularly interesting because AS users frequently use doses of AS that are significantly greater than the recommended therapeutic dose (Duchaine, 1989; Hart, 1993; Lenehan et al., 1996). A study of sexual aggression in adolescents (Borowsky et al., 1997) has also shown a relationship between use of AS and sexual aggression.
Another particularly important issue is that there may be other drugs used in conjunction with AS; for example, the use of stimulants such as cocaine or amphetamines has been shown to be highly correlated with self reported aggressive behaviour (The Brown University Digest of Addiction Theory and Application, 1994; Yesalis et al., 1993a). This pattern of drug use is not an uncommon practice in the AS-using community (DuRant et al., 1993; Lenehan et al., 1996; Lukas, 1996).
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