in our understanding of the psychological and social reasons why individuals take these drugs, when current information appears unconvincing. Disclosures The authors have no conﬂicts of interest to declare. References Argetsinger LS, Campbell GS, Yang X, et al. 1993. Identification of JAK2 as a growth hormone receptor-associated tyrosine kinase. Cell, 74:237–44. Astrom C, Pedersen SA, Lindholm J. 1990. The inﬂuence of growth hormone on sleep in adults with growth hormone deﬁciency. Clinical Endocrinol (Oxf), 43:143–9. Baker JS, Graham MR, Davies B. 2006. “Steroid” and prescription medi- cine abuse in the health and ﬁtness community; a regional study. Eur J Intern Med, 17:479–84. Baumann G. 1991. Growth hormone heterogeneity: genes, isohormones, variants, and binding proteins. Endocr Rev, 12:424–49. Berggren A, Ehrnborg C, Rosen T, et al. 2005. Short-term administration of supraphysiological recombinant human growth hormone (GH) does not increase maximum endurance exercise capacity in healthy, active young men and females with normal GH-insulin-like growth factor I axes. J Clin Endocrinol Metab, 90:3268–73. Bhasin S, Storer TW, Berman N, et al. 1996. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med, 335:1–7. Biolo G, Fleming RYD, Wolfe RD. 1995. Physiologic hyperinsulinaemia stimulates protein synthesis and enhances transport of selected amino acids in human skeletal muscle. J Clin Invest, 95:811–19. Blackman MR, Sorkin JD, Münzer T, et al. 2002. Growth hormone and sex steroid administration in healthy aged women and men. J Am Med Assoc, 288:2282–92. Bonadonna RC, Saccomani MP, Cobelli C, et al. 1993. Effect of Insulin on System A Amino Acid Transport in Human Skeletal Muscle. J Clin Invest, 91:514–21. Boroujerdi MA, Umpleby AM, Jones RH, et al. 1995. A simulation model for glucose kinetics and estimates of glucose utilization rate in type I diabetic patients. Am J Physiol, 268:766–74. Brill KT, Weltman AL, Gentili A, et al. 2002. Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. J Clin Endocrinol Metab, 87:5649–57. Brown RJ, Adams JJ, Pelekanos RA, et al. 2005. Model for growth hormone receptor activation based on subunit rotation within a receptor dimer. Nat Struct Mol Biol, 12:814–21. Cassidy EM, O’Halloran DJ, Barry S. 1999. Insulin as a substance of misuse in a patient with insulin dependent diabetes mellitus. BMJ, 319:1417–18. Coghlan A. 2001. Athletes may be increasingly abusing insulin [online]. New Scientist, August 8. Accessed on December 12, 2007. URL: http://www.newscientist.com/article/dn1129-athletes-may-be-increas- ingly-abusing-insulin.html. Crist DM, Peake GT, Egan PA, et al. 1988. Body composition response to exogenous GH during training in highly conditioned adults. J Appl Physiol, 65:579–84. Dahl RE, Birmaher B, Williamson DE, et al. 2000. Low growth hormone response to growth hormone-releasing hormone in child depression. Biol Psychiatry, 48:981–8. Dawson RT. 2001. Drugs in sport. The role of the physician. J Endocrinol, 170:55–61. Deyssig R, Frisch H, Blum WF, et al. 1993. Effect of growth hormone treatment on hormonal parameters, body composition and strength in athletes. Acta Endocrinol (Copenh), 128:313–18. Therapeutics and Clinical Risk Management 2008:4(3) AAS, growth hormone, and insulin abuse Doessing M, Kjaer M. 2005. Growth hormone and connective tissue in exercise. Scand J Med Sci Sports, 15:202–10. Duchaine D. 1983. Underground steroid handbook, 1st ed. California: HLR Technical Books, p 84. Ehrnborg C, Ellegard