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 About | Disclaimer | Links | Contact | Home 3:49 pm | 5.21.08 
« Steroids Discovered in Usain Bolt’s Yams
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Steroids Are Evil Quote of the Day - Linn Goldberg

[August 29th, 2008] by Millard Baker

Steroid education expert Linn Goldberg is in the news again. The NFL recently earmarked $1.4 million for Goldberg’s ATLAS and ATHENA steroid education programs. The programs do have some empirical support showing that they reduce teen steroid use. However, we are concerned with some of the inaccurate side effects promoted by Dr. Goldberg in the media, like the “fact” that steroids cause “paranoia.”

“Unlike many other drugs, kids don’t admit it because it’s not cool to be on steroids, not to mention the fact that it makes you paranoid,” explained Linn Goldberg, professor of medicine at Oregon Health & Science University in Portland.

 

 

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This entry was posted on Friday, August 29th, 2008 at 12:31 pm and is filed under Posts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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    Androgens are not evil, however there is a greater incidence of paranoia at relatively low doses. When taken at high doses (the level required for a greater anabolic effect) reports of paranoia are present in the medical literature from all over the world. Certainly androgens do not do this in every person or most individuals. However, when studying a drug, you need to know the side-effects and whether taking them are worth the risk.

    See:
    1) Mayo Clinic website: http://www.mayoclinic.com/health/drug-informati...
    2) BritishSociety for Neuroendocrinology: http://www.neuroendo.org.uk/content/view/66/11/
    3) Pharmacogenetics and Pharmacogenomics Knowledge Base: http://www.pharmgkb.org/do/serve?objId=998&objC...
    to name just a few sites


    Now some of the reports from the National Library of Medicine from different countries regarding paranoia:
    Acute paranoid psychotic symptoms after i.m. injection of nandrolone. Psychiatr Prax. 2003 May;30 Suppl 2:S73-4.
    Psychiatric and hostility factors related to use of anabolic steroids in monozygotic twins. Eur Psychiatry. 2006 Dec;21(8):563-9.
    Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse.Eur Psychiatry. 2006 Dec;21(8):551-62. Epub 2005 Dec 13.

    To not list paranoia as a potential consequence of use of androgens is using blinders. You may want to take anabolic steroids, but you should at least know the potential side-effects. I prescribe anabolic steroids to patients who need them, however, it is in physiological doses.

    All hormones taken at multiple times the physiological dose can have side-effects that can be very dangerous, including:
    Insulin
    Estrogen
    Growth Hormone
    Thyroxine
    Corticosteroids
    Erythropoetin
    Glucagon
    Aldosterone
    Parathyroid Hormone
    Calcitonin
    Antidiuretic Hormone
    Angiotensin
    Adrenaline
    and many more
    Androgens at therapeutic and small increases in doses (not close to abuse levels) have been shown to cause the following:
    1) increase LDL-Cholesterol
    2) reduction in HDL-Cholesterol
    3) High blood pressure
    4) Peliosis hepatis (blood filled liver cysts that can rupture)
    5) Increased blood clotting
    6) cholestatic jaundice (most oral androgens)
    7) stunted height in growing adolescents
    8) liver tumors
    9) psychological abnormalities: anxiety/depression/aggressive behavior
    10) Acne
    11) Male pattern baldness
    12) masculinization among women

    The following are some citations from the world literature, with the country reporting the side effect:

    1. TUMORS/CANCERS
    Liver cancer associated with anabolic steroid therapy: report of a case and review of the Japanese literature. J. Gastroenterology. 1996;31(3):450-4. JAPAN

    Liver tumors associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature. Br J Sports Med.2005 May;39(5):e27. GREAT BRITAIN

    Blood filled liver cysts found in a young adult bodybuilder. Med Sci Sports Exerc. 1994 Jan;26(1):2-4. USA

    Multiple liver tumors caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis. J Gastroenterology. 2000;35(7):557-62. USA

