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Anabolic Steroid Usage, Prices & Effects

Matthew J Atha BSc MSc LL.B

Director - Independent Drug Monitoring Unit

1          Introduction

1.1       Anabolic steroids are a group of compounds which mimic sex and growth hormones in the body. They are typically used without prescription by athletes and bodybuilders in order to build up muscle mass and reduce the fatigue involved in training regimes. There are around 500 steroidal substances identified in mammals, with 5 major groups distinguished by physiological action, these are glucocorticoids, mineralocorticoids, androgens, oestrogens and progestins[1]. The classical sex steroid is testosterone, which has many derivatives, all of which are to a greater or lesser extent effective as androgens (masculinising) and anabolics (tissue-building), without separation of these two discrete effects, with the result that the class is known as anabolic-androgenic steroids. These promote tissue growth by reducing the breakdown of protein, particularly following exercise.

1.2       The effects of steroids on mood has long been recognised, from Aristotle prior to 300BC noting the psychological and behavioural aspects of maleness. In the 1800s, the testes were demonstrated to contain substances which maintained vitality, strength, energy and youthfulness, and sex-hormones were used to treat mood and mental disorders in the early part of this century, particular melancholia and depression. However, more recent studies have pointed to severe behavioural side effects, including violent psychotic episodes, associated with the use of anabolic-androgenic steroids in particular users.

1.3       IDMU deals only rarely with cases involving anaboic steroids and related bodybuilding products, and only a handful of drug users report lifetime steroid use each year in our surveys.

1.4 Unlike most controlled drugs, the majority of steroids appear on the market as pharmaceutical preparations, in blister packs of tablets, glass ampoules for injection, or multi-dose vials, labelled with brand-names and/or contents. Such products can be either legitimate - manufactured legally by pharmaceutical companies, mainly overseas - or counterfeit, where the contents do not match the description and often contain either different substances or no active ingredients.

2          Consumption of steroids

2.1       There are a number of sources on the internet which outline regimes (cycles) whereby steroids are taken as part of a training regime over a period of 6-12 weeks, gradually increasing then reducing the dose and then coming off completely (e.g. to enter a competition). These regimes commonly recommend dosages well in excess of recommended levels, sometimes 4-8 times the pharmaceutical dose[2].

2.2       The recommended route of administration for steroids is an intramuscular injection, which delivers the drug to the site of action and bypasses first-pass metabolism in the liver, as would occur with oral tablets/capsules, with an increased risk of liver damage as a result. Clearly, any medically-unsupervised injection practice carries with it the risk of blood-borne infections such as hepatitis and HIV.

2.3       A number of studies have considered steroid usage and their effects on behaviour, including the syndrome popularly known as Ģroid-rage". Pope & Katz[3], in a study of 41 bodybuilders and US Footballers using 10-100 times the medical doses of steroids (15mg-600mg per day), found 12% reported Ģmajor" psychiatric symptoms from Ģstacking" different preparations. In a controlled study using 20 healthy non-athletic male volunteers with no prior history of steroid use, Su et al[4] measured placebo baseline, low dose methyltestosterone (40mg), high dose methyltestosterone (240mg) and placebo. In a single case report, Conacher et al[5] cited the case history of a 32 year old Canadian bodybuilder convicted or murdering his partner. He had been taking steroids for 3 months before the incident, at about 6 times the medical dose (6x tablets dianabol per day plus one ĢDeca" injection per week). Corrigan[6] reports on a male bodybuilder 22 yrs who violently murdered a woman after an 8 week course of 50mg per week nandrolone (deca-durabolin, organon), increased to 85mg (of a veterinary preparation) for 3 weeks before the murder.

2.4       The dosage is complicated by the plethora of counterfeit pharmaceutical steroids available on the market. Although anabolic steroids are controlled drugs in the UK, USA and other developed countries, there are a number of countries throughout the world where these are still manufactured legitimately. Illicit steroid products will commonly mimic the appearance or packaging of legitimate products, but will often contain either a different dosage or different drug to that denoted on the label. This phenomenon is well known among regular steroid users, and there are a number of internet publications (mostly subscription only) which provide information on the content of the latest products, and warnings about faulty or counterfeit tablets.

