Tuesday, September 20, 2011

Steroids on the brain:Fit to Be Tried by Jerry Brainum

In a fit of incomprehensible anger, a 16-year-old boy kills his 14-year-old girlfriend. The youthful killer has no prior record of either criminal activity or violence. In another incident a muscular man goes into an irrational fit, using his fists and a metal bar to attack the drivers of three other cars, thinking that they are the cause of a traffic delay. In a meaningless display of bravado, another man drives his car straight into a tree. The connection between those incidents is that the perpetrators were all taking anabolic steroid drugs.

Anabolic steroids are often in the news, mainly because of an apparently wide usage of so-called designer steroids, which until recently couldn’t be detected by the usual tests. Steroid use seems to explain in many people’s minds the often out-of-control personality characteristics of professional athletes. Whenever an athlete throws a temper tantrum, people suggest that “the steroids make him crazy.” The supposed psychological effects of steroids are known in the popular parlance as “’roid rage.”

The concept of ’roid rage is fueled by popular media and even physicians. The basis is simple: Men have higher levels of testosterone than women, which explains why men are naturally more aggressive. Others like to point out that women never start wars; only men do (an observation obviously made by those who’ve never gone through a divorce).

Anabolic steroids weren’t always linked to increased aggression. In the 1940s, not long after testosterone was discovered, it was suggested as an effective treatment for depression in men. In fact, a common symptom of hypogonadism, or low testosterone levels in men, is severe depression.

Over the past 20 years, however, the medical pendulum has swung: Testosterone is a drug that induces severe mental disturbances in users. Among the symptoms associated with anabolic steroid use are irritability, aggression, euphoria, grandiose beliefs, hyperactivity and reckless or dangerous behavior. In those who have such mental conditions as depression, psychosis or mania, using steroids either makes the conditions worse or makes them apparent.

Not all the research indicts testosterone or other anabolic steroids. In several studies giving testosterone to men had no effect on any aspect of behavior. Other studies have shown that the angriest of men had lower-than-normal testosterone levels. Then there’s the self-fulfilling-prophecy effect: If you think something will happen, it often will. Doctors who prescribe antidepressants often don’t tell male patients that a side effect of such drugs is impotence. The fear is that putting the suggestion in the patient’s head will yield the side effect.

No one would deny that anabolic steroids have potent effects on muscle. But you have to wonder just how much of the gains experienced by those who use them accrue from a strong belief in the drugs, which may lead to harder training, better nutrition and other factors that result in real muscle gains. The same is true for the mental effects of steroids: Those who think they’re supposed to act crazy while on the drugs often do, then use the drugs as an excuse for their bad behavior. Yet not every athlete who takes steroids shows aggressive tendencies. Much depends on the inherent personality of the user. Angry people may get angrier while taking large doses of anabolic steroids. In fact, the medical literature notes that the higher the doses, the greater the chance of psychological symptoms.

The minimal level of testosterone thought to produce adverse psychological effects is 1,000 milligrams a week, an amount that greatly exceeds the dosages suggested for testosterone-replacement therapy. Symptoms that manifest often abate shortly after the drugs are withdrawn, although they can last up to a month afterward.

Several case studies in the medical literature suggest that steroids are hard not only on users but also on those closest to the users, such as family, wives or girlfriends. Although outright psychosis is rare, irritability is common. Things that would normally not upset you bring on what could be mildly called an overcompensation effect. Some athletes on steroids have beaten their wives or girlfriends to the extent of sending them to the hospital.

Some research links cases of homicide, suicide and other causes of death to steroids. One study examining the cause of death in 34 steroid users found that 11 had killed themselves, nine were homicide victims and 12 died accidentally. The conclusion of the study was that anabolic steroid abusers were at higher risk because of impulsive and aggressive behavior or increased depression.1

Steroids affects brain function. Experiments have demonstrated that anabolic steroids, when given to adolescent rats, lead to a decrease in receptors in the brain for GABA, an inhibitory neurotransmitter. That substance, which is synthesized from amino acids, calms the brain. In fact, most prescription sleeping pills work by interacting with the GABA receptor, and if the receptor malfunctions, mania and delusional thinking, as well as loss of control, can result.

GABA functions in a section of the brain called the amygdala, the site of emotional response and anger expression. It’s not difficult to see how inhibiting GABA could lead to increased aggression and anger.

