Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Clin Endocrinol Metab. 2019 Apr 1;104(4):1069-1074. doi: 10.1210/jc.2018-01706.
The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales. Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AASs, and the need for an integrated health policy and regulatory response.
We searched for studies published prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment.
Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from "muscle dysmorphia," a form of body dysmorphic disorder. AASs has been associated with cardiovascular disorders, psychiatric disorders, AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections. Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated Internet sales of AASs and selective androgen receptor modulators, which are easily purchased without a prescription, are of concern because of their potential to fuel the epidemic among adolescents and the military.
Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AASs and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.
尽管有证据表明其严重的健康影响，并且已经通过了规范其销售的法律，但身体意象障碍和合成代谢雄激素类固醇（AAS）使用的流行率仍在上升。在这里，我们回顾了身体意象障碍和 AAS 使用这两种新兴流行疾病的演变、AAS 的不良健康影响，以及对综合健康政策和监管应对措施的需求。
我们搜索了截至 2018 年 6 月之前发表的研究。由于其观察性质、资格标准的异质性、剂量的变化、许多研究依赖于回顾性自我报告数据，以及结果确定的质量变化，证据质量为低到中度。
大多数 AAS 用户是非运动员的年轻男性，他们使用这些物质来使自己看起来更瘦、更肌肉发达。其中一些男性患有“肌肉变形障碍”，这是一种身体畸形障碍。AAS 与心血管疾病、精神疾病、AAS 戒断性腺功能减退症、不育、神经毒性作用、肌肉骨骼损伤、肝毒性和针源性感染有关。其他物质（如阿片类药物）和高危行为的使用可能会使潜在的不良反应更加复杂。未经监管的 AAS 和选择性雄激素受体调节剂的互联网销售令人担忧，因为它们有可能在青少年和军队中引发这一流行疾病。
需要全国范围内的综合努力来提高公众对这一流行疾病的认识，研究 AAS 的长期健康影响和治疗策略，并改革法规，以遏制 AAS 使用和身体意象障碍的流行。