3          Steroid Consumption -IDMU Survey Data

3.1       IDMU drug user surveys have included questions about steroid usage, prices and attitudes since 1999.

3.2       To date (Jan 2004), 10070 questionnaires have been returned and analysed, from which only 157 (1.6%) respondents have reported lifetime usage of steroids. The usage pattern shows fewer regular (weekly/monthly) than daily users, a similar ĢJ" shaped distribution to addictive drugs such as heroin or crack (Table 1). Users generally report higher ratings than non-users, a pattern common with most illicit drugs.

Table 1 - Steroid Usage Data 1999-2003

Usage Level

n

%

Rating

Experimental

50

0.50%

3.19

Occasional

11

0.11%

6.71

Regular

7

0.07%

3.33

Daily

21

0.21%

3.80

Stopped Using

68

0.68%

1.55

Might Use

75

0.74%

2.13

Would Never Use

2596

25.8%

1.00

Other/Blank

7242

71.9%

1.12

Total Ever

157

1.57%

2.97

Saturation

67.7%

Overall

1.15

3.3       The drug has an overwhelmingly negative reputation among drug users as a whole, with the average user-rating of 1.15/10, among the lowest ratings for any drug, and only 75 respondents (0.74%) who had not used the drug being willing to try it. Average monthly spending (9x respondents) was £23.57, with a maximum of £80 per month (fig 1)

Fig 1 - Steroid Ratings & Monthly Spending 1999-2003

3.4       The age of initiation data, with a surprising 30% of respondents reported first having used before age 15, suggests that many respondents may have been using prescribed steroids for medical conditions in childhood (fig 2), although the majority started between ages 14 and 23, consistent with use in connection with sporting activity.


Fig 2 - Age of Initation to Steroid Use

3.5       Summary: Usage of anabolic steroids is limited to certain niche markets, and has little appeal to drug users outside, bodybuilding/fitness, sports and Ģsecurity" personnel. Whilst the number of regular users is very small, they can use excessively - many times the therapeutic dose. There is evidence of physical and psychological dependence from prolonged use, risking a pattern of violence and aggression commonly known as ĢRoid Rage".

 

4.         UK Steroid Prices

4.1       IDMU Survey Prices: The average reported prices of steroid preparations in our suveys from 1999-2003 is shown in table 2, and the distribution of reported prices between1999 and 2003 in fig 3 below. Note that reports of steroid use or prices amongst users of illicit drugs are very rare (19 reports from 10061 respondents), and Ģtab/amp" prices do not distinguish between different drug preparations and dosages.

Table 2 - UK Steroid Prices 1999-2003*

Type

Number

Price

Amp

6

£ 9.17

Tab

13

£ 7.99

Overall

19

£ 8.37

* Provisional 2003 dataset n=2040

Fig 3 - Steroid Price Distributions 1999-2003

4.2       Internet Prices: A range of steroid products are available from internet retailers and wholesalers. The prices depend on the type of steroid or brand, the dosage, the quantity bought, and where manufactured or sold.

4.3       A Google search for named steroid compounds revealed several sites[7] offering online purchase facilities, quoting prices in Euros and/or in US Dollars. These have been converted to Sterling at approximate prevailing exchange rates of €1.40=£1 and $1.60=£1. Those entries denoted Ė(BNF)Ó are prices quoted in the British National Formulary.

Table 3 - Online Prices of Anabolic Steroid Preparations

Trade Name and/or Drug

Preparation

Qty

Euros

Dollars

Sterling

Unit (£)

Anabol (methanenedione)

tabs (5mg)

500

€ 220.00

 

£ 157.14

£ 0.31

Anabol

tabs (5mg)

50

 

$19.00

£ 11.88

£ 0.24

Anabol

tab (10mg)

50

 

$85.00

£ 53.13

£ 1.06

Anabol 5 mg.

tabs (5mg)

50

 

$45.00

£ 28.13

£ 0.56

Dianabol/Anabol

tab

1500

€ 479.00

 

£ 342.14

£ 0.23

Dianabol/Anabol

tabs (5mg)

100

€ 54.00

 

£ 38.57

£ 0.39

Methanenedione

tabs (50mg)

300

 

$450.00

£ 281.25

£ 0.94

Anadrol - 50 (oxymetholone)

Tab

50

 

$250.00

£ 156.25

£ 3.13

Anadrol - 50 (oxymetholone)

tab

200

 

$350.00

£ 218.75

£ 1.09

Anadrol - Anapolone oxymetholone

tab (50mg)

20

€ 55.00

 

£ 39.29

£ 1.96

Anapolon (oxyymetholone)

tabs (50mg)

100

 

