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The term steroid refers to a group of drugs that are similar to the male sex hormones. Steroids are synthetic and their effects are similar to those of testosterone and dihydrotestosterone both of which are male sex hormones (Hoffman and Ratamess 2006). The structures of steroids are similar to that of cholesterol and are used medically to create the effects of the male hormone testosterone. The drugs are administered medically to persons whose bodies do not produce adequate testosterone-a condition known as hypogonadism (NIDA, 2010). These drugs act in a similar way to testosterone therefore they are able to increase cellular protein synthesis resulting to buildup of cellular tissue especially in muscles (Pery et al, 2005). The androgenic properties of steroids also stimulate development of masculine characteristics.  The androgenic and anabolic effect of steroid usage cannot be dissociated therefore individuals who take steroids are display the androgenic effect which may include aggressive behavior (NIDA, 2010).

Why people take steroids

Unlike other drugs such as heroin, marijuana and cocaine, people take steroids to boost their performance and not just the desire to experience immediate euphoria (NIDA, 2010). People take steroids to improve their athletic performance (Tahtamouni et al, 2008). This is not only done by professional athletes but also those people who want to remain athletic. Majority of the steroid users are not aware of the side effects that come along with steroid use and abuse (Goulet et al, 2010).

How anabolic steroids are abused

Steroids are abused by athletes in an effort to improve their performance with intent of swinging the outcome of sport contests in their favor. Steroids and steroid supplements (e.g. TGH and androstenedione) are usually sold in gyms, competition, mail orders and through peddlers (NIDA, 2010). Today, some professional athletes often acquire new generic drugs which are undetectable and enable them to cheat their way to victory. The development of new generic steroid drugs has kept the drug abusers one step ahead of the testing efforts therefore there is need for new technology and methods to check for steroid abuse among athletes. People who are not involved in athletics usually take these drugs for a variety of reasons. Most of them take steroids in order to increase their muscle size and/or reduce the body fat (NIDA, 2010). This is common with people suffering from a behavioral syndrome known as dysmorphia. People experiencing dysmorphia often imagine that they are weak and less muscular (NIDA, 2010). This condition could affect both men and women some of whom end up taking steroids in order to look more appealing to the public. Dysmorphia may be common in people who experienced sexual abuse such as rape in some earlier stage in life (NIDA, 2010). They imagine after becoming muscular and stronger they can successfully resist any sexual abuse in future. Some adolescents abuse steroids for the thrill of it (Tahtamouni et al, 2008). They engage in numerous high risk behaviors and steroid abuse is just one of their thrill seeking ventures.

How steroids are abused

Anabolic steroids can be taken orally or intramuscularly while others are provided as creams and gels. The dosage taken by the drug abusers is usually higher than doses administered by physicians. The criteria used to abuse steroids could be through stacking, cycling or pyramiding. Stacking is a term mostly used by athletes or body builders which refers to the use of two or more anabolic steroids in relatively higher doses than the normal doses prescribed by physicians (Pery et al, 2005). Injectables may be stacked with oral doses or the long acting steroids may be stacked with short performing steroids (NIDA, 2010). The effects of stacking steroids are usually compounded because all the stacked steroids involved act at the same time.

Cycling is as term also commonly used by athletes to refer to the act of alternating anabolic dosage periods with drug free periods (NIDA, 2010). The drug free periods vary from six to fourteen weeks. The purpose of cycling steroids as opposed to their continuous use is to reduce the development of tolerance. NIDA (2010) explains that other reasons are;

Pyramiding is also another commonly used method of abusing steroids. In this case the user gradually increases the dose and frequency of steroid abuse until he reaches peak performance and then slowly reduces the amount of steroid until he reaches a level close to nil(NIDA, 2010). Pyramiding is also a cycle which lasts between six and twelve weeks. The methods used to abuse steroids are sometimes used in combination such as stacking and pyramiding (Pery et al, 2005). The abusers believe these methods are necessary for one to get the best performance during abuse. For instance they believe pyramiding allows the body to adjust slowly to high steroid levels while cycling allows the body's hormonal system to recuperate. These theories however have not been substantiated scientifically.

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Consequences of steroid abuse

The effects of steroid abuse are adverse but luckily majority of them are reversible if the individual stops taking the steroids (Hoffman and Ratamess 2006). Some on the other hand such as breaking of voice in women are permanent. The effects of steroid abuse have not been well document with most information coming from case studies instead of epidemiological studies. Case studies cannot provide reliable results because most incidences especially the severe ones may be underreported or under-recognized. However, even within the existing case reports the incidence of the life threatening conditions is low.

Association against steroid abuse explains that steroid abuse disrupts the normal production of hormones in the body. This is because there are excess supplementing hormones this may have reversible and irreversible changes. The reversible changes include the reduction in sperm production, testicular atrophy while irreversible changes include breaking of voice in women, male pattern baldness and development of breasts by men.

In females the abuse of steroids results in masculinization which is characterized by increase in breast size, enlargement of clitoris and deepening of voice (NIDA, 2010). The musculoskeletal system is normally affected by high intake of steroids. Young adults and adolescents who take high amount of steroids can result to premature signaling which limits the growth of bones (Hoffman and Ratamess 2006). The cardiovascular system is also affected by the use of steroids resulting to complications such as stroke and heart attacks. Steroids also increase the rate of formation of blood clots which have disrupted blood flow and in some cases damaged the heart muscle (Hoffman and Ratamess 2006). There are several other effects of the steroids on other parts of the body which include the liver, where the steroid abuse is associated with tumors and hepatitis, Skin, acne and cysts. There are also other infections which can result from the abuse of steroids especially where the abusers share needles which may result in spread of bacterial and viral infections such as hepatitis B and HIV.