    Jaundice (yellowing of skin and eyes from plugging bile pigment in liver) Androgenic/anabolic steroid-induced intrahepatic cholestasis: a review with four additional case reports. J. Okla State Med Assoc. 1994. 1994;87(9):399-404. USA

    2. Diseases of the URINARY TRACT
    Kidney failure from anabolic steroids in a body builder. Dtsch Med Wochenschr. 1999 Sep 10;124(36):1029-32. GERMANY

    Nephrotic syndrome (protein in urine) in a young man taking anabolic steroids and creatine. Orv Hetil. 2003 Dec 7;144(49):2425-7. HUNGARY

    Prostate cancer Adenocarcinoma of prostate in 40-year-old body-builder. Lancet. 1986 Sep 27;2(8509):742. GREAT BRITAIN

    MUSCULOSKELETAL Problems:
    Bilateral rupture of the quadriceps tendon associated with anabolic steroids. Br J Sports Med. 1995 Jun;29(2):77-9. GREAT BRITAIN

    Simultaneous bilateral quadriceps rupture: a complication of anabolic steroid abuse. J Bone Joint Surg Br. 1995 Jan;77(1):159-60. GREAT BRITAIN

    Spontaneous rupture of the extensor pollicis longus tendon after anabolic steroids. J Hand Surg [Br]. 1986 Feb;11(1):87. GREAT BRITAIN

    PSYCHIATRIC Problems:
    Acute paranoid psychotic symptoms after i.m. injection of nandrolone]. Psychiatr Prax. 2003 May;30 Suppl 2:S73-4.

    A case of affective (emotional) disorder associated with the misuse of anabolic steroids. Br J Sports Med. 1992 Dec;26(4):219-20. GREAT BRITAIN

    Affective (emotional) and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry. 1988 Apr;145(4):487-90. USA

    Homicide and near-homicide by anabolic steroid users. J Clin Psychiatry. 1990 Jan;51(1):28-31. USA

    Psychiatric disturbances in users of anabolic steroids. S Afr Med J. 1994. 84(8):509-12. SOUTH AFRICA

    Psychiatric and hostility factors related to use of anabolic steroids in monozygotic twins. Psychiatry 2006;21(8):563-9. GREECE

    CARDIOVASCULAR Problems:
    Myocardial infarction and death of a body builder after using anabolic steroids. Ugeskr Laeger. 1991 Feb 18;153(8):587-8. DENMARK

    Sudden cardiac death in a 20-year-old bodybuilder using anabolic steroids. Cardiology. 1995;86(2):172-3. USA
    
Acute myocardial infarction in a 22-year-old world class weight lifter using anabolic steroids. Am J Cardiol. 1988 Jul 1;62(1):164. USA

    Myocardial infarction with extensive intracoronary thrombus induced by anabolic steroids. Br J Clin Pract. 1996 Jun;50(4):222-3. GREAT BRITAIN

    Anabolic androgenic steroids and stroke in an athlete: case report. Arch Phys Med Rehabil. 1988 Aug;69(8):632-3. USA

    Acute myocardial infarction with simultaneous occlusions of two major coronary arteries in a young man. Clin Cardiol. 1998 Feb;21(2):140-2. USA

    Myocardial infarction and cerebral hemorrhage in a young body builder taking anabolic steroids. Aust N Z J Med. 1993 Dec;23(6):713. AUSTRALIA & NEW ZEALAND

    Death caused by pulmonary embolism in a body builder taking anabolic steroids. Wiad Lek. 1990 Oct 1-15;43(19-20):972-5. POLAND

    Good luck!
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    It is one thing to publish case studies where an individual exhibiting paranoia has used anabolic steroids. To establish a causal relationship is much more difficult. IF paranoia is a side effect of anabolic steroid use, it is exceedingly rare. What do you think - maybe 1 in 1000, 1 in 10,000, 1 in 100,000?