$270.00

£ 168.75

£ 1.69

Boldabol

vial (200mg)

4

€ 375.00

 

£ 267.86

£ 66.96

Boldenone Undeclynate

vial (200mg)

1

€ 125.00

 

£ 89.29

£ 89.29

Clenbuterol

tabs

150

€ 99.00

 

£ 70.71

£ 0.47

Clenbuterol

tab (20µg)

50

 

$50.00

£ 31.25

£ 0.63

Clenbuterol

tab (20µg)

200

 

$160.00

£ 100.00

£ 0.50

Clenbuterol

tab

50

 

$20.00

£ 12.50

£ 0.25

Pregnyl

amp (150µg)

1

 

$15.00

£ 9.38

£ 9.38

Pregnyl

amp (5mg)

1

 

$30.00

£ 18.75

£ 18.75

Primobolan

amp(50mg)

1

 

$21.39

£ 13.37

£ 13.37

Trenabol (Trenbolone)

vial (750mg)

1

€ 119.00

 

£ 85.00

£ 85.00

Trenabol (Trenbolone)

vial (750mg)

3

 

$320.00

£ 200.00

£ 66.67

Decabol (nandrolone)

vial (250mg)

1

€ 115.00

 

£ 82.14

£ 82.14

Deca-Durabolin

vial (200mg)

1

€ 16.00

 

£ 11.43

£ 11.43

Deca-Durabolin

amp(50mg)

10

 

$160.00

£ 100.00

£ 10.00

Deca-Durabolin

amp (100mg)

14

 

$266.00

£ 166.25

£ 11.88

Deca-Durabolin

amp(50mg)

1

 

$9.00

£ 5.63

£ 5.63

Deca-Durabolin

amp (100mg)

1

 

$15.00

£ 9.38

£ 9.38

Deca-Durabolin (BNF)

amp(50mg)

1

   

£ 3.54

£ 3.54

Tamoxifen

tab (20mg)

10

 

$32.00

£ 20.00

£ 2.00

Tamoxifen

tab (10mg)

10

 

$18.00

£ 11.25

£ 1.13

Tamoxifen

tab

30

 

$20.00

£ 12.50

£ 0.42

Proviron

tabs (25mg)

50

 

$39.00

£ 24.38

£ 0.49

Proviron

tabs (25mg)

10

 

$15.00

£ 9.38

£ 0.94

Proviron

tabs (25mg)

10

 

$15.95

£ 9.97

£ 1.00

Proviron (mesterolone) BNF

tabs (25mg)

30

   

£ 4.75

£ 0.16


Trade Name and/or Drug

Preparation

Qty

Euros

Dollars

Sterling

Unit (£)

Omnadren (Sustanon 250)

amp (250mg)

1

€ 11.00

 

£ 7.86

£ 7.86

Sten (testosterone propio/cypionate)

amp (120mg)

2

 

$8.15

£ 5.09

£ 2.55

Sustanon 250

amp

50

€ 550.00

 

£ 392.86

£ 7.86

Sustanon 250

amp

30

 

$300.00

£ 187.50

£ 6.25

Sustanon 250

amp (250mg)

14

 

$238.00

£ 148.75

£ 10.63

Sustanon 250

amp (250mg)

1

 

$15.00

£ 9.38

£ 9.38

Sustanon 250

amp (250mg)

1

 

$16.85

£ 10.53

£ 10.53

Sustanon 250 BNF

amp (100mg)

1

   

£ 2.74

£ 2.74

Testabol

vial (1000mg)

4

 

$200.00

£ 125.00

£ 31.25

Testex

amp

15

€ 199.00

 

£ 142.14

£ 9.48

Testex/Testabol Depot

vial (2000mg)

4

 

$225.00

£ 140.63

£ 35.16

Testosterone Depot

amp (250mg)

30

€ 224.00

 

£ 160.00

£ 5.33

Testosterone Depot

amp (250mg)

1

 

$8.00

£ 5.00

£ 5.00

Testosterone enanthate

amp(250mg)

1

 

$11.55

£ 7.22

£ 7.22

Cetabon (Stanozolol)

tab (2mg)

10

 

$13.00

£ 8.13

£ 0.81

Winstrol

tabs (5mg)

50

 

$35.00

£ 21.88

£ 0.44

Winstrol (Stanozolol)

tabs (5mg)

200

 

$108.00

£ 67.50

£ 0.34

Menabol (Stanozolol + Vit B)

tab (10mg)

1

 

$1.10

£ 0.69

£ 0.69

Stanabol (stanozolol

tab (10mg)

150

€ 170.00

 

£ 121.43

£ 0.81

Stanabol (stanozolol

tab (10mg)

200

 

$250.00

£ 156.25

£ 0.78

Winstrol

tab (20mg)

50

 

$250.00

£ 156.25

£ 3.13

Winstrol

tab (20mg)

1

 

$7.00

£ 4.38

£ 4.38

Stanabol (stanozolol

tab (50mg)

100

 

$350.00

£ 218.75

£ 2.19

Winstrol

vial (50ml/10g)

1

 

$195.00

£ 121.88

£ 121.88

Winstrol

amp(50mg)

1

 

$15.00

£ 9.38

£ 9.38

Winstrol Depot

amp

20

€ 227.00

 

£ 162.14

£ 8.11

4.4       From the above internet sources, the average prices of different steroid preparations are as follows (Table 4).

Table 4 - Steroid Price Summary

Drug

Tab

Amp

Vial

Methanenedione

£0.53

n/a

n/a

Oxymetholone

£1.97

n/a

n/a

Boldenone

n/a

n/a

£78.13

Clenbuterol

£0.46

n/a

n/a

Nandrolone

n/a

£8.09

£46.79

HCG (Pregnyl)

n/a

£14.06

n/a

Mesterolone

£0.65

n/a

n/a

Stanozolol

£1.51*

£8.75

£121.88

Tamoxifen

£1.18

n/a

n/a

Testosterone

n/a

£7.07

£33.21

Trenbolone

n/a

n/a

£75.84

5.         Behavioural effects of Steroids

5.1       Animal Behavioural Studies: The effects of testosterone on dominance and aggressive behaviour has been established in numerous species of animals including primates Rejeski et al[8] showed increased aggressive behaviour in monkeys given intramuscular injections of 4mg/kg testosterone propionate (a.k.a. sustenon), including slapping, grabbing, stare threat, chasing, fleeing etc. Joslyn[9] found that female rhesus monkeys injected with 2mg testosterone propionate 3x per week for 6 weeks increased aggressive behaviour to such an extent that they replaced males at the top of the social hierarchy. Rada et al[10] indicated that social factors and learning influence the expression of adult aggression.

5.2       Human behavioural studies: Susman et al[11] monitored the relationship between differences in natural levels of steroids in adolescents and their reported behaviour, finding those with higher levels to be more sociable and outgoing, but more prone to emotional sadness and other psychopathology. Udry et al[12] found serum testosterone levels to predict sexual motivation and behaviour in early teenage boys, and Olweus et al[13] identified a significant association between testosterone levels and self-reported verbal and physical aggression, Ģlack of frustration tolerance", and responsiveness to provocation and threat, but not with antisocial behaviour or impulsiveness. Bahrke raises the question as to the nature of this association, i.e. to what extent aggressive behaviour per se may increase levels of testosterone, rather than the reverse.

5.3       ĢNormal" Adult Males: Persky et al[14] found a correlation between testosterone production rates and overall hostility among younger men. Brown & Davis[15] report a significant correlation between plasma testosterone and irritability, but noted expression of aggressive behaviour to be highly dependent on other factors and was absent in their 15 healthy college subjects. Other researchers have questioned these results, either finding weak positive relationships[16], or no significant relationship[17] between aggressive behaviour and endogenous testosterone levels.

5.4       In a controlled study using 20 healthy non-athletic male volunteers with no prior history of steroid use, Su et al[18] measured placebo baseline, low dose methyltestosterone (40mg), high dose methyltestosterone (240mg) and placebo withdrawal, and found the high dose condition to produce significant increases in positive mood (euphoria, energy, sexual arousal), negative mood (irritability, mood swings, violent feelings & hostility) and cognitive impairment (distractibility, forgetfulness & confusion). One subject suffered an acute manic episode with another subject becoming hypomanic. Previous psychiatric history did not predict the reactions of subjects.

5.5       Athletes & Bodybuilders: Studying bodybuilders who were either current, past or non-users of steroids, Lefavi et al[19] found that present users reported increased anger-arousal and hostile outlook, while both present and former users reported increased aggression, euphoria, irritability and hyperactivity, the authors suggesting:

Ģpsychoactivity of anabolic steroids may be much greater than previously believed"

5.6       In a retrospective study of 20 steroid users and 20 nonusers, Perry et al[20] reported users to show significantly more depression, anxiety and hostility, with symptom clusters including paranoid ideation (14 subjects - 70%) and psychotic features (13-65%).