Psychological effects of steroid abuse

Most athletes take steroids with a goal to enhance their physical capacities. This is their primary goal for taking these drugs. However there are emotional and behavioral effects that are associated with the abuse of these drugs (Tahtamouni et al, 2008). Research conducted on majority of regular drug users has shown that majority of the abusers display a known psychological effects. Therefore the psychological effects are inseparable from the physical effects.

Psychological effects of steroid abuse have been studied for quite a while now. The methods of research used to establish the effect of steroid abuse involve comparing regular steroid users with other individuals who are not using steroids or were previous users. The non-steroid users involved in the study could be resistance trainers (i.e. people who are involved in weight lifting, body building and power lifting) or non-resistant trainers.  There are also a number of psychological changes that may occur to non-users and users that may or may not be related to steroid abuse. These factors could most likely influence the outcome of the studies (NIDA, 2010). Therefore in order to achieve the best possible results groups or individuals are chosen randomly and given steroids and placebos. This is done in order to mirror the likely effects of steroid abuse in the real world.  

Most research suggest that steroid users are more hostile aggressive, irritable manic and depressed than former users and non-users (Darkes, 2009). The empirical studies which have been discussed above and anecdotal studies have revealed that steroid users display emotional instability, aggression and impulsivity (Williamson 1994). Hoffman and Ratamess (2006), explain that 60% of steroid abusers experience irritability and aggression. Despite the consistency of reports emanating from these studies which seem to agree that steroid abuse has negative psychological effects, there is no direct link to prove this. In addition to this Darkes (2009) explains that there are more questions which arise regarding the interpretation of these results. First, in what percentage do psychological effects present in steroid abusers? Second, is there any difference in psychological effects between users and non users? Do these results differ depending on the abuse method i.e. cycles such as stacking and pyramiding (Darkes, 2009)? If these questions could be answered then it is possible to establish the relationship between steroids and psychological disorders.

Relationship between dose and the psychological effects of steroids

Steroid abuse displays a dose response relationship whereby with the higher the dose the higher the anabolic and psychological effects. When carrying out empirical studies it is obvious that the human participants cannot be given heavy doses of steroids because it is inhuman and goes against research ethics (Darkes 2009). Therefore the research results will not mirror happens in the real world where individuals take large amount of steroids in order to boost their performance. The maximum allowable dose in these experiments is usually at 600mg per week (Darkes 2009). It is even more interesting to note that even on these dose levels the results are still inconsistent. The maximum limit of 600 mg of steroids use per week for the human participants makes it difficult for researchers to establish the psychological effects of steroids at high dosage levels (Darkes 2009).

The individuals preexisting characteristics may also influence the decision to use the drugs at a certain dose (Williamson 1994). Therefore linking the individual's subsequent behavior with steroid abuse may not reflect the true relationship. Therefore dose on its own is not sufficient enough in explaining the relationship between steroid abuse and psychological effects. This is because preexisting conditions such as a bad mood may influence an individual into taking high/ low doses of steroids. (Goulet et al, 2010).

Methodology used in establishing the psychological effects of steroid abuse.

In cases where research findings are in doubt, every one is tempted to look at the methodology that has been used to arrive at these findings. The psychological factors that have been discussed above have been researched using a variety of psychometric methods. These include; Buss-Durke Hostility inventory, Multi dimensional anger Inventory, Multidimensional personality questionnaire and/ or Personality diagnostic questionnaires (Darkes 2009).  These measures look at behavior expressed verbally and physically and then correlate this with results from several participating individuals in order to arrive at the results. There should be more findings on how these methods relate to each other and their reliability.

Despite the presence of overwhelming literature that suggests that indeed steroid abuse results to psychological disorders, there are no empirical studies out there that give a direct link between the two issues (Pery et al, 2005). Researchers have to look for reliable methods that can indeed separate the preexisting psychological characteristics of humans participating in the studies from the final psychological findings. They also have to find ethical methods of studying steroid abuse at high dosage levels.

Findings and recommendations

Existing data and research suggest that steroid abuse is more prevalent among professional athletes who do so in order to improve their performance. Therefore the research has mostly been directed towards the physical effects of steroid abuse leaving out the psychological effects. This is because the physical effects of steroid abuse are more pronounced with some being irreversible whereas the psychological effects such as mood swings and aggressiveness are reversible once the individual ceases the consumption of the steroids.

More research into the usage of steroids is needed because the existing statistics are not based on epidemiological studies but rather on the reported cases. This means that it is likely that steroid abuse is underreported while adverse effects of steroid abuse are not recognized (Williamson 1994). On the other hand existing literature and research has concentrated on the prevalence and effects of steroid abuse among athletes. This has ignored the effect of steroids on other groups such as adolescents and adults who are not athletes and may not necessary take steroids with an aim of improving athletic performance. The law enforcement agencies have also not done enough to prevent the abuse of steroids.  This might be attributed to the fact that steroid users do not pose a serious threat on public and individual safety. Therefore in most countries steroids are easily obtained whereas the steroid supplements are legal.

Steroid abuse has negative physical and psychological effects on the health of the abusers. Physical effects include; heart disease, masculinization of women, and breast growth in men, testicular atrophy, liver complications and breaking voice in women. The psychological effects include irritability, aggressiveness, mood swings, hostility and depression. There are overwhelming studies that have reported that the psychological effects of steroid abuse are common in most steroid abusers. However, these claims are not well founded because the methodology used in most studies is questionable. Therefore there is need for more research on the issue to substantiate these claims.

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