Several reports of mental status changes associated with AASs have been published. These include acute paranoia,[32] delirium,[33] mania or hypomania,[34,35] and homicidal rage.[36,37] Studies comparing Anabolic Androgenic Steroids (AAS) users to nonusing weight lifter controls have found significantly more episodes of depression, anxiety, hostility, paranoia, and aggression in users of AAS.[38, 39] One study comparing Anabolic Androgenic Steroids (AAS) users on vs off AASs reported a higher rate of aggressive feelings, verbal aggression, and aggression toward objects, but not physical aggression toward people, while on the agents. Anabolic Androgenic Steroids (AAS) users have also been observed to have a significantly greater rate of personality psychopathology compared with community controls.[40,41] As none of these studies are randomized, causality is difficult to establish in the association of AASs and psychiatric changes, including aggression and hypomania.
At least 5 studies have administered supraphysiologic doses of testosterone in a placebo-controlled design to psychiatrically "normal" subjects.[42-46] Overall, these studies indicate that the majority of normal individuals will not experience psychiatric changes with testosterone doses up to 500-600 mg/week. However, this response is not uniform and individual patients will experience marked affective changes, particularly as the dose increases beyond 500 mg/week. Furthermore, the majority of real-world Anabolic Androgenic Steroids (AAS) abusers will use doses greater than the equivalent of 500 mg of testosterone. Patients with underlying psychopathology (eg, antisocial personality disorder) or a general predisposition toward anger are probably more likely to experience an increase in angry or aggressive behavior. This relationship is important because these individuals are probably more likely to use anabolic steroids illicitly, compared with "healthy, psychologically normal men."
The potential for addiction to the AASs has been investigated. In interviews with 49 Anabolic Androgenic Steroids (AAS) users, at least 1 DSM-III-R symptom of dependence was reported by 94% of the sample, while 3 or more symptoms were reported by 57% of the sample.[47] The authors concluded that AASs were addictive and suggested that dissatisfaction with body size and increases in size and strength obtained with AASs may lead to patterns of dependent use.
