Should steroid users take drugs to treat 'roid rage'?
By Jessica Hamzelou Editorial: “Drug help for drug harms“ BASEBALL star Barry Bonds is back in the spotlight this week, for all the wrong reasons. The sports legend is on trial in the US, accused of lying to a grand jury when he denied that he had ever knowingly taken performance-enhancing steroids. Meanwhile, psychologists are beginning to work out how these drugs can trigger aggressive behaviour and suggesting potential therapies that could be taken alongside steroids to block this unwelcome side effect. But could such a therapy encourage drug abuse? At the end of 2007, Bonds was charged with making false statements and obstruction of justice. He pleaded not guilty and his trial commenced on 21 March this year. In support of the case that Bonds took steroids, his ex-girlfriend, Kimberly Bell, gave evidence in which she claimed that he exhibited periods of aggressive behaviour. Aggression is one of the better-known side effects of steroid use and is often referred to as “roid rage”. A survey in 2008 of 7000 American teenage boys found those who took anabolic steroids reported significantly higher levels of violent behaviour than boys who did not take them (American Journal of Public Health, DOI: 10.2105/ajph.2008.137018). Now, Thomas Hildebrandt’s team at Mount Sinai School of Medicine in New York are conducting the first longitudinal study of anabolic steroid users. By monitoring participants before, during and after cycles of steroid use, the group hopes to work out how the drugs exert their effects and how long these might last. Once injected or swallowed, anabolic steroids are broken down into either androgen or oestrogen. The group’s preliminary results suggest that the amount and rate of breakdown varies between individuals and that the ratio of the two hormones may predict which users develop aggressive behaviours. Those with more oestrogen than androgen appear more likely to exhibit aggression. Hildebrandt reckons steroid users could have a blood test to find out how likely they are to experience roid rage. Altered levels of androgen and oestrogen would be evident within the first couple of weeks of a three-to-six-month cycle of steroid use. Controversially, Hildebrandt also suggests that a drug that blocks the conversion of steroid to oestrogen could be taken to help suppress the aggressive side effects. These kinds of drugs – called aromatase inhibitors – are already prescribed to people who need to keep their oestrogen levels low, such as those with breast cancer. Sports scientist Charles Yesalis at Pennsylvania State University in University Park isn’t convinced that prescribing these drugs to steroid abusers would be worthwhile. “The vast majority of users can control their more aggressive behaviour,” he says. “And if it is a problem, I wouldn’t mess around with hormone ratios, I’d just tell them to stop taking the drug.” But since health services offer help to alcoholics and drug addicts who continue to abuse, it’s only fair to help steroid users overcome side effects, says Hildebrandt, particularly ones that could affect those around them. “It’s more responsible to help steroid users than demonise them,” he says. More on these topics: