R E V I E W AAS, growth hormone, and insulin abuse: psychological and neuroendocrine effects Michael R Graham1 Peter Evans2 Bruce Davies1 Julien S Baker1 1Health and Exercise Science Research Unit, Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, Wales, United Kingdom; 2Royal Gwent Hospital, Newport, Gwent, United Kingdom Correspondence: Michael R Graham Health and Exercise Science Research Unit, Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, Wales, United Kingdom Tel +44 1443 482293 Fax +44 1443 482285 Email drgraham@glam.ac.uk Abstract: The nontherapeutic use of prescription medicines by individuals involved in sport is increasing. Anabolic-androgenic steroids (AAS) are the most widely abused drug. Much of our knowledge of the psychological and physiological effects of human growth hormone (hGH) and insulin has been learned from deﬁciency states. As a consequence of the Internet revolution, previously unobtainable and expensive designer drugs, particularly recombinant human growth hormone (rhGH) and insulin, have become freely available at ridiculously discounted prices from countries such as China and are being abused. These drugs have various physiological and psychological effects and medical personnel must become aware that such prescription medicine abuse appears to be used not only for performance and cosmetic reasons, but as a consequence of psychological pre-morbidity. Keywords: AAS, cosmesis, growth hormone, insulin, performance, strength Introduction Athletes, bodybuilders, and recreational weightlifters have been abusing anabolic- androgenic steroids (AAS) since their synthetic production (Ruckzika et al 1935). They are a powerful group of synthetic compounds similar in chemical structure to the natural male steroid hormone testosterone (T) and dihydrotestosterone (DHT) (Haupt and Rovere 1984; Shahidi 2001). They differ from T by the addition of an ethyl, methyl, hydroxyl, or benzyl groups at one or more sites along the synthetic steroid structure (Figure 1). The risks from chronic administration of AAS may appear relatively low when compared with the use of socially acceptable drugs such as tobacco and alcohol. The literature tends to rely heavily on speciﬁc case reports, identifying psychiatric or psychological disorder, because of the private and personal nature of the abuse of this class of drug (Pagonis et al 2006a; Papazisis et al 2007). AAS are taken for their desirable cosmetic effects, to increase size and in the belief that they enhance sport- ing performance. AAS self-administration has increased over the last decade, in the wake of the demonstration that AAS increase muscle mass and strength in healthy adult males, over and above resistance training (Bhasin et al 1996). The administration of AAS has undesirable effects, which have been extensively reviewed (Haupt and Rovere 1984; Hartgens and Kuipers 2004; Hartgens et al 2004). However, there may be other reasons why individuals abuse anabolic substances. Thirteen percent of 75 female weightlifters, who admitted to abusing AAS to gain muscle mass, had increased their weightlifting activities to be better able to defend themselves against men and also reported that they were previously sexually abused (Gruber and Pope 1999). It is believed that compulsive weightlifting and AAS abuse may represent a form of response to the trauma of sexual assault and also may assist in raising self-esteem. The psychiatric evaluation of dedicated female athletes also demonstrated the exhibition of ergogenic polysubstance dependence, Therapeutics and Clinical Risk Management 2008:4(3) 587–597 © 2008 Graham et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 587