L, Bosaeus I, et al. 2005. Supraphysiological growth hormone: less fat, more extracellular ﬂuid but uncertain effects on muscles in healthy, active young adults. Clin Endocrinol (Oxf), 62:449–57. Elkin SL, Brady S, Williams IP. 1997. Bodybuilders ﬁnd it easy to obtain insulin to help them in training. BMJ, 314:1280. Eriksson A, Kadi F, Malm C, et al. 2005. Skeletal muscle morphology in power-lifters with and without anabolic steroids. Histochem. Cell Biol, 124:167–75. Evans PJ, Lynch RM. 2003. Insulin as a drug of abuse in body building. Br J Sports Med, 37:356–7. Fryburg DA, Gelfand RA, Barrett EJ. 1991. Growth hormone acutely stimulates forearm muscle protein synthesis in normal humans. Am J Physiol, 260:499–504. GonderFreerick LA, Clarke WL, Cox DJ. 1997. The emotional, social and behavioural implications of insulininduced hypoglycemia. Semin Clin Neuropsychiatry, 2:57–65. GonderFreerick LA, Cox DJ, Bobbitt SA. 1989. Mood changes associ- ated with ﬂuctuations in insulindependent diabetes mellitus. Health Psychol, 8:45–9. Gonzalez-Cadavid NF, Taylor WE, Yarasheski K, et al. 1998. Organiza- tion of the human myostatin gene and expression in healthy men and HIV-infected men with muscle wasting. Proc Natl Acad Sci USA, 95:14938–43. Gotherstrom G, Bengtsson BA, Sunnerhagen KS, et al. 2005. The effects of ﬁve-year growth hormone replacement therapy on muscle strength in elderly hypopituitary patients. Clin Endocrinol (Oxf), 62:105–13. Gottesman I, Mandarino L, Verdonk C, et al. 1982. Insulin increases the maximum velocity of glucose uptake without altering the Michaelis constant in man. J Clin Invest, 70:1310–14. Grace FM, Baker JS, Davies B. 2001. Anabolic androgenic steroid (AAS) use in recreational gym users – A regional sample of the Mid-Glamorgan area. J Substance Use, 12:145–53. Graham MR, Baker JS, Evans P, et al. 2007a. Recombinant human growth hormone in abstinent androgenic-anabolic steroid use: Psychological, endocrine, and trophic factor effects. Curr Neurovasc Res, 4:9–18. Graham MR, Davies B, Hullin D, et al. 2007b. Short-term recombinant human growth hormone administration improves respiratory function in abstinent anabolic-androgenic steroid users. Growth Horm IGF Res, 17:201–9. Gruber AJ, Pope HG Jr. 1999. Compulsive weight lifting and anabolic drug abuse among women rape victims. Compr Psychiatry, 40:273–7. Gruber AJ, Pope HG Jr. 2000. Psychiatric and medical effects of anabolic-androgenic steroid use in women Psycother Psychosom, 69:19–26. Gullestad L, Birkeland K, Bjonerheim R. 1998. Exercise capacity and hormonal response in adults with childhood onset growth hormone deﬁciency during long-term somatropin treatment. Growth Horm IGF Res, 8:377–84. Hamer D, Sanjeev D, Butterworth E, et al. 1991. Using the Hospital Anxiety and Depression Scale to screen for psychiatric disorders in people presenting with deliberate self-harm. Br J Psychiatry, 158:782–4. Harro J, Rimm H, Harro M, et al. 1999. Association of depressiveness with blunted growth hormone response to maximal physical exercise in young healthy men. Psychoneuroendocrinology, 24:505–17. Hart SP, Frier BM. 1998. Causes, management and morbidity of acute hypoglycaemia in adults requiring a hospital admission. Quart J Med, 91:505–10. Hartgens F, Kuipers, H. 2004. Effects of androgenic-anabolic steroids in athletes. Sports Med, 34:513–14. Hartgens F, Rietjens G, Keizer HA, et al. 2004. Effects of androgenic- anabolic steroids on apolipoproteins and lipoprotein (a). Br J Sports Med, 38:253–9. 595