Anabolic steroids and effects on cognition, brain- and cardiovascular health: a longitudinal study of long-term steroid users and non-using weightlifters
In this longitudinal research project we investigate effects of long-term anabolic androgenic steroids (AAS) use on brain structure and function, cognition, emotions and cardiovascular health. The first data-collection of the research project was completed in 2013-15, while a follow-up of the sample with a new series of investigations were carried out in 2017-19. The follow-up contains both participants from the first round and newly recruited participants.
Background
Non-medical use of high-dose anabolic-androgenic steroids (AAS) is associated with a range of consequences, including psychiatric, cognitive and cardiac deficits. Of the least studied effects of AAS-use is the potential consequence it may have on brain health. This is a critical issue, since sex steroids readily pass the blood-brain barrier and affect the central nervous system. We have recently completed a large cross-sectional study of the long-term effects of AAS on brain and behavior, comparing 89 current or past AAS users with 70 non-AAS-using weightlifters. In this study we found that long-term AAS exposure was associated with thinner cortex in widespread regions, that could suggest accelerated aging of the brain. However, the nature of such relations are complex, not least because it is difficult to distinguish what is caused by premorbid psychological characteristics and what is a direct cause of AAS use. Understanding the impact of AAS use on brain and its cognitive and psychiatric correlates is important in order to safeguard the needs of the growing numbers of long-term AAS now entering middle age. In this study we retest our existing sample to assess volumetric changes in gray and white matter, together with changes in cognitive functions and mental health. This will provide more secure insights into how AAS use affects brain health, cognition and emotions in AAS users.
There are medical side-effects associated with AAS use that potentially could compromise brain and cognition. Cardiovascular conditions are among the most serious health complications being linked to AAS-use, and are in turn associated with accelerated structural brain aging. Examples of cardiovascular effects of AAS use, with the potential to compromise brain functions, include hypertension, atherosclerosis and dyslipidemia. Still, there are few large studies of cardiovascular effects of AAS-use, and none have investigated the association between vascular changes and brain structure and function in AAS-users.
Moreover, long-term AA use suppresses the hypothalamic-pituitary-testicular axis, with the consequence that male users often become temporarily hypogonadal upon discontinued use. Hypogonadism is common among former AAS-users and may persist years after AAS secession. It is known that testosterone loss in older age may be a risk factor for cognitive decline, thus AAS-induced subnormal or impaired production of testosterone may in turn negatively influence brain and cognitive processes.
In collaboration with cardiologist Vibeke M. Almaas, circulation physiologist Jonny Hisdal, and endocrinologist Per M. Thorsby at different departments of the hospital, we have included full cardiovascular evaluation and detailed hormone analyses of the participants, providing us with a rich data-material to examine the links between AAS use cardiovascular and endocrine effects, and brain health.
Aims
The major aim of the study is to increase our knowledge of potential medical and psychological side-effects of long-term AAS use, particularly related to brain health and cognition. Moreover we seek to understand factors that might explain why some experience several psychological and medical side effects while others are not affected.
Methods
The study is a multidisciplinary collaboration and includes advanced brain imaging, cognitive and psychological data, full cardiac and vascular examination, and detailed hormonal analysis. Computational models will be applied to examine how these different domains are linked, especially in relation to altered brain structure and function.
Participants in the study
In this research project we compare two groups:
1) Males who have used AAS for at least one year (summarized time on AAS).
2) Males engaged in heavy resistance training with no experience with AAS or other doping substances (have bench-pressed 120 kg for at least one repetition).
Status
Data-collection is finalized.