5.7       Pope & Katz[21], in a study of 41 bodybuilders and US Footballers using 10-100 times the medical doses of steroids (15mg-600mg per day), found 12% reported Ģmajor" psychiatric symptoms from Ģstacking" different preparations. In a 1992 review[22], the same authors considered the pattern of abuse and withdrawal to be characterised by manic symptoms such as irritability and euphoria, followed by depressive symptoms[23] such as fatigue and suicidal tendencies in withdrawal.

5.8       In 1994, Pope & Katz[24] undertook a controlled study of 160 athletes, finding 23% of users to report major mood syndromes - including mania, hypomania & major depression - associated with periods of use, but were less likely to abuse other drugs. They concluded that steroids in high doses may cause serious mood disorders with substantial morbidity for the user and victims of his irritability and aggression. In a further study Choi & Pope[25] compared 23 steroid-using athletes with 14 nonuser athletes finding users to report significantly more fights, verbal aggression and violence towards their Ģsignificant other" when using than between cycles (all but 3 users were Ģstacking"). They considered steroids to increase the levels of violence in those with pre-existing violent tendencies, and to create a risk of violence in otherwise nonviolent individuals. In March 1991, a UK magazine article[26] from a woman whose spouse had changed his personality when using steroids, led to the formation of the Steroid Users Wives Association.

5.9       In a critical 1994 review, Williamson & Young[27] considered thatÓ

Ģit is possible that people with a tendency towards violence or a predispostion towards the development of a psychiatric illness may me more likely to take anabolic-androgenic steroids. It is also possible that, in susceptible individuals, anabolic-androgenic steroids may induce psychological changes or precipitate psychotic symptoms which could, in turn, lead to violenceÓ

5.10     In a 1992 paper, Bahrke et al[28] interviewed weightlifters divided into current (12) previous(14) steroid users and nonusers (24). Current and previous users repored increased enthusiasm, aggression, irritability, insomnia, physical changes and changes in libido, but found no significant dose-related effects, and considered the effects to be either too subtle or the assessment inventories insufficiently sensitive to detect psychological changes. However, Bhasin & Drew[29] reported no evidence of increased violence among steroid-using athletes - psychological tests and questioning of the men's spouses found no evidence that steroids made them angrier or more aggressive.

5.11     Prisoners: Kreuz & Rose[30] first studied levels of testosterone and fighting, verbal aggression and past criminal behaviour among 21 young prisoners, finding those with adolescent records of violent crime to have significantly higher testosterone levels, suggesting testosterone to have an additional effect on top of environmental and social factors increasing the risk of, rather than creating, violent or criminal behaviour.

5.12     Ehrenkrantz et al[31], in an inadequately-controlled study, found significantly higher levels of testosterone among prisoners classified as Ģaggressive" and convicted of offences including aggravated assault and murder, compared to nonviolent offenders.

5.13     Rada et al[32] found a group of violent rapists to have higher mean testosterone levels than groups of child molesters, non-violent rapists or healthy prison employees.

5.14     Schiavi et al[33] found significantly increased testosterone levels among Ģviolent delinquents" compared to nondelinquents and non-violent delinquents, but no relationship between self-reported measures of aggressivity.

5.15     Case histories involving anabolic-androgenic steroids and violent crime: Pope & Katz[34] described three men with no history of violence who had committed violent impulsive crimes when taking steroids.

(a)        The first case was a prison officer with no history of psychiatric disorder or violence, who had taken increasing doses of a combination of steroids over 5 cycles, during which he described himself as irritable and aggressive, on a Ģhate the world" campaign, but with massively increased self-confidence. During the fifth cycle driving to work he was the butt of a mild joke at a local store concerning a phone call, and returned later that day in order to Ģscare the lady", forcing her into his car, and shooting her when she tried to escape. His identical twin brother, who also worked out with weights but had never used steroids, showed no signs of psychopathology.

