To summarize recent advances in studies of illicit use of androgens and other hormones.
Androgens and other appearance-enhancing and performance-enhancing substances are widely abused worldwide. Three notable clusters of findings have emerged in this field in recent years. First, studies almost unanimously find that androgen users engage in polypharmacy, often ingesting other hormones (e.g., human growth hormone, thyroid hormones, and insulin), ergo/thermogenic drugs (e.g., caffeine, ephedrine, and clenbuterol), and classical drugs of abuse (e.g., cannabis, opiates, and cocaine). Second, reports of long-term psychiatric and medical adverse effects of androgens continue to accumulate. In cardiovascular research particularly, controlled studies have begun to supersede anecdotal evidence, strengthening the case that androgens (possibly acting synergistically with other abused drugs) may cause significant morbidity and even mortality. Third, it is increasingly recognized that androgen use may lead to a dependence syndrome with both psychological and physiological origins. Androgen dependence likely affects some millions of individuals worldwide, and arguably represents the least studied major class of illicit drug dependence.
Given mounting evidence of the adverse effects of androgens and associated polypharmacy, this topic will likely represent an expanding area of research and an issue of growing public health concern.
aBiological Psychiatry Laboratory, McLean Hospital, Belmont
bDepartment of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
Correspondence to Harrison G. Pope Jr, MD, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. Tel: +1 617 855 2911; fax: +1 617 855 3585; e-mail: firstname.lastname@example.org