Anabolic-androgenic Steroid Use in the Nordic Countries: A Meta-analysis and Meta-regression Analysis

Open access

Abstract

AIMS – To investigate the lifetime prevalence and moderators of non-medical AAS use in the five Nordic countries. METHODS – We conducted a meta-analysis and meta-regression using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference checks. Included were 32 studies that provided original data on 48 lifetime prevalence rates based on a total of 233,475 inhabitants of the Nordic countries. RESULTS – The overall lifetime prevalence obtained was 2.1% [95% confidence interval (CI): 1.3-3.4, I 2 = 99.5, P < 0.001]. The prevalence for males, 2.9% (95% CI: 1.7-4.8, I 2 = 99.2, P < 0.001), was significantly higher (Qbet = 40.5, P < 0.001) than the rate for females, 0.2% (95% CI: 0.1-0.4, I 2 = 90.5, P < 0.001). Sweden has the highest prevalence of AAS use: 4.4%, followed by Norway: 2.4%, Finland: 0.8%, Iceland: 0.7%, and Denmark: 0.5%. Country, sample type, and male sample percentage significantly predicted AAS use prevalence in a meta-regression analysis. No indication of publication bias was found. CONCLUSION – Though subject to some limitations, our findings suggest that non-medical AAS use should be regarded as a serious public health problem in the Nordic countries.

References

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    • Crossref
  • Lindqvist A. S. Moberg T. Eriksson B. O. Ehrnborg C. Rosén T. & Fahlke C. (2013). A retrospective 30-year follow-up study of former Swedish-elite male athletes in power sports with a past anabolic androgenic steroids use: A focus on mental health. British Journal of Sports Medicine 47 965–969.

    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
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    • Crossref
  • Pagonis T. A. Angelopoulos N. V. Koukoulis G. N. & Hadjichristodoulou C. S. (2006). Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. European Psychiatry 21 551–562.

    • Crossref
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  • Andrade A. G. Duarte P. C. A. V. Barroso L. P. Nishimura R. Alberghini D. G. & Oliveira L. G. (2012). Use of alcohol and other drugs among Brazilian college students: Effects of gender and age. Revista Brasileira de Psiquiatria 34(3) 294–305.

    • Crossref
  • Bahrke M. S. & Yesalis C.E. (2004). Abuse of anabolic androgenic steroids and related substances in sport and exercise. Current Opinion in Pharmacology 4(6) 614–620.

    • Crossref
  • Baker J. S. Thomas N. E. Davies B. & Graham M. R. (2008). Anabolic androgenic steroid (AAS) abuse: Not only an elite performance issue? Open Sports Medicine Journal 2 38–39.

  • Biostat Inc. (2014). Comprehensive Meta- Analysis Version 3.0. Englewood NJ.: Biostat Inc.

  • Bojsen-Møller J. & Christiansen A. V. (2010). Use of performance-and image-enhancing substances among recreational athletes: A quantitative analysis of inquiries submitted to the Danish anti-doping authorities. Scandinavian Journal of Medicine and Science in Sports 20(6) 861–867.

    • Crossref
  • Borenstein M. Hedges L. Higgins J. & Rothstein H. (2009). Introduction to Meta- Analysis. Chichester West Sussex: Wiley- Blackwell.

    • Crossref
  • Boyadjiev N. Georgieva K. Massaldjieva R. & Gueorguiev S. (2000). Reversible hypogonadism and azoospermia as a result of anabolic-androgenic steroid use in a bodybuilder with personality disorder. A case report. Journal of Sports Medicine and Physical Fitness 40(3) 271–274.

  • Calabria B. Degenhardt L. Nelson P. Bucello C. Lynskey M. Hall W. Roberts A. & McLaren J. (2009). Methodology used in a systematic review of evidence on the prevalence of cannabis use and dependence. Global Burden of Disease Mental Disorders and Illicit Drug Use Expert group. Illicit drugs discussion paper No. 14. Sydney: National Drug and Alcohol Research Centre University of New South Wales.

  • Degenhardt L. & Hall W. (2012). The extent of illicit drug use dependence and their contribution to global burden of disease. Lancet 379(9810) 55–70.

  • Dodge T. & Hoagland M. F. (2011). The use of anabolic androgenic steroids and polypharmacy: a review of the literature. Drug and Alcohol Dependence 114(2-3) 100–109.

    • Crossref
  • Dodge T. L. & Jaccard J. J. (2006). The effect of high school sports participation on the use of performance-enhancing substances in young adulthood. Journal of Adolescent Health 39(3) 367–373.

    • Crossref
  • Duval S. & Tweedie R. (2000). Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2) 455–463.