    To state as fact that "[steroids] makes you paranoia" is akin to saying it is a fact that peanuts will kill you (because some people will have a fatal allergic reaction) or it is a fact that water will kill you (because some people usually endurance athlete die from overhydration). Technically true, but a little misleading don't you think?

    Scare tactics like this overstate the likelihood of rare events to make steroids seem more dangerous than than they really are.

    Thank you very much for taking the time to leave feedback. I appreciate to opportunity to engage in a conversation regarding the side effects of anabolic steroids.
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    The research on androgens show that paranoia occurs more frequently if you take them, especially as the dose increases. There are numerous neurotransmitter studies, showing the neurochemistry of aggression and paranoia. Certainly some people are more susceptible to the problems. Cigarette smoking doesn't cause emphysema in everyone and alcohol doesn't cause cirrhosis in most who abuse alcohol, however, there are risks of smoking and alcohol use. Vioxx, the anti-inflammatory drug has been shown to cause heart attacks in a higher level of individuals who take them vs those who take a placebo. The fact that I took Vioxx when it was on the market and am fine, without having a heart attack does not mean that Vioxx does not promote heart attacks.

    We have case reports of paranoia and have neurochemical evidence in experimental animals of the genesis of these behavioral changes. It is not that steroids MAKE you anything, it promotes changes in neurochemistry that make the susceptible more likely to suffer these effects. To believe that powerful hormones don't cause these changes are to deny both behavioral evidence and evidence of neurochemistry. It is causal! It just requires the susceptible individual.
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    Since anabolic steroids are associated with a change in neurotransmitters AND aggression and paranoia are associated with a change in neurotransmitter levels THEN anabolic steroids can cause paranoia BUT ONLY IF you have a "susceptible individual"?!

    This sounds more like the argument of a defendant invoking the dumbbell defense to explain away criminal behavior than the argument of a researcher or scientist. Does the scientific research really support such a huge leap in reasoning? I don't think it does.

    Do you think steroids caused the following defendant to threaten, physically and sexually abuse his girlfriend? The paradigm you propose would support it?

    http://www.mesomorphosis.com/blog/2008/08/30/ro...
    • ^
    • v
    Certainly some people are more susceptible to the problems. Cigarette smoking doesn't cause emphysema in everyone and alcohol doesn't cause cirrhosis in most who abuse alcohol, however, there are risks of smoking and alcohol use. Vioxx, the anti-inflammatory drug has been shown to cause heart attacks in a higher level of individuals who take them vs those who take a placebo. The fact that I took Vioxx when it was on the market and am fine, without having a heart attack does not mean that Vioxx does not promote heart attacks.

    This is a red herring. No where have I suggested that the absence of a side effect in a single individual proves that that side effect does not exist.

    You overlooked my question about the probabilities of side effects. I think it is extremely misleading to overstate the occurrence of very rare side effects in an attempt to demonize a substance. Instead of telling everyone that "steroids make you paranoia" when paranoia is an extremely rare outcome of steroid use, perhaps it would be more credible and accurate to state something like:

    Paranoia has been seen in 1 in 100,000 users of anabolic steroids. Then, perhaps you could compare this to the base rates of paranoia in the general population...
    • ^
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    A side-effect in a single individual is not the problem. It is an occurrence and supported by neurotransmitter research. Thus there is a clinical finding and evidence of support on a molecular level.

    You can't say that paranoia has been seen in 1 in 100,000 users of anabolic steroids, as people use them at different doses and there are multiple types of anabolic steroids with different properties (water soluble, fat soluble, oral, injectable, transdermal, buccal), all have varied elimination and absorption properties. That paranoia has been well described by clinicians and that there is a basis for this paranoia gives warning.

    The topic of this discussion is the presumption that paranoia is NOT a side effect. Well, the evidence, both clinically and neurochemically is that it indeed is a side-effect and is more likely to occur in those who use androgens than take a palcebo. The premise of this discussion is wrong, as the writer has only their belief, which is base (I suppose) on only their limited personal experience, not the world's medical literature.
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    The topic of this discussion is the presumption that paranoia is NOT a side effect.