Anabolic steroids also adversely affect the density of neurons that express serotonin, a brain chemical associated with sleep and feelings of relaxation. Before it was unjustly banned several years ago, the amino acid L-tryptophan was often used as a sleep and relaxation aid. It worked because it was the direct precursor of serotonin synthesis in the brain. Although tryptophan was banned for several years, follow-up research showed that tryptophan itself was never the cause of any health problems in those who had ingested the amino acid. In fact, the cause was a processing impurity incorporated into tryptophan by a Japanese company. As such, tryptophane has quietly re-entered the commercial supplement market.

A lack of serotonin activity would make someone feel not only jumpy and on edge but also depressed. Many antidepressants, such as Prozac, work by interacting with serotonin in the brain. It’s possible that for a person with tendencies toward depression, using steroids may make the feelings worse. The suicides related to steroid use likely occurred through that mechanism.

Testosterone is known to increase a hormone synthesized in the posterior pituitary gland. Vasopressin, or anti-diuretic hormone (ADH), mainly helps the body retain water and maintain vital blood fluid volume. In excess, however, ADH is associated with increased aggressive behavior, dominance and memory. ADH has a correlation with serotonin: When serotonin is low and ADH is high, increased aggression occurs. Since testosterone increases ADH while lowering serotonin, the possible aggression-producing effects are clear. The increased water retention observed in those who inject testosterone also represents an increase in ADH.

Some suggest that you can become psychologically addicted to steroids, especially if you’re taking large doses. Addiction requires a withdrawal syndrome, a set of symptoms that occur when drug use ceases. Popular movies have depicted what happens when drugs such as heroin are withdrawn, with junkies experiencing excruciating mental and physical effects.

Some studies suggest a withdrawal syndrome likewise exists with anabolic steroids. The symptoms include depression; anhedonia, or an inability to feel joy or happiness; fatigue; impaired concentration; and, in some cases, thoughts of suicide. The feelings can become so overwhelming that the user promptly goes back on the drugs. In other cases the notion that all the muscle gains made while on the drugs are dissipating rapidly leads to a return to the drugs. Most of the addictive effects are more associated with the oral or 17-alpha ankylated versions of the drugs.

Anabolic steroids have been characterized as gateway drugs, in the sense that using them often leads to use of other, more immediately dangerous drugs. Why that’s so is hard to say, although the mental euphoria induced by steroids may induce some to experiment with other drugs that have no anabolic properties.

Although not often discussed, some well-known bodybuilders have indeed become hooked on hard-line drugs. Some started with a drug called Nubain, which was characterized as nonaddictive. The original rationale for using Nubain was that it provided an antistress effect during intense training and dulled pain to the extent that it enabled harder training in the gym. But Nubain turned out to be not so innocent. Although no one died from using it, many users went on to drugs such as heroin. The recent death of a former national champion bodybuilder was linked to his heroin use. He started with Nubain.

So, do anabolic steroids actually cause ’roid rage? In a small percentage of users they amplify what’s already there. That is, an angry person may get even angrier when using large doses of steroids. Most who use the suggested steroid cycles that feature large doses of several drugs experience greater irritability because of the chemical changes induced in the brain. The key to how a person acts while on steroids relates to the higher brain centers, which determine intellectual functions and rationality. Some people can maintain control and not engage in antisocial behavior, such as beating people up, crashing cars voluntarily or throwing insane public temper tantrums.

For those unable to tap into their higher intellectual centers, the drugs represent a serious mental-health risk. Such people could represent a danger to themselves, their families and society. The ultimate solution for those who say that using steroids drove them to commit negative acts is to either reduce intake of the drugs or, better yet, get off them completely.

The interaction of testosterone with serotonin suggests that increasing serotonin levels in the brain may help blunt aggressive tendencies while on steroids. Since the amino acid, L-tryptophan is directly converted into serotonin in the brain, ingesting L-tryptophan supplements may help offset some steroid-induced mental symptoms. Another OTC supplement called L-5-hydroxy tryptophan, derived from a type of bean,, is an even more direct precursor of serotonin than tryptophan is. Taking at least 300 milligrams a day while on steroids may help. One company is also selling a natural GABA derivative that appears to be able to cross the blood-brain barrier and exert calming effects. That, too, may offer benefits for those experiencing increased aggression while on steroids.

Fish oil is particularly effective for modulating aggressive tendencies. Fish oil, or omega-3 fatty acids, interacts with serotonin receptors in the brain to help tame aggression. Various studies have shown that those with low brain levels of omega-3 fats are often depressed and have increased aggression. A good dose for people who are taking steroids is five to 10 grams of fish oil a day. The liquid form of the supplement is preferable, since you’d need to take far too many capsules to reach that dose range.


1 Thiblin, I., et al. (2000). Causes and manner of death among users of anabolic steroids. J Forensic Sci. 45:16-23.

©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.

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