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Monday, January 21, 2013

Ominous news about anabolic androgenic steroid use and midlife memory dysfunction

A recent study published in Drug and Alcohol Dependence reported finding an association between spatial memory problems and lifetime cumulative exposure to anabolic androgenic steroids in middle-aged men. CPDDBLOG interviewed the senior author of the study, Harrison G. Pope, Jr., M.D., to learn more.

CPDDBLOG: We've been hearing a lot lately about many different forms of substance abuse including nicotine dependence, alcohol abuse, and prescription painkiller abuse, but we don't hear as much about anabolic androgenic steroid abuse. What substances are considered anabolic androgenic steroids?

Dr. Pope: Anabolic-androgenic steroids, usually abbreviated as “AAS,” are the family of hormones that comprises testosterone (the natural male hormone), together with dozens of synthetic derivatives of testosterone that have been created by chemists over the last 75 years. AAS should NOT be confused with corticosteroids, such as cortisol and its synthetic derivatives such as prednisone. Although these latter substances are often also called “steroids,” they have no muscle-building properties and are almost never abused.

CPDDBLOG: Why do people abuse these substances?

Dr. Pope: AAS allow individuals to gain large amounts of muscle mass and to lose body fat (i.e., to become very lean). If used in large doses, AAS allow individuals to reach levels of leanness and muscularity far beyond what can be attained by natural means.

CPDDBLOG: What are the major biological effects of anabolic androgenic steroids?

Dr. Pope: AAS have 1) anabolic effects, namely stimulating muscle growth; 2) androgenic (masculinizing) effects such as beard growth, male secondary sexual characteristics, and aggression; and 3) at least some hedonic effects, as illustrated by the fact that male hamsters will self-administer AAS to the point of death. AAS also have adverse effects, one of which is that in markedly supraphysiological doses (i.e., doses far above natural levels of testosterone secretion, such as the doses used by bodybuilders and other illicit AAS users), they can accelerate apoptosis in many types of cells. This means that AAS can cause cells, including neuronal (brain) cells to die prematurely, faster than they would do under natural conditions.

CPDDBLOG: Your group recently published new information on the cognitive effects of these substances in Drug and Alcohol Dependence; what did your study find?

Dr. Pope: Given laboratory evidence of accelerated apoptosis of neuronal cells with supraphysiologic doses of AAS, we were concerned that long-term high-dose AAS abusers might show cognitive deficits from possible loss of brain cells. In a preliminary study, using a battery of computerized cognitive tests, we compared 31 AAS users with 13 non-AAS-using weightlifters. We found no differences on measures of attention, reaction time, or verbal memory, but the AAS users showed significant deficits compared to non-users on both of our two tests of visuospatial memory [e.g., remembering the appearance of an object and/or where it was located]. Ominously, when we looked within the AAS group, the degree of visuospatial deficit was significantly associated with total lifetime dose of AAS ingested.

CPDDBLOG: What next steps are you planning to take to follow up on this study?

Dr. Pope: We plan three followups: 1) continued cognitive testing of AAS users; 2) neuroimaging of long-term AAS users to seek structural and functional evidence of brain effects; and 3) a study administering high-dose testosterone to rats, which will then be tested for visuospatial deficits using the Morris Water Maze, and also examined for brain effects by serial neuroimaging and by histology.

CPDDBLOG: Thanks very much for these informative answers.

Additional information on AAS abuse and its effects can be found on the National Institute on Drug Abuse website and in a review and position statement on AAS use and abuse (co-authored by Dr. Pope) on the National Athletic Trainers Association (NATA) website (PDF).

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

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