    • Crossref
  • Gårevik N. & Rane A. (2010). Dual use of anabolic-androgenic steroids and narcotics in Sweden. Drug and Alcohol Dependence 109(1) 144–146.

    • Crossref
  • Gmel G. & Daeppen J. B. (2007). Recall bias for seven-day recall measurement of alcohol consumption among emergency department patients: Implications for case-crossover designs. Journal of Studies on Alcohol and Drugs 68 303–310.

    • Crossref
  • Grace F. Baker J. & Davies B. (2001). Anabolic androgenic steroid use in recreational gym users: a regional sample of the Mid-Glamorgan area. Journal of Substance Use 6(3) 189–195.

    • Crossref
  • Hakansson A. Mickelsson K. Wallin C. & Berglund M. (2012). Anabolic androgenic steroids in the general population: user characteristics and associations with substance use. European Addiction Research 18(2) 83–90.

    • Crossref
  • Haug J. & Ingvaldsen R. (1974). Noen synspunkter pa bruken av hormonpreparater blant aktive idrettsutøvere [Some views on the use of hormone drugs among active athletes]. Oslo: Institute of Psychology University of Oslo.

  • Hibell B. Anderson B. Ahlström S. Balakieva O. Bjarnason T. Kokkevi A. & Morgan M. (2000). The 1999 ESPAD report. Alcohol and other drug use among students in 30 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).

  • Hibell B. Anderson B. Bjarnason T. Ahlström S. Balakieva O. Kokkevi A. & Morgan M. (2004). The ESPAD Report 2003. Alcohol and other drug use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).

  • Hibell B. Andersson B. Bjarnason T. Kokkevi A. Morgan M. & Narusk A. (1997). Alcohol and other drug use among students in 26 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe.

  • Hibell B. Guttormsson U. Ahlström S. Balakireva O. Bjarnason T. Kokkevi A. & Kraus L. (2012). The 2011 ESPAD report: substance use among students in 36 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).

  • Hibell B. Guttormsson U. Ahlström S. Balakireva O. Bjarnason T. Kokkevi A. & Kraus L. (2007). The 2007 ESPAD report. Substance use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

  • Hibell B. Guttormsson U. Ahlström S. Balakireva O. Bjarnason T. Kokkevi A. & Kraus L. (2009). The 2007 ESPAD report. Substance use among students in 35 European countries. The Swedish Council for Information on Alcohol and Other Drugs Stockholm Sweden.

  • Hoffman J. R. & Ratamess N.A. (2006). Medical issues associated with anabolic steroid use: are they exaggerated. Journal of Sports Science and Medicine 5(2) 182–193.

  • Johnson M. D. Jay M. S. Shoup B. & Rickert V.I. (1989). Anabolic steroid use by male adolescents. Pediatrics 83(6) 921–924.

  • Kanayama G. Boynes M. Hudson J. I. Field A. E. & Pope Jr. H. G. (2007). Anabolic steroid abuse among teenage girls: An illusory problem? Drug and Alcohol Dependence 88 156–162.

  • Kanayama G. Hudson J. I. & Pope Jr. H. G. (2008). Long-term psychiatric and medical consequences of anabolic–androgenic steroid abuse: A looming public health concern? Drug and Alcohol Dependence 98(1) 1–12.

  • Kanayama G. Hudson J. I. & Pope Jr. H. G. (2010). Illicit anabolic–androgenic steroid use. Hormones and Behavior 58(1) 111–121.

    • Crossref
  • Kanayama G. Hudson J. I. & Pope Jr. H. G. (2012). Culture psychosomatics and substance abuse: The example of body image drugs. Psychotherapy and Psychosomatics 81(2) 73–78.

    • Crossref
  • Kindlundh A. M. Isacson D. G. Berglund L. & Nyberg F. (1998). Doping among high school students in Uppsala Sweden: A presentation of the attitudes distribution side effects and extent of use. Scandinavian Journal of Public Health 26(1) 71–74.

    • Crossref
  • Klötz F. Petersson A. Hoffman O. & Thiblin I. (2010). The significance of anabolic androgenic steroids in a Swedish prison population. Comprehensive Psychiatry 51(3) 312–318.

    • Crossref
  • Korte T. Pykäläinen J. & Seppälä T. (1998). Drug abuse of Finnish male prisoners in 1995. Forensic Science International 97(2-3) 171–183.

    • Crossref
  • Leifman H. Rehnman C. Sjöblom E. & Holgersson S. (2011). Anabolic androgenic steroids—use and correlates among gym users—an assessment study using questionnaires and observations at gyms in the Stockholm region. International Journal of Environmental Research and Public Health 8(7) 2656–2674.

