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Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100
Diederik L Smit1, Madelon M Buijs2, Olivier de Hon3
1Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands.
Insights
Anabolic-androgenic steroid (AAS) users reported positive effects like increased strength, but also negative health effects such as fluid retention and decreased libido. While most side effects were mild and temporary, four users experienced serious adverse events during the study.
Area of Science:
- Sports Medicine
- Endocrinology
- Public Health
Background:
- Anabolic-androgenic steroids (AAS) are performance-enhancing drugs with an estimated 4-6% usage among fitness center visitors.
- Reliable data on the adverse reactions associated with AAS use remain scarce.
- The HAARLEM study was initiated to investigate the multifaceted effects of AAS consumption.
Purpose of the Study:
- To comprehensively assess the positive and negative effects of anabolic-androgenic steroid (AAS) use in men initiating a cycle.
- To document the incidence and nature of adverse events during and after AAS cycles.
- To evaluate the impact of AAS use on physical health, psychological well-being, and quality of life.
Main Methods:
- A prospective cohort study involving 100 men (≥18 years) intending to start an AAS cycle.
- Regular clinic visits for medical history, physical examinations, laboratory analyses (including ALT and creatinine), and psychological questionnaires at multiple time points (T0, T1, T2, T3).
- Follow-up extended for one year post-cycle initiation to observe long-term effects.
Main Results:
- All participants reported positive effects, primarily increased strength (100%).
- Common negative effects included fluid retention (56%) and agitation (36%) during cycles, and decreased libido (58%) post-cycle. Acne (28%) and gynecomastia (19%) were also observed.
- Four serious adverse events occurred: congestive heart failure, acute pancreatitis, suicidal ideation, and ulcerative colitis exacerbation. Mean ALT and creatinine levels increased.
- No association was found between AAS dose/cycle duration and side effect severity. Effects largely returned to baseline within one year, with no significant changes in well-being, quality of life, or depression scores.
Conclusions:
- All anabolic-androgenic steroid (AAS) users in the study experienced positive effects, alongside mostly anticipated, mild, and transient negative health effects.
- A significant minority of users experienced serious adverse events, highlighting potential health risks.
- Observed physical and psychological effects generally resolved by the one-year follow-up, suggesting a transient impact for most users.
Abstract:
An estimated 4-6% of fitness center visitors uses anabolic-androgenic steroids (AAS). Reliable data about adverse reactions of AAS are scarce. The HAARLEM study aimed to provide insight into the positive and negative effects of AAS use. One hundred men (≥18 years) who intended to start an AAS cycle on short notice were included for follow-up. Clinic visits took place before (T0 ), at the end (T1 ), and three months after the end of the AAS cycle (T2 ), and one year after the start of the cycle (T3 ), and comprised a medical history, physical examination, laboratory analysis, and psychological questionnaires. During the follow-up period, four subjects reported a serious adverse event, that is, congestive heart failure, acute pancreatitis, suicidal ideation, and exacerbation of ulcerative colitis. All subjects reported positive side effects during AAS use, mainly increased strength (100%), and every subject reported at least one negative health effect. Most common were fluid retention (56%) and agitation (36%) during the cycle, and decreased libido (58%) after the cycle. Acne and gynecomastia were observed in 28% and 19%. Mean alanine transaminase (ALT) and creatinine increased 18.7 U/l and 4.7 µmol/L, respectively. AAS dose and cycle duration were not associated with the type and severity of side effects. After one-year follow-up (T3 ), the prevalence of observed effects had returned to baseline. There was no significant change in total scores of questionnaires investigating wellbeing, quality of life, and depression. In conclusion, all subjects experienced positive effects during AAS use. Four subjects experienced a serious adverse event. Other side effects were mostly anticipated, mild, and transient.
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