(b)       The second case involved a 23 year old construction worker who reported social drinking and occasional cocaine use prior to using steroids. When using steroids he reported severe mood changes, including Ģincredibly shortened" temper, and Ģchallenging others for no apparent reason". He became manic, irritable, reckless and suffered delusions of grandeur ĢI was the strongest person in the world, I was superhuman". During his second cycle of steroid use, the man stopped at a store and vandalised a payphone, later picking up a hitchhiker to Ģhassle a little", drove him to a remote woodland spot, and violently beat him up without provocation, tying him between two polesm smashing 2x4 plank across his back, and kicking him, the victim was later found dead. The attacker, following arrest and withdrawal from steroids, reverted to his previous mild-mannered personality with no subsequent indications of violent tendencies. Although convicted of murder, he escaped the death penalty as the judge considered the steroid use to be a mitigating factor during sentencing.

(c)        The third case involved a 24yr old US football player, having taken 12 courses of steroids since age 20. During cycles he became more irritable at home, with family and school, developing an attitude that he was the Ģbest" and expecting special treatment from others, and was assessed as Manic on DSM-III-R criteria, engaging in reckless, dangerous and/or illegal behaviour. His fiancee had broken off their engagement as he had been seeing other women and, although at first indifferent, the man became increasingly obsessed and discussed slandering her, and eventually murdering his ex, stating he could not get it out of his mind. He placed a homemade device beneath her car and set it off as she left a party. Although she was unharmed, he was arrested for attempted murder. Following his arrest he developed a range major depressive symptoms which cleared after four months. Following conviction, the effects of steroids were taken into account in determining sentence.

            The authors considered the psychiatric symptoms as described to be strikingly similar to those found in their 1988 study, with a stereotypic quality to the irritability, aggressiveness and grandiosity experienced by steroid users, and an obsessive escalation of responses to minor insults, reinforcing their impression that

Ėthe symptoms and behaviour in the three men in our study were primarily attributable to steroid ingestionÓ ĢOur observations raise the possibility that anabolic steroids may have contributed to many other violent crimes, but that their role has gone unrecognised".

5.16     Lubell[35] reported the cases of Horace Williams & Glenn Wollstrum (Pope & Katz cases (b) & (a) above). In evidence in the Williams case, Katz stated the defendant to be:

Ģsuffering the effects of anabolic steroids and had become psychotic, unable to appreciate the wrongfulness of his acts or the consequences of what he was doing."

5.17     In a single case report, Conacher et al[36] cited the case history of a 32 year old Canadian bodybuilder convicted or murdering his partner. He had been taking steroids for 3 months before the incident, at about 6 times the medical dose (6x tablets dianabol per day plus one ĢDeca" injection per week). Around a month before the crime her reported becoming Ģhyper", i.e. irritable, quarreling noisily, sleepless and increased alcohol consumption. After a bout of heavy drinking and discussing infidelities with his wife, he Ģsnapped" and beat her severely such that she died of a subdural haematoma. His changed mental state prior to the offence were not related to steroid use at the time of his trial. Following cessation of steroid use in prison, his mental state reverted to normal.

5.18     Choi et al[37] noted prominent hostility and aggression in subjective and objective ratings among 3 illicit steroid users compared with 3 comparable nonusers in a longitudinal study over several months. One user admitted an attempted murder during an earlier steroid cycle.

5.19     Schulte et al[38] reported a case of domestic violence associated with steroid use, the 19 year old student & US football player Ģstacked" intramuscular testosterone with oral methandrostenolone over a 4 month period, increasing his physical performance, but became increasingly irritable and Ģrough" with his wife and 2 year-old son, whose buttocks he scalded with boiling water in an attempt at discipline. Two months following cessation of steroid use the irritability and violent outbursts were resolved, with no recurrence reported on 18 months follow-up.

5.20     Corrigan[39] reports two homicides from Sydney, Australia, associated with steroid use, also noting that by 1988 there had been over 20 such cases reported in the USA[40].

(a)        Male bodybuilder, 29yrs battered wife to death with claw-hammer while children were in the house, then shot himself through the head. He had been using anabolic steroids for several years, and was 7 weeks into a cycle involving injections of stanozolol (sustanon) and testosterone (organon), and was found to have a testosterone/epitestosterone ration of 17:1, three times the ratio permitted in sports testing (normal ratio 1:1). Corrigan considered there to be little doubt that the behaviour fitted the features of a steroid rage, as the home life was apparently happy and he had not been known to be aggressive.