    • Crossref
  • Lindqvist A. S. Moberg T. Eriksson B. O. Ehrnborg C. Rosén T. & Fahlke C. (2013). A retrospective 30-year follow-up study of former Swedish-elite male athletes in power sports with a past anabolic androgenic steroids use: A focus on mental health. British Journal of Sports Medicine 47 965–969.

    • Crossref
  • Lindström M. Nilsson A. Katzman P. Janzon L. & Dymling J. F. (1990). Use of anabolic-androgenic steroids among body builders—frequency and attitudes. Journal of Internal Medicine 227(6) 407–411.

    • Crossref
  • Ljungqvist A. (1975). The use of anabolic steroids in top Swedish athletes. British Journal of Sports Medicine 9(2) 82.

    • Crossref
  • Lood Y. Eklund A. Garle M. & Ahlner J. (2012). Anabolic androgenic steroids in police cases in Sweden 1999–2009. Forensic Science International 219(1-3) 199–204.

    • Crossref
  • Lorang M. Callahan B. Cummins K. M. Achar S. & Brown S. A. (2011). Anabolic androgenic steroid use in teens: Prevalence demographics and perception of effects. Journal of Child and Adolescent Substance Abuse 20(4) 358–369.

    • Crossref
  • Lundholm L. Haggård U. Möller J. Hallqvist J. & Thiblin I. (2013). The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: A case-crossover study. Drug and Alcohol Dependence 129(1-2) 110–115.

    • Crossref
  • Lundholm L. Käll K. Wallin S. & Thiblin I. (2010). Use of anabolic androgenic steroids in substance abusers arrested for crime. Drug and Alcohol Dependence 111(3) 222–226.

    • Crossref
  • Mattila V. Parkkari J. Laakso L. Pihlajamäki H. & Rimpelä A. (2009). Use of dietary supplements and anabolic-androgenic steroids among Finnish adolescents in 1991–2005. European Journal of Public Health 20(3) 306–311.

    • Crossref
  • Mattila V. Rimpelä A. Jormanainen V. Sahi T. & Pihlajamäki H. (2010). Anabolic-androgenic steroid use among young Finnish males. Scandinavian Journal of Medicine and Science in Sport 20(2) 330–335.

    • Crossref
  • Moher D. Liberati A. Tetzlaff J. & Altman D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Medicine 6(6) e1000097.

    • Crossref
  • Nilsson S. (1995). Androgenic anabolic steroid use among male adolescents in Falkenberg. European Journal of Clinical Pharmacology 48 9–11.

    • Crossref
  • Nilsson S. Baigi A. Marklund B. & Fridlund B. (2001a). Trends in the misuse of androgenic anabolic steroids among boys 16-17 years old in a primary health care area in Sweden. Scandinavian Journal of Primary Health Care 19(3) 181–182.

  • Nilsson S. Baigi A. Marklund B. & Fridlund B. (2001b). The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden. European Journal of Public Health 11(2) 195–197.

  • Nilsson S. Spak F. Marklund B. Baigi A. & Allebeck P. (2005). Attitudes and behaviors with regards to androgenic anabolic steroids among male adolescents in a county of Sweden. Substance Use and Misuse 40(1) 1–12.

    • Crossref
  • Nøkleby H. (2013). Use of doping agents and symptoms of eating disorders among male and female patients in drug addiction treatment. Nordic Studies on Alcohol and Drugs 30(4) 331–346.

    • Crossref
  • Pagonis T. A. Angelopoulos N. V. Koukoulis G. N. & Hadjichristodoulou C. S. (2006). Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. European Psychiatry 21 551–562.

    • Crossref
  • Pallesen S. Jøsendal O. Johnsen B.-H. Larsen S. & Molde H. (2006). Anabolic steroid use in high school students. Substance Use and Misuse 41(13) 1705–1717.

    • Crossref
  • Parkinson A. B. & Evans N. A. (2006). Anabolic androgenic steroids: a survey of 500 users. Medicine and Science in Sports and Exercise 38(4) 644–651.

    • Crossref
  • Pope Jr. H. G. & Kanayama G. (2012). Anabolic–androgenic steroids. In J. Verster K. Brady M. Galanter & P. Conrod (Eds.) Drug abuse and addiction in medical illness: Causes consequences and treatment (pp. 251–264). New York: Springer.

  • Pope Jr. H. G. Kanayama G. & Hudson J. I. (2012). Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: A cross-sectional cohort study. Biological Psychiatry 71(3) 254– 261.

    • Crossref
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CiteScore 2018: 0.64

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