Use of legal performance enhancing substances increases risk of future anabolic steroid use

1. Young men who used legal performance-enhancing substances were more likely to engage in future anabolic-androgenic steroid use.

2. Compared to non-users, use of legal performance-enhancing substances among young adult males was associated with a three-fold increase in risk of future anabolic-androgenic steroid use.

3. No associations between these substance use activities were found among young women.

Evidence Rating Level: 2 (Good)

There is limited research investigating the longitudinal associations between legal performance-enhancing substances such as creatine monohydrate and later use of anabolic-androgenic steroids among young adults. Given that these schedule III drugs are frequently used without a valid prescription, this is an important area of study. This prospective cohort study of the National Longitudinal Study of Adolescent to Adult Health examined data of 12,695 young adults (mean [SE] age = 21.8 [0.1] years). Both waves III (ages 18 to 26 years) and IV (ages 24-32 years) were available among this sample. Use of legal performance-enhancing substances in wave III were observed in 16.1% of males and 1.2% of females. In wave IV, however, only 4.2% of men and 0.8% of women reported anabolic-androgenic steroid use during the previous year. Men who initially reported legal performance-enhancing substance use were more likely to transition to using anabolic-androgenic steroid use than those who did not use legal performance-enhancing substances (difference 9.8%, p<0.001). Compared to non-users, the male group that engaged in legal performance-enhancing substance use had higher odds of wave IV anabolic-androgenic steroid use (adjusted OR 3.18, 95% CI 1.90 to 5.32, p<0.001). There was no association between legal performance-enhancing substance use at wave III and anabolic-androgenic steroid use at wave IV among females (p = 0.14). Overall, this study highlights the importance of imposing regulations on performance-enhancing substances in vulnerable populations such as young adults, as this activity may graduate to more significant concerns related to a three-fold increase in odds of illicit steroid use.

Click to read the study in JAMA Pediatrics

Image: PD

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