(b)       Male bodybuilder 22 yrs murdered a woman by repeatedly bashing her head against a wall and kicking her, showed no evident remorse and went home to bed. Had been on 8 week course of 50mg per week nandrolone (deca-durabolin, organon), increased to 85mg (of a veterinary preparation) for 3 weeks before the murder. He had never been known to use other drugs, was from an apparently caring family and had never been known to be violent. He had drunk 5-6 pints of beer in the 3 hours prior to the murder. Corrigan considered this behaviour also to suggest a steroid rage with the severe degree of violence and indifference, albeit with the smallest dose of steroids yet recorded for such a rage.

5.21     Oxymetholone, Methyltestosterone & Stimulants Wilson et al[41] studied depressed men treated with tricyclic antidepressants and methyltestosterone (oral 15mg/day), and found that patients showed a paranoid response which cleared when methyltestosterone was withdrawn. They concluded that the paranoid reaction may arise from an increase in aggression as a result of the combined effect of the hormone (as MAO inhibitor) and increased plasma monoamines (arising from imipramine), causing additive effects on moodiness, paranoia and depression.

5.22     The study of Su et al[42] demonstrated the effect of methyltestosterone on irritability, violent feelings, hostility among other symptoms, and an acute manic episode among one otherwise healthy volunteer.

5.23     Internet Ģuser guides": Oxymetholone (Anadrol, Hemogenin,Anapolon 50, Oxitosona 50) is considered by illicit users to be one of the strongest preparations available in terms of anabolic effect and levels of side effects[43]. One internet Ģuser guide" quotes daily methyltestosterone dosages of 10-40mg per day, with the highest rating for side effects, with lower levels of efficacy than other preparations[44]. A Finnish internet steroid Ģuser guide" quotes the following re methyltestosterone:

ĢMethyltestosterone is one of the oldest available oral steroids. It is produced by many various manufacturers and sold in a number of countries including the U.S.. It is quite androgenic, with minimal anabolic effects. For athletic purposes, methyltest is generally only used to stimulate aggression among power lifters and those looking to boost up their workouts. Many methyltest tabs are sublingual (to be placed under the tongue) for faster absorption. These tabs can generally be identified by a notable citrus flavor to them. A couple tabs placed under the tongue before a visit to the gym may make for an aggressive workout. Aside from this, methyltest offers little except androgenic side effects. It is quite toxic, elevating liver enzymes and causing acne, gynocomastia, aggression and water retention quite easily. Were one to tolerate these side-effects, methyltest will offer little more than some slight strength gains. One looking for quality muscle mass from a steroid cycle should be looking elsewhere. Counterfeit steroids sometimes contain only methyltest in an effort to deceive the buyer. This is due to the fact that it is very cheap in bulk and obviously may fool an inexperienced user."

 

5.24     Summary - steroids and violence The preponderance of evidence from self-report and controlled studies of steroids and behaviour, indicates a classical pattern including the following symptoms.

Exaggerated self-confidence

Irritability

Lack of frustration tolerance

Excessive response to provocation

Hostility

Mood swings

Confusion/Forgetfulness

Distractibility

Libido

Paranoia

Violent feelings

Mania

Violent actions (verbal abuse and fights)

Serious assaults with excessive violence

Reckless as to consequences of actions

Obsessive escalation of violence

5.25     Case studies and basic scientific research both point to a particular danger of steroids used in combination with stimulant drugs, whether antidepressants or illicit stimulants. Both types of drug can cause unprovoked or under-provoked aggression acting alone, in combination their different modes of action would not only increase brain catecholamine production, but would also inhibit breakdown, causing a potential additive effect greater than the sum of the two parts.

© IDMU Ltd January 2004



References

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[2]                Burkett & Falduto (1984), cited Bahrke MS et al (1990) op cit

[3]                Pope HG & Katz DL (1988) Affective and psychotic symptoms associated with anabolic steroid use American Journal of Psychiatry 145 (4) p487-490

[4]                Su TP, Pagliaro M, Schmidt PJ, Pickar D Wolkowitz O & Rubinow DR (1993) Neuropsychiatric effects of anabolic steroids in male normal volunteers. Journal of the American Medical Association 269 (21) pp2760-2764

[5]                Conacher GN & Workman DG (1989) Violent crime possibly associated with anabolic steroid use (Letter). American Journal of Psychiatry 146 (5) p679

[6]                Corrigan B (1996) Anabolic Steroids and the Mind Medical Journal of Australia 165 pp222-226

[7]                http://www.elitesteroids.com

                  http://www.united-pharmacy.com/

                  http://www.overseaspharmacyconnection.com/steroid.htm

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[10]              Rada et al (1976), cited Bahrke MS et al (1990) op cit