    No, I don't think it is.

    The discussion concerns overstating the occurrence of an extremely rare side effect.

    The subject of this blog article states that "[anabolic steroids] make you paranoid" as if this were a common side effect.

    IT IS NOT.
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    Pardon me for jumping in late, but the topic of this discussion is clearly the initial assertion that AAS “…make you paranoid.” Reading over it, it seems you have consistently attempted to change that focus and back away from that argument. But no one has suggested that paranoia cannot be experienced by some who use AAS or a wide range of drugs. Such as assertion would lack validity, as does saying that everyone does; that is, it MAKES you paranoid. We cannot prove absence of effect, present evidence that something can never happen. Of course we can never prove an absolute either, but at best, that something can happen given the right set of circumstances (your susceptible individual). Besides, the evidence is there…it is seen…in a small percentage of users. No one is arguing that point. But one can fall prey to over-generalizing that notion.

    First and foremost, it is clear that adolescents should not be using any powerful drug, including AAS. A wide range of research shows that drug use during adolescence can be associated with longer term dysfunction in a number of areas as a result of disrupted brain development.

    However, no valid scientific evidence exists to support such an absolute statement ("...it makes you paranoid"). Hence, such a quote seems clearly meant to create fear and loathing. It personifies the drug and does assert that AAS are evil; it does not acknowledge the complex biopsychosocial influences on human behavior, including paranoia. The public and policy makers are so uninformed because they are exposed to such misleading summary statements without the knowledge to know whether they are valid. Reviewers, including some whose work you cited, note the limitations in the literature and acknowledge the shortcomings of anecdotal reports and survey-assessed associations. For instance, “As none of these studies are randomized, it is difficult to establish a causal relationship between AAS and psychiatric changes (Pagonis et al., 2006; European Psychiatry, 21, p. 552).” And animal studies (many of which use experimental designs that fail to mimic any realistic pattern of human AAS use; e.g., exceedingly large doses across the full pubertal period) have shown that such effects emerge from a much more complex picture than “AAS equal aggression or paranoia”. Most results are more in line with the notion of the challenge hypothesis, not some kind of automatic direct causal link. This argument seeks to extend the fallacious notion that testosterone CAUSES aggression to exogenous AAS administration.

    In some people AAS use and paranoia co-occur, just as paranoia CAN co-occur with use of other drugs or exist in the absence of drug use. There is no evidence that this association is specific to AAS or that AAS use, at any dose, cause paranoia (or aggression for that matter). Yes, AAS side effects show a clear dose-response relationship, but no dose in the literature (experimental or survey) achieves a 100% rate of response – is “The dose that MAKES you paranoid”. By your own account, such effects reflect an interaction, emerging from predisposing characteristics and potentially from current psychological factors; I would add also at least one context as a feature of this; paranoia related to using an illegal drug. To take the complex interplay of antecedent, drug use, circumstance, and response and reduce it to a simplistic picture is antithetical to scientific inquiry. One might make probability statements, say that AAS CAN or MAY in certain individuals given certain circumstances, but to say “…makes you paranoid” is imprecise.

    Those at risk, thinking about using or intending to use AAS, need to know the risks to make informed decisions and, should they decide to use, reduce potential harms. Large scale surveys show that some percentage of the population (adolescents and adults) will use these drugs, dire warnings be damned; to not make them aware of the POTENTIAL side effects is foolhardy. But not all risks are equal and to exaggerate risk and assert that any given effect is inevitable serves no purpose and leads, ultimately, to distrust of science and “authorities” as a source of information (data have shown this time and again). Adolescents are experimenters, and some percentage of them will use drugs of all kinds, despite overstated dire warnings. Research tells us (notwithstanding your assertion) that a large percentage of them will not experience such immediate and dire consequences and will likely, for one reason or another (a complex story), accrue some perceived benefit. We must appreciate the ramifications of telling the public, policy makers and all prospective users that "...it will make you…" when the vast majority will not experience this effect.
 

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