Anabolic-androgenic steroid use is associated with psychopathy, risk-taking, anger, and physical problems.
Nelson, B. S., Hildebrandt, T., & Wallisch, P. (2022). Anabolic-androgenic steroid use is associated with psychopathy, risk-taking, anger, and physical problems. Scientific reports, 12(1), 9133. https://doi.org/10.1038/s41598-022-13048-w
So, let’s get real. Steroid use is common. Up to 4% of boys in secondary schools use it. It is pretty normalized, fuelled by the Australian image of washboard abs, beach bodies, and now the increased prevalence of the “gym fit.” In the gay and bisexual male community, 6-10% use steroids. On dating apps, that’s roughly 1 out of every 10 potential matches! No wonder body dysmorphic disorder is on the rise!
The unfortunate truth is that steroid use results in a poor quality of life. It is, however, a reality of our culture and society. It is often ignored or played down even by those interested in men’s mental health. The same people who might even work in psychiatric fields will comment about the body shape and image of their colleagues, friends, and others. I find it heartbreaking that despite significant positive actions for women and girls, we still see very harmful attitudes and behaviors in males, often perpetuated by both men and women. Going to a strip club has become sleazy and objectifying, yet "Magic Mike" is entertaining and acceptable. My own experience, seeing my peers (doctors, mind you) falling into the difficult trap of competitive body image, has been tough. The shirtless parties, looking “hot” in scrubs, and the obsession with being an alpha fit all-rounder result in poor role modeling. Obviously, the problems are complicated and perhaps beyond the scope of this article, but something we must advocate for and explore in more detail.
The point of the study, from NYC and supported by the New York University Dean’s Undergraduate Fund, is to explore more nuanced risks associated with steroid use—perhaps the stuff we don’t know very well.
When I offer a medication or treatment to a patient, I try to make sure the patient is making an “informed decision.” That means they know the value of the decision, including the consequences one way or another. The fantastic authors of Nelson et al. help users of this substance make said decision, providing a more in-depth understanding of the consequences of using it. It does make me think, however, about whether there may even be a legal consequence of these findings (which we will discuss later).
The article starts by providing some background information, including the known physical health side effects (e.g., liver, kidney, heart, testicular issues, hair loss, and gynecomastia). They also discuss how users often will use other drugs. Psychologically, using steroids can give a false sense of confidence and invincibility, while others can be moody, impulsive, and even violent. In imaging, we know that using this agent can thin the cortex of the brain, seem to accelerate brain aging and apoptosis (nerve death)—and this could lead to a drop in IQ or intelligence in the user.
The researchers then discuss how there is not much evidence about how the use of steroids impacts personality, particularly psychopathy (a severe personality disorder with a lack of empathy, shallowness in emotions, and indecency or lawlessness). The study explores if those who use steroids are more likely to have psychopathic traits, impulsiveness, anger problems, psychiatric problems (anxiety, depression), cognitive problems, and physical health issues.
So how did they go about this? They anonymously recruited 492 bodybuilders online and asked them about all these in a survey. They were given a raffle $50 gift card for their time, and the survey was advertised on multiple bodybuilding and fitness forums. All ethical protocols were followed.
Most of the people surveyed were white males under 25 who were educated beyond high school. They found that using steroids is associated with higher odds of psychopathic traits, even if they hadn’t used any other drugs. Interestingly, even considering steroid use has a 2x greater chance of having psychopathic traits. It is hard to know which direction this association is, but it is likely bidirectional and could be due to both the environment and the agent itself.
This study reinforced that using steroids is associated with increased risk-taking behaviors in other parts of life, such as sexually and with drug use. Steroids could be a gateway drug, but it could also be the icing on the cake.
Anger problems are also higher in those who use steroids. Interestingly, even those who would consider using steroids have problems with their psychological states. On a positive note, those who stopped using steroids actually experienced improvements in their anxiety and depression as well as impulsivity. Lastly, physical health problems were higher in those who use steroids versus those who don’t—so using them actually makes users unhealthy, even though they want to portray an outward appearance of health.
Given this is a cross-sectional survey, it is hard to know what “causes” what. The authors also think about what kind of self-esteem or narcissism leads an individual to consider steroids in the first place.
The take-home message for me is that for those who use steroids, the problems can be quite deep and complex, with not only physical health but also personality issues that are worth exploring, investigating, and treating. The other take-home is that despite the “bro-science,” using or even considering using steroids might indicate a problem in your physical or mental health. Could these symptoms, particularly aggression, result in the same legal ramifications as intoxication is also a possibility—particularly in criminal and insurance situations.