[11]              Susman et al (1985, 1987), cited Bahrke MS et al (1990) op cit

[12]              Udry et al (1985), cited Bahrke MS et al (1990) op cit

[13]              Olweus et al (1980), cited Bahrke MS et al (1990) op cit

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[18]              Su TP, Pagliaro M, Schmidt PJ, Pickar D Wolkowitz O & Rubinow DR (1993) Neuropsychiatric effects of anabolic steroids in male normal volunteers. Journal of the American Medical Association 269 (21) pp2760-2764

[19]              Lefavi RG, Reeve TG & Newland MC (1990) Relationship between anabolic steroid use and selected psychological parameters in male bodybuilders Journal of Sport Behaviour (University of Alabama) 13 pp157-166

[20]              Perry PJ, Yates WR, Andersen KH (1990) Psychiatric symptoms associated with anabolic steroids, a controlled retrospective study Annals of Clinical Psychiatr 2 pp11-17

[21]              Pope HG & Katz DL (1988) Affective and psychotic symptoms associated with anabolic steroid use American Journal of Psychiatry 145 (4) p487-490

[22]              Pope HG & Katz DL (1992) Psychiatric Effects of Anabolic Steroids Psychiatric Annals 22(1) pp24-29

[23]              Brower KJ, Eliopulos GA, Blow FC, Catlin DH & Beresford TP (1989) Evidence for physical and psychological dependents on anabolic-androgenic steroids in eight weight lifters. Americal Journal of Psychiatry 47 pp510-512

[24]              Pope HG & Katz DL (1994) Psychiatric and medical effects of anabolic-androgenic steroid use - a controlled study of 160 athletes. Archives of General Psychiatry 51 pp375-382

[25]              Choi PYL & Pope HG (1994) Violence towards women and illicit androgenic/anabolic steroid use. Annals of Clinical Psychiatry 6(1) pp21-25

[26]              Take a Break magazine Issue 8 (2-3-1991) cited Choi & Pope (1994) op cit

[27]              Williamson DJ & Young AH (1992) Psychiatric effects of androgenic and anabolic-androgenic steroid abuse in men: a brief review of the literature. Journal of Psychopharmacology 6(1) 20-26

[28]              Bahrke MS, Wright JE, Strauss RH & Catlin DH (1992) Psychological moods and subjectively perceived behavioural and somatic changes accompanying anabolic-androgenic steroid use American Journal of Sports Medicine 20 (6) pp717-724

[29]              Bhasin & Drew (1996) New England Journal of Medicine April 1996 (reported Associated Press 7-4-96) (internet source)

[30]              Kreuz & Rose (1972), cited Bahrke MS et al (1990) op cit

[31]              Ehrenkrantz et al (1974), cited Bahrke MS et al (1990) op cit

[32]              Rada et al (1976), cited Bahrke MS et al (1990) op cit

[33]              Schiavi et al (1984), cited Bahrke MS et al (1990) op cit

[34]              Pope HG & Katz DL (1990) Homicide and near-homicide by anabolic steroid users Journal of Clinical Psychiatry 51 (1) pp28-31

[35]              Lubell A (1989) Does steroid abuse cause - or excuse - violence? The Physician and Sports Medicine 17(2) pp176-185

[36]              Conacher GN & Workman DG (1989) Violent crime possibly associated with anabolic steroid use (Letter). American Journal of Psychiatry 146 (5) p679

[37]              Choi PYL, Parrott AC & Cowan AD (1990) High-dose anabolic steroids in strength athletes: Effects upon hostility and aggression Human Psychopharmacology 5 pp 349-356

[38]              Schulte HM. Hall MJ. & Boyer M (1993) Domestic violence associated with anabolic steroid abuse (Lett) American Journal of Psychiatry 150 (2) p348

[39]              Corrigan B (1996) Anabolic Steroids and the Mind Medical Journal of Australia 165 pp222-226

[40]              Moss DC (1988) And now the steroid defence. Journal of the American Bar Association 74 pp22-23, cited Corrigan B (1996) op cit

[41]              Wilson et al (1974), cited Bahrke MS et al (1990) op cit

[42]              Su TP et al (1993) op cit

[43]              ĢUsers guide" on internet. Web-addresses of such sites change on a regular basis. Type Ģsteroids" or Ģhulkster" into a search engine to locate.

[44]              Hosn F (1995-97) Anabolic Steroids FAQ (internet)

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